Lumbar epidural lipomatosis is associated with visceral fat and metabolic disorders
Lumbar spinal epidural lipomatosis (LEL) is a condition characterized by excessive deposition of epidural fat in the spinal canal. Metabolic abnormalities may be associated with LEL, but few validated reports exist. Thus, we investigated the association between LEL and metabolic disorders in this study.
A total of 218 patients who had neurological symptoms due to neural compression in the lumbar spinal canal were examined by magnetic resonance imaging (MRI), abdominal computed tomography (CT) scans and blood tests. We evaluated the epidural fat, dural sac and spinal canal areas using MRI, and the visceral fat and subcutaneous fat areas using abdominal CT. We compared the patients’ demographics and the radiological parameters between the LEL and non-LEL patients.
There were 58 LEL patients and 160 non-LEL patients. The LEL group included more men than women. In the MRI measurement, the dural sac area was similar between the LEL and non-LEL patients; however, the epidural fat/spinal canal ratio was much greater in the LEL group. In the LEL patients, factors associated with metabolic disorders, such as visceral fat area, uric acid (UA) and insulin levels, were significantly greater, compared to the non-LEL patients. In the logistic regression analysis, UA and visceral fat area were the independent explanatory factors in the pathogenesis of LEL.
LEL patients had significantly more visceral fat and increased levels of insulin, UA and ferritin, which are closely related with metabolic disorders. This study indicates that the increased epidural fat in the spinal canal seen in the LEL patients is associated with metabolic syndrome.
KeywordsEpidural fat Lumbar epidural lipomatosis Abdominal computed tomography Visceral fat Metabolic syndrome
We gratefully acknowledge Dr. Toshihiko Ohama MD to help our work.
Compliance with ethical standards
Conflict of interest
None of the authors has any potential conflict of interest.
- 1.Ishikawa Y, Shimada Y, Miyakoshi N, Suzuki T, Hongo M, Kasukawa Y, Okada K, Itoi E (2006) Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature. J Neurosurg Spine 4:24–30. https://doi.org/10.3171/spi.2006.4.1.24 CrossRefPubMedGoogle Scholar
- 7.Fujita N, Hosogane N, Hikata T, Iwanami A, Watanabe K, Shiono Y, Okada E, Ishikawa M, Tsuji T, Shimoda M, Horiuchi K, Nakamura M, Matsumoto M, Ishii K (2016) Potential involvement of obesity-associated chronic inflammation in the pathogenesis of idiopathic spinal epidural lipomatosis. Spine (Phila Pa 1976) 41:E1402–E1407. https://doi.org/10.1097/brs.0000000000001646 CrossRefGoogle Scholar
- 10.Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K (2003) Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and short-form 36. Spine (Phila Pa 1976) 28:1601–1607Google Scholar
- 11.Naka N, Matsuoka T, Yamamoto H, Mitsuhashi H, Kono J (1998) Lumbar epidural lipomatosis-morphological evaluation of epidural fat. Central Jpn J Orthop Trauma 41:327–328Google Scholar
- 15.Zając-Gawlak I, Kłapcińska B, Kroemeke A, Pośpiech D, Pelclová J, Přidalová M (2017) Associations of visceral fat area and physical activity levels with the risk of metabolic syndrome in postmenopausal women. Biogerontology 18:357–366. https://doi.org/10.1007/s10522-017-9693-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Matsuura F, Yamashita S, Nakamura T, Nishida M, Nozaki S, Funahashi T, Matsuzawa Y (1998) Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism 47:929–933CrossRefPubMedGoogle Scholar
- 23.Avula NR, Shenoy D (2016) Evaluation of Association of Hyperuricaemia with Metabolic Syndrome and Insulin Resistance. J Clin Diagn Res 10:OC32-OC34. https://doi.org/10.7860/jcdr/2016/22182.9113