Negative impact of spinal epidural lipomatosis on the surgical outcome of posterior lumbar spinous-splitting decompression surgery

a multicenter retrospective study

Nobuyuki Fujita, Shinichi Ishihara, Takehiro Michikawa, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Eijiro Okada, Mitsuru Yagi, Takashi Tsuji, Hitoshi Kono, Masaya Nakamura, Morio Matsumoto, Kota Watanabe

研究成果: Article

抄録

BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) results from excess lumbar epidural fat (EF) accumulation that compresses the cauda equina or nerve roots. Guidelines for the therapeutic management of SEL are not currently available. PURPOSE: To elucidate the efficacy of lumbar decompression surgery in SEL. STUDY DESIGN: Multicenter retrospective study. PATIENT SAMPLE: A total of 288 consecutive patients who underwent posterior lumbar spinous-splitting decompression surgery for lumbar spinal canal stenosis and followed up greater than 2 years at participating institutions were retrospectively reviewed. OUTCOME MEASURES: Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Roland-Morris Disability Questionnaire (RDQ). METHODS: Participants were divided into two groups according to the ratio of EF to anteroposterior diameter of the spinal canal (EF/SC-L) at the spinal level with maximum dural tube compression. Patients with EF/SC-L of ≥0.6 and <0.6 were defined as those with SEL and non-SEL, respectively. We assessed whether surgical treatment was “effective” or “not effective” using the JOABPEQ based on the following: an increase of ≥20 points in the postoperative score compared with the preoperative score, or a preoperative score <90 with a postoperative score ≥90 points. We constructed a multiple Poisson regression model by adjusting for confounding factors, and determined estimated relative risk (RR) for “not effective” with surgical treatment using the JOABPEQ. Additionally, we selected age-, sex-, BMI-, and decompression levels-matched patients with non-SEL and compared the frequency of “not effective” between SEL patients (n=60) and non-SEL patients (n=60). RESULTS: Analysis using the RDQ and JOABPEQ showed that the 1- and 2-year postoperative scores were significantly better than the preoperative scores in the both groups. Multivariable Poisson regression analysis demonstrated that SEL was significantly associated with “not effective” for decompression surgery in the 1-year postoperative outcomes of walking ability ([RR] 1.5, 95% confidence interval [CI] 1.0–2.2) and social life (RR 1.3, 95% CI 1.0–1.8) and the 2-year postoperative outcomes of walking ability (RR 1.6, 95% CI 1.2–2.3). Matching analysis showed that SEL was significantly associated with “not effective” with lumbar decompression surgery in the 2-year postoperative outcomes of walking ability (p=.02). CONCLUSIONS: Patients with SEL exhibited significant improvements in surgical outcomes at 1 and 2 years postoperatively. However, compared with the non-SEL group, the efficacy of posterior lumbar spinous-splitting decompression surgery was worse in the SEL group, especially for walking ability. These results indicate that EF accumulation should be considered when planning treatment for patients with lumbar spinal canal stenosis and estimating the efficacy of lumbar decompression surgery.

元の言語English
ジャーナルSpine Journal
DOI
出版物ステータスPublished - 01-01-2019

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Lipomatosis
Decompression
Multicenter Studies
Retrospective Studies
Back Pain
Fats
Spinal Canal
Walking
Orthopedics
Spinal Stenosis
Confidence Intervals
Cauda Equina
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

