Spinal Epidural Lipomatosis: Are Its Prevalence and Severity Increasing

Nonrandomized, quantitative study.

The goal of this study is to determine whether the prevalence and severity of spinal epidural lipomatosis (SEL) in patients undergoing lumbar spine decompression surgery have increased over the past decade.

There are no reports on whether the incidence of symptomatic spinal stenosis due to epidural lipomatosis has changed over time. This study assesses whether the prevalence and characteristics of spinal epidural lipomatosis have changed over 10 years.

This retrospective cohort study assesses consecutive patients who underwent lumbar decompression surgery (laminotomy/laminectomy, with or without fusion) for treatment of degenerative stenosis in the calendar years of 2013 and 2023 by a single surgeon. Patient demographic factors, surgical details, SEL grade, body mass index, and smoking status were analyzed. Statistical analyses were conducted using the χ2 tests to compare demographic and surgical variables. Binary logistic regressions were used to model the prediction of SEL, adjusting for age, BMI, and smoking status.

The prevalence of SEL at multiple levels in the lumbar spine increased significantly from 2013-2023, rising from 47.5%-63% (P=0.028). Elevated Body Mass Index (BMI) was associated with an increased odds of SEL (OR=1.03, P=0.021). Cigarette smoking had a significant association with higher SEL grades, including a 3-fold increase in odds for SEL ≥60%.

This study found a significant increase in multilevel SEL involvement from 2013-2023. Smoking and elevated BMI were associated with significantly increased odds of SEL, underscoring their impact as modifiable risk factors. These results support continued efforts to minimize smoking and obesity, while suggesting that additional, unmeasured factors may also be contributing to the increased prevalence of SEL over time.