Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome

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 equinaor nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndromehas 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 navellevel using abdominal computed tomography. Metabolic syndromewas diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndromeand 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 syndromeis 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.