Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome

Shinichi Ishihara, Nobuyuki Fujita, Koichiro Azuma, Takehiro Michikawa, Mitsuru Yagi, Takashi Tsuji, Michiyo Takayama, Hideo Matsumoto, Masaya Nakamura, Morio Matsumoto, Kota Watanabe

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)


BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has 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 navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and 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 syndrome is 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.

Original languageEnglish
Pages (from-to)493-500
Number of pages8
JournalSpine Journal
Issue number3
Publication statusPublished - 2019 Mar


  • Body mass index
  • Epidural fat
  • Medical checkups
  • Metabolic syndrome
  • Obesity
  • Spinal epidural lipomatosis
  • Visceral fat area

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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