Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome

Ishihara, Shinichi; Fujita, Nobuyuki; Azuma, Koichiro; Michikawa, Takehiro; Yagi, Mitsuru; Tsuji, Takashi; Takayama, M.; Matsumoto, Hideo; Nakamura, Masaya; Matsumoto, Morio; Watanabe, Kota

doi:10.1016/j.spinee.2018.07.022

Cited by 31 publications

(36 citation statements)

References 30 publications

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“…We obtained approval from the institutional review board of our institution before initiating this retrospective cross-sectional study, and the study was a part of the musculoskeletal health checkup studies 24,25 . Study subjects were notified of this study's opt-out option.…”

Section: Methodsmentioning

confidence: 99%

Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis

Okada

Ishihara²,

Azuma

et al. 2021

Neurospine

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Objective Diffuse idiopathic skeletal hyperostosis (DISH) causes spinal ankylosis, which can result in patients suffering specific spinal fractures that lead to a reduction in the activities of daily life in older patients. Currently, DISH is associated with diabetes mellitus and cardiovascular disease; however, the association between DISH and metabolic syndrome has not been established. The purpose of this study was to investigate a potential association between DISH and metabolic syndrome. Methods We retrospectively reviewed clinical data from consecutive subjects undergoing the musculoskeletal health medical checkups, and enrolled 327 subjects (174 men and 153 women; mean, 63.4 ± 13.7-years). Subjects who had spinal ankylosis at least 4 contiguous vertebral bodies were classified as the DISH group (n = 39) while the others were part of the non-DISH group (n = 288). The definition of the metabolic syndrome comes from diagnostic criteria used by the Japanese Society for Internal Medicine. Age, sex, body max index (BMI), hematological evaluation, blood pressure, presence of metabolic syndrome, the visceral fat area on abdominal computed tomography, and spinal epidural lipomatosis (SEL) on magnetic resonance imaging were evaluated. Results Compared to the non-DISH group, in the DISH group, mean age (DISH group, 74.3 years; non-DISH group, 1.9 years; p < 0.001), male prevalence were higher (DISH group, 82.1%; non-DISH group, 49.3%; p < 0.001), and BMI was greater (DISH group, 24.8; non-DISH group, 23.0; p = 0.006). the metabolic syndrome was more frequently observed in DISH group (28.9%) than in the non-DISH group (16.0%) (p = 0.045). The visceral fat area was significantly larger in the DISH group than in the non-DISH group (DISH group, 130.7 ± 58.2 cm 2 ; Non-DISH group, 89.0 ± 48.1 cm 2 ; p < 0.001). The prevalence of SEL was similar between the 2 groups (10.3% in the DISH group vs. 8.7% in the nonDISH group; p = 0.464). Poisson regression analysis revealed that the metabolic syndrome was significantly associated with DISH with odds ratio of 2.0 (95% confidence interval, 1.0–3.7; p = 0.004). Conclusion Metabolic syndrome was significantly associated with DISH. Our data showed metabolic syndrome is potentially related to DISH.

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Section: Methodsmentioning

confidence: 99%

Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis

Okada

Ishihara²,

Azuma

et al. 2021

Neurospine

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“…Depending on the degree of spinal cord or nerve compression and presenting neurological symptoms SEL can be managed either surgically or conservatively. In patients with exogenous steroid excess a reduction in the dose of steroid medication and weight loss can help to improve neurological symptoms ( 8 ). Surgical management involves a decompressive laminectomy and excision of epidural adipose tissue.…”

Section: Discussionmentioning

confidence: 99%

Spinal epidural lipomatosis: a rare association of Cushing’s disease

Ahmad

Best

Lansdown

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Excess cortisol is associated with hypertrophy and redistribution of adipose tissue leading to central obesity which is classically seen in Cushing’s syndrome. Abnormal accumulation of fatty tissue in the spinal canal is most commonly associated with chronic steroid therapy and rarely reported with endogenous Cushing’s syndrome. Herein, we describe a case of spinal epidural lipomatosis (SEL) associated with Cushing’s disease. A 17-year-old man was referred with lower limb weakness, weight gain, multiple stretch marks, back pain and loss of height. He had clinical and biochemical features of Cushing’s syndrome. MRI and Inferior Petrosal Sinus Sampling (IPSS) confirmed a pituitary adenoma as the source. On day 1 post trans-sphenoidal adenectomy he developed spastic paraparesis with a sensory deficit to the level of T5. MRI spine showed increased fat deposition in the spinal canal from T2 to T9 consistent with a diagnosis of SEL. He was managed conservatively and made a good recovery following restoration of eucortisolism and a period of rehabilitation. Learning points: SEL is a serious complication of glucocorticoid excess and should be considered in any patient presenting with new lower limb neurological symptoms associated with hypercortisolism. It is important to distinguish symptomatic SEL from cortisol-induced proximal myopathy by good history and clinical examination. MRI of the spine is the gold standard investigation for making a diagnosis of SEL. Restoration of eucortisolism can lead to resolution of fat accumulation and good neurological outcome.

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“…This state, known as lumbar spinal epidural lipomatosis (LSEL), is considered to be a manifestation of LSS. Although LSEL has been shown to be related to obesity and metabolic syndrome [10][11][12][13][14][15][16] , its pathology is largely unknown, and clear treatment guidelines are not available.…”

Section: Hypertrophy Of the Ligamentum Flavum Degeneration Of Intervmentioning

confidence: 99%

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

Fujita

2021

Spine Surg Relat Res

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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.

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Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome

Cited by 31 publications

References 30 publications

Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis

Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis

Spinal epidural lipomatosis: a rare association of Cushing’s disease

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

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