Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome

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

Research output: Contribution to journalArticle

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Abstract

BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted. PURPOSE: To elucidate potential association between SEL and metabolic syndrome. STUDY DESIGN: An observational study used data of a medical checkup. PATIENT SAMPLE: We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study. OUTCOME MEASURES: The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated. METHODS: The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated. RESULTS: The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5–9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm 2 (OR=4.8, 95% CI=1.5–15.3) and hypertension (OR=3.5, 95% CI=1.1–11.8) were observed to be independently associated with SEL. CONCLUSION: This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome.

Original languageEnglish
Pages (from-to)493-500
Number of pages8
JournalSpine Journal
Volume19
Issue number3
DOIs
Publication statusPublished - 01-03-2019

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Lipomatosis
Fats
Intra-Abdominal Fat
Subcutaneous Fat
Odds Ratio
Confidence Intervals
Cauda Equina
Internal Medicine
Observational Studies
Adipose Tissue
Body Mass Index
Logistic Models
Tomography
Regression Analysis
Magnetic Resonance Imaging
Demography
Hypertension

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Ishihara, S., Fujita, N., Azuma, K., Michikawa, T., Yagi, M., Tsuji, T., ... Watanabe, K. (2019). Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome. Spine Journal, 19(3), 493-500. https://doi.org/10.1016/j.spinee.2018.07.022
Ishihara, Shinichi ; Fujita, Nobuyuki ; Azuma, Koichiro ; Michikawa, Takehiro ; Yagi, Mitsuru ; Tsuji, Takashi ; Takayama, Michiyo ; Matsumoto, Hideo ; Nakamura, Masaya ; Matsumoto, Morio ; Watanabe, Kota. / Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome. In: Spine Journal. 2019 ; Vol. 19, No. 3. pp. 493-500.
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abstract = "BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted. PURPOSE: To elucidate potential association between SEL and metabolic syndrome. STUDY DESIGN: An observational study used data of a medical checkup. PATIENT SAMPLE: We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study. OUTCOME MEASURES: The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated. METHODS: The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated. RESULTS: The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95{\%} confidence interval [CI]=1.5–9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm 2 (OR=4.8, 95{\%} CI=1.5–15.3) and hypertension (OR=3.5, 95{\%} CI=1.1–11.8) were observed to be independently associated with SEL. CONCLUSION: This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome.",
author = "Shinichi Ishihara and Nobuyuki Fujita and Koichiro Azuma and Takehiro Michikawa and Mitsuru Yagi and Takashi Tsuji and Michiyo Takayama and Hideo Matsumoto and Masaya Nakamura and Morio Matsumoto and Kota Watanabe",
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Ishihara, S, Fujita, N, Azuma, K, Michikawa, T, Yagi, M, Tsuji, T, Takayama, M, Matsumoto, H, Nakamura, M, Matsumoto, M & Watanabe, K 2019, 'Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome', Spine Journal, vol. 19, no. 3, pp. 493-500. https://doi.org/10.1016/j.spinee.2018.07.022

Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome. / Ishihara, Shinichi; Fujita, Nobuyuki; Azuma, Koichiro; Michikawa, Takehiro; Yagi, Mitsuru; Tsuji, Takashi; Takayama, Michiyo; Matsumoto, Hideo; Nakamura, Masaya; Matsumoto, Morio; Watanabe, Kota.

In: Spine Journal, Vol. 19, No. 3, 01.03.2019, p. 493-500.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome

AU - Ishihara, Shinichi

AU - Fujita, Nobuyuki

AU - Azuma, Koichiro

AU - Michikawa, Takehiro

AU - Yagi, Mitsuru

AU - Tsuji, Takashi

AU - Takayama, Michiyo

AU - Matsumoto, Hideo

AU - Nakamura, Masaya

AU - Matsumoto, Morio

AU - Watanabe, Kota

PY - 2019/3/1

Y1 - 2019/3/1

N2 - BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted. PURPOSE: To elucidate potential association between SEL and metabolic syndrome. STUDY DESIGN: An observational study used data of a medical checkup. PATIENT SAMPLE: We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study. OUTCOME MEASURES: The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated. METHODS: The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated. RESULTS: The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5–9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm 2 (OR=4.8, 95% CI=1.5–15.3) and hypertension (OR=3.5, 95% CI=1.1–11.8) were observed to be independently associated with SEL. CONCLUSION: This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome.

AB - BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted. PURPOSE: To elucidate potential association between SEL and metabolic syndrome. STUDY DESIGN: An observational study used data of a medical checkup. PATIENT SAMPLE: We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study. OUTCOME MEASURES: The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated. METHODS: The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated. RESULTS: The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5–9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm 2 (OR=4.8, 95% CI=1.5–15.3) and hypertension (OR=3.5, 95% CI=1.1–11.8) were observed to be independently associated with SEL. CONCLUSION: This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome.

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