Negative impact of spinal epidural lipomatosis on the surgical outcome of posterior lumbar spinous-splitting decompression surgery: a multicenter retrospective study.
Spine J
; 19(12): 1977-1985, 2019 12.
Article
en En
| MEDLINE
| ID: mdl-31254650
ABSTRACT
BACKGROUND CONTEXT Spinal epidural lipomatosis (SEL) results from excess lumbar epidural fat (EF) accumulation that compresses the cauda equina or nerve roots. Guidelines for the therapeutic management of SEL are not currently available. PURPOSE:
To elucidate the efficacy of lumbar decompression surgery in SEL. STUDYDESIGN:
Multicenter retrospective study. PATIENT SAMPLE A total of 288 consecutive patients who underwent posterior lumbar spinous-splitting decompression surgery for lumbar spinal canal stenosis and followed up greater than 2 years at participating institutions were retrospectively reviewed. OUTCOMEMEASURES:
Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Roland-Morris Disability Questionnaire (RDQ).METHODS:
Participants were divided into two groups according to the ratio of EF to anteroposterior diameter of the spinal canal (EF/SC-L) at the spinal level with maximum dural tube compression. Patients with EF/SC-L of ≥0.6 and <0.6 were defined as those with SEL and non-SEL, respectively. We assessed whether surgical treatment was "effective" or "not effective" using the JOABPEQ based on the following an increase of ≥20 points in the postoperative score compared with the preoperative score, or a preoperative score <90 with a postoperative score ≥90 points. We constructed a multiple Poisson regression model by adjusting for confounding factors, and determined estimated relative risk (RR) for "not effective" with surgical treatment using the JOABPEQ. Additionally, we selected age-, sex-, BMI-, and decompression levels-matched patients with non-SEL and compared the frequency of "not effective" between SEL patients (n=60) and non-SEL patients (n=60).RESULTS:
Analysis using the RDQ and JOABPEQ showed that the 1- and 2-year postoperative scores were significantly better than the preoperative scores in the both groups. Multivariable Poisson regression analysis demonstrated that SEL was significantly associated with "not effective" for decompression surgery in the 1-year postoperative outcomes of walking ability ([RR] 1.5, 95% confidence interval [CI] 1.0-2.2) and social life (RR 1.3, 95% CI 1.0-1.8) and the 2-year postoperative outcomes of walking ability (RR 1.6, 95% CI 1.2-2.3). Matching analysis showed that SEL was significantly associated with "not effective" with lumbar decompression surgery in the 2-year postoperative outcomes of walking ability (p=.02).CONCLUSIONS:
Patients with SEL exhibited significant improvements in surgical outcomes at 1 and 2 years postoperatively. However, compared with the non-SEL group, the efficacy of posterior lumbar spinous-splitting decompression surgery was worse in the SEL group, especially for walking ability. These results indicate that EF accumulation should be considered when planning treatment for patients with lumbar spinal canal stenosis and estimating the efficacy of lumbar decompression surgery.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Estenosis Espinal
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Descompresión Quirúrgica
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Lipomatosis
Tipo de estudio:
Clinical_trials
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Etiology_studies
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Evaluation_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Qualitative_research
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Spine J
Asunto de la revista:
ORTOPEDIA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Japón