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Treatment results for lumbar epidural lipomatosis: Does fat matter?

  • Simon Heinrich Bayerl
  • Malte Dinkelbach
  • Petra Heiden
  • Vincent Prinz
  • Tobias Finger
  • Peter Vajkoczy
Original Article

Abstract

Purpose

The lumbar epidural lipomatosis (LEL) is a rare disease that can cause sciatic pain syndrome or neurological deficits comparable to symptoms caused by a classical spinal canal stenosis. In severe cases surgical decompression was conducted. However, the outcome after decompressive surgery has only been investigated in small case series. In this study we compared the outcome of LEL patients after microsurgery with the outcome of patients with classical spinal stenosis (CSS).

Methods

Patients with LEL (n = 38) and patients with CSS (n = 51), who received microsurgical decompression, were followed in a prospective observational study for 3 years. The clinical results including the Oswestry Disability Index, Numeric Pain Rating Scale (NRS), Roland and Morris Disability Questionnaire, the Short Form-36 Score and the Walking Distance were analysed and compared between both groups.

Results

Patients with LEL improved significantly after microsurgical decompression in a 3-year follow-up concerning back pain, leg pain and pain-associated disability equal to patients with CSS (NRSback_LEL_preop. = 6.4; NRSback_CSS_preop. = 6.3; NRSback_LEL_3-years = 3.2; NRSback_CSS_3-years = 3.6; NRSleg_LEL_preop. = 6.3; NRSleg_CSS_preop. = 6.5; NRSleg_LEL_3-years = 2.5; NRSleg_CSS_3-years = 2.9; ODILEL_preop. = 52.7; ODICSS_preop = 51.8; ODILEL_3-years = 32.3; ODICSS_3-years = 27.6). The microsurgical decompression had a positive effect on the health-related quality of life, and patient satisfaction was high in both groups (LEL group—71%, CSS group—69%).

Conclusions

LEL can influence the quality of life dramatically and cause a high degree of disability. A surgical decompression is a safe and effective procedure with a good clinical outcome comparable to the results in patients with an osteoligamentous spinal stenosis. Therefore, microsurgical decompression can be recommended in patients with LEL if conservative treatment fails.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Spinal epidural lipomatosis Lumbar spinal stenosis Microsurgical decompression Walking distance Quality of life 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional research comittee (reference number: EA1/101/17) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All authors confirmed consent for publication.

Supplementary material

586_2018_5771_MOESM1_ESM.pptx (7.1 mb)
Supplementary material 1 (PPTX 7257 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Simon Heinrich Bayerl
    • 1
  • Malte Dinkelbach
    • 1
  • Petra Heiden
    • 2
  • Vincent Prinz
    • 1
  • Tobias Finger
    • 1
  • Peter Vajkoczy
    • 1
  1. 1.Department of NeurosurgeryCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  2. 2.Department of NeurosurgeryUniversity of CologneCologneGermany

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