Volumetric evaluation of lumbar epidural fat distribution in epidural lipomatosis and back pain in patients who are obese: introducing a novel technique (Fat Finder algorithm)

• Authors: Marcus Anthony Walker, Georgia Institute of Technology; Yara Younan, Emory University; Christopher de la Houssaye, Emory University; Nickolas Reimer, Emory University; Douglas D. Robertson, Emory University; Monica Umpierrez, Emory University; Gulshan B. Sharma, University of Calgary; Felix Gonzalez, Emory University
• Journal Title: BMJ Open Diabetes Research and Care
• Volume: Volume 7, Number 1
• Publisher: BMJ Publishing Group: Open Access | 2019-06-01, Pages e000599-e000599
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/bmjdrc-2018-000599
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; SPINAL-CORD COMPRESSION; EXTRADURAL FAT; ASSOCIATION

Abstract

Objective: Spinal epidural lipomatosis (EL) represents an excessive deposition of unencapsulated adipose tissue in the spinal canal that can result in chronic back pain in patients who are obese with and without diabetes. We aim to calculate the total volumetric epidural fat on lumbar spine MRI in a predominately obese population and correlate total epidural fat to lower back pain (LBP) and body mass index (BMI). Research design and methods: We developed a program (Fat Finder) to quantify volumetric distribution of epidural fat throughout the lumbar spine. Eleven patients with LBP were imaged using two MRI protocols: Parallel axial slices and conventional clinical protocol. The distribution of epidural fat per level was analyzed and normalized to the spinal canal size. Results: Our sample had an average age of 59.9 years and BMI of 31.57 kg/m 2. EL subgroup consisted of seven patients. The L2-L5 total fat volume was 3477.6 mm 3 (1431.1-5595.9) in the EL group versus 1783.8 mm 3 (815.0-2717.5) in the age-similar non-EL group. A higher percentage of fat volume in the canal was associated with higher LBP scores. The fat percentage was 32.2% among patients with EL versus 15.4% for age-similar non-EL with LBP score of 6.1 and 4.0, respectively. Conclusions: The Fat Finder is a novel volumetric method to quantify epidural lumbar spinal fat. The epidural fat favors the lower spinal segment with direct proportionality between the fat volume and LBP score, independent of BMI.