Background: Epidural lipomatosis (EL) is an increase of adipose tissue, normally occurring in the epidural space,\nsufficient to distort the thecal sac and compress neural elements. There is a lack of knowledge of risk factors,\nimpact on patientâ��s symptoms, and its possible association with epidural steroid injections.\nMethods: History, physical examination, patient chart, and MRI were analyzed from 856 outpatients referred for\nepidural steroid injections. Seventy patients with signs of EL on MRI comprised the study group. Thirty-four randomly\nselected patients comprised the control group. The severity of EL was determined by the MRI assessment. The impact\nof EL was determined by the patientâ��s history and physical examination. Logistic regression was used to correlate the\nprobability of developing EL with BMI and epidural steroid injections.\nResults: EL was centered at L5 and S1 segments. The average BMI for patients with EL was significantly greater than\nthat of control group (36.0 �± 0.9 vs. 29.2 �± 0.9, p <0.01). The probability of developing EL with increasing BMI was linear\nup to the BMI of 35 after which it plateaued. Triglycerides were significantly higher for the EL group as compared to\ncontrols (250 �± 30 vs. 186 �± 21 mg/dL p < 0.01). The odds of having EL were 60% after two epidural steroid injections,\n90% after three epidural steroid injections and approached 100% with further injections, independent of BMI. Other risk\nfactors considered included alcohol abuse, use of protease inhibitors, levels of stress, hypothyroidism and genetic\npredisposition. However there were insufficient quantities to determine statistical significance with a degree of\nconfidence. The impact of EL on patientâ��s symptoms correlated with EL severity with Spearman correlation coefficient\nof 0.73 at p < 0.01 significance level.\nConclusions: The BMI and triglycerides levels were found to be significantly elevated for the EL group, pointing\nto an increased risk of EL occurrence in progressively more obese US population. The data also revealed a strong\ncorrelation between the number of subsequent epidural steroid injections and EL occurrence calling for caution\nwith the use of corticosteroids.
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