Yildirim Baris, Puvanesarajah Varun, An Howard S, Novicoff Wendy M, Jain Amit, Shen Francis H, Hassanzadeh Hamid
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
World Neurosurg. 2016 Dec;96:209-214. doi: 10.1016/j.wneu.2016.08.125. Epub 2016 Sep 5.
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.
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.
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/m; P < 0.001).
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.
我们呈现了已知最大的连续性硬膜外脂肪增多症（EL）患者系列，以描述EL患者在磁共振成像（MRI）上的人口统计学特征和临床症状，并将这些特征与匹配的对照组进行比较。
回顾性分析2010年9月至2015年9月期间因病理检查而接受腰椎MRI检查的患者。如果他们在任何一次到我们医疗中心就诊时的放射学报告中被诊断为EL，则纳入本研究。199例患者符合研究标准并被纳入研究队列。从同一时期接受腰椎MRI检查的患者数据库中生成了一个由199名年龄和性别匹配、无腰骶部EL的独立患者队列作为对照组。
诊断时的平均年龄为54.9岁（范围25 - 84岁）。133例患者（66.8%）为男性。单因素分析显示，EL患者更有可能有吸烟史（比值比[OR] 1.90，95%置信区间[CI] 1.23 - 2.94，P = 0.004）、2型糖尿病（OR 2.17，95% CI 1.33 - 3.56，P = 0.002）或残疾（OR 4.43，95% CI 2.48 - 7.91，P < 0.001）。此外，与对照组相比，EL患者的中位数体重指数显著升高（36.7 vs. 29.4 kg/m²；P < 0.001）。
腰骶部EL患者往往肥胖，2型糖尿病发病率高，提示这种病理状况可能是代谢综合征的后遗症。未来的研究主题应包括EL的发病机制以及手术治疗与初级保健管理的治疗结果。
