Lumbar Spinal Canal Stenosis from the Perspective of Locomotive Syndrome and Metabolic Syndrome: A Narrative Review

Abstract

Patients with lumbar spinal canal stenosis (LSS) have impaired activities of daily living because of pain or motor paralysis, but no effective preventive treatment is currently available. The number of patients with LSS is predicted to continually increase as the average age of the global population increases. To provide a conceptual framework for improving healthy life expectancy, the Japanese Orthopaedic Association introduced the concept of locomotive syndrome, to which LSS is related. Ours and other studies have shown that LSS exacerbates locomotive syndrome and that surgical treatment is one method for improving it. Furthermore, we propose that the two-step test, a locomotive syndrome risk test, is effective for assessing the risk for falls and severity of LSS. Meanwhile, lumbar spinal epidural lipomatosis (LSEL), which is a manifestation of LSS, has been shown to be related to metabolic syndrome. Previous studies have suggested that the whole LSS can be also associated with metabolic syndrome. Although locomotive syndrome is very different from metabolic syndrome, which involves lipid metabolism, these two syndromes overlap, such as in LSS. Conducting research on LSS from the perspectives of both locomotive syndrome and metabolic syndrome may lead to novel methods for prevention and treatment of LSS and, conversely, may yield clues for resolving symptoms of the two syndromes. This review 2 provides an overview of LSS from the perspective of locomotive syndrome and metabolic syndrome, along with findings from our research group.

Is there an association between lumbosacral epidural lipomatosis and lumbosacral epidural steroid injections? A comprehensive narrative literature review

“…It is apparent that there are coexisting, interwoven, collective and likely compounding factors that predispose to SEL. This has been a focus of recent studies and metabolic syndrome is postulated to be the connecting link [ 1 , 5 , 18 , [22] , [23] , [24] , [25] , [26] , [27] ]. Based on the National Health and Nutritional Examination Survey (NHANES) data, it has been estimated that at least 68 million U.S. adults meet the criteria for the metabolic syndrome and the trend only seems to be increasing [52] .…”

“…This has been a focus of recent studies and metabolic syndrome is postulated to be the connecting link. 1,5,18,[22][23][24][25][26][27] Based on the National Health and Nutritional Examination Survey (NHANES) data, it has been estimated that at least 68 million U.S. adults meet the criteria for the metabolic syndrome and the trend only seems to be increasing. 52 It has been observed that the clinical findings associated with metabolic syndrome exist more frequently in SEL patients than would be expected by chance alone and that this accretion is of clinical importance.…”

“…There is inconsistency in the usage of the idiopathic categorization, however, this generally refers to the development of SEL in non-obese patients without a known predisposing underlying risk factor or disorder [ 3 , 8 ]. Although the multifactorial pathophysiology of epidural adipose tissue hyperplasia in SEL is not fully understood, recent investigations have focused on the association between the metabolic syndrome and SEL [ 5 , 18 , [22] , [23] , [24] , [25] , [26] , [27] ].…”

“…3,8 Although the multifactorial pathophysiology of epidural adipose tissue hyperplasia in SEL is not fully understood, recent investigations have focused on the association between the metabolic syndrome and SEL. 5,18,[22][23][24][25][26][27] Most of the literature demonstrating an association between SEL and long-term exogenous steroid use revolves around systemic utilization for purposes such as the prevention or treatment of post-organ transplantation rejection, various autoimmune diseases, chronic obstructive pulmonary disease (COPD), nephritic syndromes, asthma, radiation pneumonitis, in the setting of cancer-related care and even anabolic steroid (without glucocorticoid) use. [1][2][3][6][7][8]12,24 Pediatric SEL cases have also been reported.…”

10-year Longitudinal MRI Study of Intervertebral Disk Degeneration in Patients With Lumbar Spinal Canal Stenosis After Posterior Lumbar Decompression Surgery

“…5 In addition, according to recent studies, surgical treatment improves musculoskeletal function in elderly patients with LSS. 6 Previous reports have shown that significant cause of LSS include degenerative changes of spinal components such as hypertrophy of the ligamentum flavum, formation of degenerative osteophytes, and intervertebral disk (IVD) degeneration 7 ; however, the time-dependent changes in those components are still unclear. IVD degeneration, a significant cause of LSS, increases with age and predisposes affected individuals to the low back pain (LBP).…”