Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Department for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Acta Neurochir (Wien). 2023 Nov;165(11):3479-3491. doi: 10.1007/s00701-023-05814-0. Epub 2023 Sep 25.
In contrast to osteoligamentous lumbar stenosis (LSS), outcome of surgical treatment for spinal epidural lipomatosis (SEL) is still not well defined. We present risk factors for SEL and clinical long-term outcome data after surgical treatment for patients with pure SEL and a mixed-type pathology with combined SEL and LSS (SEL+LSS) compared to patients with pure LSS.
From our prospective institutional database, we identified all consecutive patients who were surgically treated for newly diagnosed SEL (n = 31) and SEL+LSS (n = 26) between 2018 and 2022. In addition, a matched control group of patients with pure LSS (n = 30) was compared. Microsurgical treatment aimed for posterior decompression of the spinal canal. Study endpoints were outcome data including clinical symptoms at presentation, MR-morphological analysis, evaluation of pain-free walking distance, pain perception by VAS-N/-R scales, and patient's satisfaction by determination of the Odom score.
Patients with osteoligamentous SEL were significantly more likely to suffer from obesity (body mass index (BMI) of 30.2 ± 5.5 kg/m, p = 0.03), lumbar pain (p = 0.006), and to have received long-term steroid therapy (p = 0.01) compared to patients with SEL+LSS and LSS. In all three groups, posterior decompression of the spinal canal resulted in significant improvement of these symptoms. Patients with SEL had a significant increase in pain-free walking distance during the postoperative course, at discharge, and last follow-up (FU) (p < 0.0001), similar to patients with SEL+LSS and pure LSS. In addition, patients with pure SEL and SEL+LSS had a significant reduction in pain perception, represented by smaller values of VAS-N and -R postoperatively and at FU, similar to patients with pure LSS. In uni- and multivariate analysis, domination of lumbar pain and steroid long-term therapy were significant characteristic risk factors for SEL.
Surgical treatment of pure SEL and SEL+LSS allows significant improvement in pain-free walking distance and pain perception immediately postoperatively and in long-term FU, similar to patients with pure LSS.
与骨-韧带性腰椎狭窄症（LSS）相比，手术治疗脊髓硬膜外脂肪增多症（SEL）的结果仍不明确。我们提出了 SEL 的风险因素，并比较了单纯 SEL 患者和伴有 SEL 合并 LSS（SEL+LSS）的混合性病变患者与单纯 LSS 患者的手术治疗后临床长期结果数据。
我们从我们的前瞻性机构数据库中确定了 2018 年至 2022 年间所有新诊断为 SEL（n=31）和 SEL+LSS（n=26）的连续接受手术治疗的患者，并与单纯 LSS 患者（n=30）的匹配对照组进行比较。手术治疗的目标是对椎管进行后路减压。研究终点包括在就诊时的临床症状、磁共振形态学分析、无痛行走距离的评估、VAS-N/-R 量表评估的疼痛感知以及 Odom 评分确定的患者满意度等结果数据。
与 SEL+LSS 患者和 LSS 患者相比，单纯骨-韧带性 SEL 患者更有可能患有肥胖症（体重指数（BMI）为 30.2±5.5kg/m，p=0.03）、腰痛（p=0.006）和接受长期类固醇治疗（p=0.01）。在所有三组患者中，椎管后路减压均显著改善了这些症状。SEL 患者在术后、出院和最后随访（FU）期间无痛行走距离明显增加（p<0.0001），与 SEL+LSS 和单纯 LSS 患者相似。此外，单纯 SEL 和 SEL+LSS 患者的疼痛感知明显减轻，表现为术后和 FU 时 VAS-N 和 -R 的值较小，与单纯 LSS 患者相似。在单因素和多因素分析中，腰痛占主导地位和长期类固醇治疗是 SEL 的显著特征风险因素。
单纯 SEL 和 SEL+LSS 的手术治疗可显著改善术后和长期 FU 期间的无痛行走距离和疼痛感知，与单纯 LSS 患者相似。
