Kim Keonhee, Mendelis Joseph, Cho Woojin
Yonsei University, Seoul, Republic of Korea.
Severance Hospital, Seoul, Republic of Korea.
Global Spine J. 2019 Sep;9(6):658-665. doi: 10.1177/2192568218793617. Epub 2018 Aug 13.
Narrative review of available literature.
To summarize current trends in pathogenesis and management of spinal epidural lipomatosis (SEL) and suggest areas where more research would be of benefit.
The available literature relevant to SEL was reviewed. PubMed, Medline, OVID, EMBASE, Cochrane, and Google Scholar were used to review the literature. Institutional review board approval is not applicable for this study.
This article clearly summarizes current trends in the pathogenesis and management of SEL.
Possible etiologies of SEL include exogenous steroid use, endogenous steroid hormonal disease, obesity, surgery induced, and idiopathic disease. Comorbidities such as acquired immunodeficiency syndrome and Scheuermann's disease have also been implicated in the pathogenesis of SEL. Steroid-induced SEL seems to have a proclivity for the thoracic region of the spine and has a higher incidence of paraplegia when compared with other forms. Several treatment modalities exist for SEL and are dictated by the underlying cause of the disorder. These include weight reduction, cessation of steroid medications, treatment of underlying endocrine abnormalities, and surgical decompression. Conservative treatments generally aim to decrease the thickness of adipose tissue in the epidural space, but the majority of patients tend to undergo surgical decompression to relieve neurologic symptoms. Surgical decompression provides a statistically significant reduction in symptoms, but postoperative mortality is high, influenced primarily by the patient's preoperative comorbidities. Physicians should consider the underlying cause of SEL in a given patient before pursuing specific treatment modalities, but alarm symptoms, such as the development of acute cauda equina syndrome, should likely be treated with urgent surgical decompression.
对现有文献的叙述性综述。
总结脊柱硬膜外脂肪增多症（SEL）发病机制和治疗的当前趋势，并指出更多研究将有益的领域。
对与SEL相关的现有文献进行综述。使用PubMed、Medline、OVID、EMBASE、Cochrane和谷歌学术搜索来查阅文献。本研究无需机构审查委员会批准。
本文清晰地总结了SEL发病机制和治疗的当前趋势。
SEL的可能病因包括外源性类固醇使用、内源性类固醇激素疾病、肥胖、手术诱发以及特发性疾病。诸如获得性免疫缺陷综合征和休曼病等合并症也与SEL的发病机制有关。类固醇诱导的SEL似乎更倾向于脊柱的胸段，与其他形式相比，截瘫发生率更高。SEL有多种治疗方式，取决于该病症的潜在病因。这些方式包括减轻体重、停用类固醇药物、治疗潜在的内分泌异常以及手术减压。保守治疗通常旨在减少硬膜外间隙脂肪组织的厚度，但大多数患者倾向于接受手术减压以缓解神经症状。手术减压在统计学上能显著减轻症状，但术后死亡率较高，主要受患者术前合并症的影响。在采取特定治疗方式之前，医生应考虑特定患者SEL的潜在病因，但诸如急性马尾综合征等警示症状可能应采用紧急手术减压治疗。