これを引用

Fujita, Nobuyuki ; Ishihara, Shinichi ; Michikawa, Takehiro ; Suzuki, Satoshi ; Tsuji, Osahiko ; Nagoshi, Narihito ; Okada, Eijiro ; Yagi, Mitsuru ; Tsuji, Takashi ; Kono, Hitoshi ; Nakamura, Masaya ; Matsumoto, Morio ; Watanabe, Kota. / Negative impact of spinal epidural lipomatosis on the surgical outcome of posterior lumbar spinous-splitting decompression surgery : a multicenter retrospective study. :: Spine Journal. 2019.
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title = "Negative impact of spinal epidural lipomatosis on the surgical outcome of posterior lumbar spinous-splitting decompression surgery: a multicenter retrospective study",
abstract = "BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) results from excess lumbar epidural fat (EF) accumulation that compresses the cauda equina or nerve roots. Guidelines for the therapeutic management of SEL are not currently available. PURPOSE: To elucidate the efficacy of lumbar decompression surgery in SEL. STUDY DESIGN: Multicenter retrospective study. PATIENT SAMPLE: A total of 288 consecutive patients who underwent posterior lumbar spinous-splitting decompression surgery for lumbar spinal canal stenosis and followed up greater than 2 years at participating institutions were retrospectively reviewed. OUTCOME MEASURES: Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Roland-Morris Disability Questionnaire (RDQ). METHODS: Participants were divided into two groups according to the ratio of EF to anteroposterior diameter of the spinal canal (EF/SC-L) at the spinal level with maximum dural tube compression. Patients with EF/SC-L of ≥0.6 and <0.6 were defined as those with SEL and non-SEL, respectively. We assessed whether surgical treatment was “effective” or “not effective” using the JOABPEQ based on the following: an increase of ≥20 points in the postoperative score compared with the preoperative score, or a preoperative score <90 with a postoperative score ≥90 points. We constructed a multiple Poisson regression model by adjusting for confounding factors, and determined estimated relative risk (RR) for “not effective” with surgical treatment using the JOABPEQ. Additionally, we selected age-, sex-, BMI-, and decompression levels-matched patients with non-SEL and compared the frequency of “not effective” between SEL patients (n=60) and non-SEL patients (n=60). RESULTS: Analysis using the RDQ and JOABPEQ showed that the 1- and 2-year postoperative scores were significantly better than the preoperative scores in the both groups. Multivariable Poisson regression analysis demonstrated that SEL was significantly associated with “not effective” for decompression surgery in the 1-year postoperative outcomes of walking ability ([RR] 1.5, 95{\%} confidence interval [CI] 1.0–2.2) and social life (RR 1.3, 95{\%} CI 1.0–1.8) and the 2-year postoperative outcomes of walking ability (RR 1.6, 95{\%} CI 1.2–2.3). Matching analysis showed that SEL was significantly associated with “not effective” with lumbar decompression surgery in the 2-year postoperative outcomes of walking ability (p=.02). CONCLUSIONS: Patients with SEL exhibited significant improvements in surgical outcomes at 1 and 2 years postoperatively. However, compared with the non-SEL group, the efficacy of posterior lumbar spinous-splitting decompression surgery was worse in the SEL group, especially for walking ability. These results indicate that EF accumulation should be considered when planning treatment for patients with lumbar spinal canal stenosis and estimating the efficacy of lumbar decompression surgery.",
author = "Nobuyuki Fujita and Shinichi Ishihara and Takehiro Michikawa and Satoshi Suzuki and Osahiko Tsuji and Narihito Nagoshi and Eijiro Okada and Mitsuru Yagi and Takashi Tsuji and Hitoshi Kono and Masaya Nakamura and Morio Matsumoto and Kota Watanabe",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.spinee.2019.06.022",
language = "English",
journal = "Spine Journal",
issn = "1529-9430",
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Negative impact of spinal epidural lipomatosis on the surgical outcome of posterior lumbar spinous-splitting decompression surgery : a multicenter retrospective study. / Fujita, Nobuyuki; Ishihara, Shinichi; Michikawa, Takehiro; Suzuki, Satoshi; Tsuji, Osahiko; Nagoshi, Narihito; Okada, Eijiro; Yagi, Mitsuru; Tsuji, Takashi; Kono, Hitoshi; Nakamura, Masaya; Matsumoto, Morio; Watanabe, Kota.

:: Spine Journal, 01.01.2019.

研究成果: Article

TY - JOUR

T1 - Negative impact of spinal epidural lipomatosis on the surgical outcome of posterior lumbar spinous-splitting decompression surgery

