Lumbosacral Epidural Lipomatosis: A Retrospective Matched Case-Control Database Study.
OBJECTIVE
We present the largest known consecutive series of patients with epidural lipomatosis (EL) to characterize demographics and clinical symptoms of patients with EL on magnetic resonance imaging (MRI), and compare these characteristics against a matched control group.


METHODS
Patients evaluated for pathology requiring lumbar MRI imaging between September 2010 and September 2015 were retrospectively reviewed and included in this study if they were diagnosed with EL on a radiologic note during any visit to our medical center. One hundred ninety-nine patients fulfilled the study criteria and were included in the study cohort. A separate patient cohort of 199 unique, age- and gender-matched controls without lumbosacral EL was generated from a database of patients with lumbar MRI imaging during the same period.


RESULTS
Average age at diagnosis was 54.9 years (range, 25-84 years). One hundred thirty-three patients (66.8%) were men. On univariate analysis, patients with EL were more likely to have history of smoking (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.23-2.94, P = 0.004), diabetes mellitus type 2 (OR 2.17, 95% CI 1.33-3.56, P = 0.002), or be on disability (OR 4.43, 95% CI 2.48-7.91, P < 0.001). Furthermore, patients with EL had significantly increased median body mass index compared with controls (36.7 vs. 29.4 kg/m2; P < 0.001).


CONCLUSIONS
Patients with lumbosacral EL tend to be obese with a high incidence of type 2 diabetes mellitus, suggesting that this pathology may be a sequela of metabolic syndrome. Future research topics should include the pathogenesis of EL, as well as treatment outcomes of surgical versus primary care management.
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Baris
B
Yildirim
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Varun
V
Puvanesarajah
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Howard S
HS
An
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Wendy M
WM
Novicoff
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Amit
A
Jain
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Francis H
FH
Shen
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: hh4xd@hscmail.mcc.virginia.edu.
Hamid
H
Hassanzadeh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004824:Epidural Space / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008068:Lipomatosis / Q000000981:diagnostic imaging / Q000473:pathology*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology*
Epidural fat; Epidural lipomatosis; Lumbar spine; Lumbosacral spine; Metabolic syndrome; Obesity