T2 - a multicenter retrospective study

AU - Fujita, Nobuyuki

AU - Ishihara, Shinichi

AU - Michikawa, Takehiro

AU - Suzuki, Satoshi

AU - Tsuji, Osahiko

AU - Nagoshi, Narihito

AU - Okada, Eijiro

AU - Yagi, Mitsuru

AU - Tsuji, Takashi

AU - Kono, Hitoshi

AU - Nakamura, Masaya

AU - Matsumoto, Morio

AU - Watanabe, Kota

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) results from excess lumbar epidural fat (EF) accumulation that compresses the cauda equina or nerve roots. Guidelines for the therapeutic management of SEL are not currently available. PURPOSE: To elucidate the efficacy of lumbar decompression surgery in SEL. STUDY DESIGN: Multicenter retrospective study. PATIENT SAMPLE: A total of 288 consecutive patients who underwent posterior lumbar spinous-splitting decompression surgery for lumbar spinal canal stenosis and followed up greater than 2 years at participating institutions were retrospectively reviewed. OUTCOME MEASURES: Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Roland-Morris Disability Questionnaire (RDQ). METHODS: Participants were divided into two groups according to the ratio of EF to anteroposterior diameter of the spinal canal (EF/SC-L) at the spinal level with maximum dural tube compression. Patients with EF/SC-L of ≥0.6 and <0.6 were defined as those with SEL and non-SEL, respectively. We assessed whether surgical treatment was “effective” or “not effective” using the JOABPEQ based on the following: an increase of ≥20 points in the postoperative score compared with the preoperative score, or a preoperative score <90 with a postoperative score ≥90 points. We constructed a multiple Poisson regression model by adjusting for confounding factors, and determined estimated relative risk (RR) for “not effective” with surgical treatment using the JOABPEQ. Additionally, we selected age-, sex-, BMI-, and decompression levels-matched patients with non-SEL and compared the frequency of “not effective” between SEL patients (n=60) and non-SEL patients (n=60). RESULTS: Analysis using the RDQ and JOABPEQ showed that the 1- and 2-year postoperative scores were significantly better than the preoperative scores in the both groups. Multivariable Poisson regression analysis demonstrated that SEL was significantly associated with “not effective” for decompression surgery in the 1-year postoperative outcomes of walking ability ([RR] 1.5, 95% confidence interval [CI] 1.0–2.2) and social life (RR 1.3, 95% CI 1.0–1.8) and the 2-year postoperative outcomes of walking ability (RR 1.6, 95% CI 1.2–2.3). Matching analysis showed that SEL was significantly associated with “not effective” with lumbar decompression surgery in the 2-year postoperative outcomes of walking ability (p=.02). CONCLUSIONS: Patients with SEL exhibited significant improvements in surgical outcomes at 1 and 2 years postoperatively. However, compared with the non-SEL group, the efficacy of posterior lumbar spinous-splitting decompression surgery was worse in the SEL group, especially for walking ability. These results indicate that EF accumulation should be considered when planning treatment for patients with lumbar spinal canal stenosis and estimating the efficacy of lumbar decompression surgery.

AB - BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) results from excess lumbar epidural fat (EF) accumulation that compresses the cauda equina or nerve roots. Guidelines for the therapeutic management of SEL are not currently available. PURPOSE: To elucidate the efficacy of lumbar decompression surgery in SEL. STUDY DESIGN: Multicenter retrospective study. PATIENT SAMPLE: A total of 288 consecutive patients who underwent posterior lumbar spinous-splitting decompression surgery for lumbar spinal canal stenosis and followed up greater than 2 years at participating institutions were retrospectively reviewed. OUTCOME MEASURES: Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Roland-Morris Disability Questionnaire (RDQ). METHODS: Participants were divided into two groups according to the ratio of EF to anteroposterior diameter of the spinal canal (EF/SC-L) at the spinal level with maximum dural tube compression. Patients with EF/SC-L of ≥0.6 and <0.6 were defined as those with SEL and non-SEL, respectively. We assessed whether surgical treatment was “effective” or “not effective” using the JOABPEQ based on the following: an increase of ≥20 points in the postoperative score compared with the preoperative score, or a preoperative score <90 with a postoperative score ≥90 points. We constructed a multiple Poisson regression model by adjusting for confounding factors, and determined estimated relative risk (RR) for “not effective” with surgical treatment using the JOABPEQ. Additionally, we selected age-, sex-, BMI-, and decompression levels-matched patients with non-SEL and compared the frequency of “not effective” between SEL patients (n=60) and non-SEL patients (n=60). RESULTS: Analysis using the RDQ and JOABPEQ showed that the 1- and 2-year postoperative scores were significantly better than the preoperative scores in the both groups. Multivariable Poisson regression analysis demonstrated that SEL was significantly associated with “not effective” for decompression surgery in the 1-year postoperative outcomes of walking ability ([RR] 1.5, 95% confidence interval [CI] 1.0–2.2) and social life (RR 1.3, 95% CI 1.0–1.8) and the 2-year postoperative outcomes of walking ability (RR 1.6, 95% CI 1.2–2.3). Matching analysis showed that SEL was significantly associated with “not effective” with lumbar decompression surgery in the 2-year postoperative outcomes of walking ability (p=.02). CONCLUSIONS: Patients with SEL exhibited significant improvements in surgical outcomes at 1 and 2 years postoperatively. However, compared with the non-SEL group, the efficacy of posterior lumbar spinous-splitting decompression surgery was worse in the SEL group, especially for walking ability. These results indicate that EF accumulation should be considered when planning treatment for patients with lumbar spinal canal stenosis and estimating the efficacy of lumbar decompression surgery.

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