Lipomatosis

[deleted185747]

Ok so if I inject steroids into subcutaneous fat it can cause fat atrophy right?
Where is the evidence that epidural steroids worsen epidural lipomatosis?
Is epidural fat different than subcutaneous fat, and does it behave differently than subcutaneous fat?

Asking for a fat friend

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[lobelsteve]

It is different at time of surgery. The stuff coming out of the spine is thicker and darker than most subQ fat I've seen in the OR.

 

[deleted185747]

Apparently they are slightly different cells:


The World Health Organization Committee for the Classification of Soft Tissue Tumors divides benign lipomatous tumors into nine distinct diagnoses: lipoma, lipomatosis, lipomatosis of the nerve, lipoblastoma/lipoblastomatosis, angiolipoma, myolipoma of soft tissue, chondroid lipoma, spindle-cell lipoma/pleomorphic lipoma, and hibernoma. Each of these characteristic lipomatous tumor types may vary in their presentation and treatment.

A review of techniques and procedures for lipoma treatment

 

[Orin]

Ok so if I inject steroids into subcutaneous fat it can cause fat atrophy right?
Where is the evidence that epidural steroids worsen epidural lipomatosis?
Is epidural fat different than subcutaneous fat, and does it behave differently than subcutaneous fat?

Right, different types of fat.

Rapid progression of spinal epidural lipomatosis
Skip ahead to the discussion and it talks a little bit about the relationship between spinal epidural lipomatosis and steroid exposure.

 

[soccrwz]

So besides surgical management, is weight loss the only option?

 

[callmeanesthesia]

Stem cells!

 

[SommeRiver]

Where's the evidence NONPARTICULATES cause this phenomenon?

 

[SSdoc33]

I'll inject stenosis due to lipomatosis. Why Not? More lipomatosis? Meh

 

[Ducttape]

no offense, but those 2 case reports are ridiculous.

the first one, the patient had epidural injections, yes.
but he also had "He had undergone anterior lumbar interbody fusion (ALIF) at L5/S1 and bilateral removal of a herniated disc via laminectomy at L3/4." how on gods earth do you blame the epidural injection for lipomatosis when you perform a surgical procedure a month after the procedure (which the patient did get better)?

in the second case, the patient had T11 and L2 compression fractures. he had perc vertebroplasty, then 1 epidural injection, then was diagnosed as having an additional L3 and L5 compression fractures. ie 4 out of 7 lower vertebrae had abnormal cortical density and subsequent fractures. this is not a normal spine, and it is not due to the single epidural injection after the apparently failed vertebroplasty.

authors' comments, and I highlighted/bolded points of concern:

Both of the cases reported herein underwent epidural steroid injection without long-term intake of steroids. In the first case, the patient was given two epidural steroid injections before ALIF. Six months after the steroid injections, SEL progressed rapidly. In the second case, the patient was given one epidural steroid injection. Five months later, SEL progressed rapidly and was symptomatic. Roy-Camille et al [13]. reported first a SEL after lumbar epidural steroid injection. Then, four cases associated with epidural steroid injection have been reported [14–17]. We summarized five reported cases in Table 1. Kinds of steroid were triamcinolone acetonide and methylprednisolone acetate. Amounts of steroid and duration of the use varied considerably. Although MR images were not obtained before the epidural injection in all cases, the clinical and radiological data indicated that the progression of SEL was relatively rapid. Especially, two cases progressed rapidly similar to our cases.

if epidural injections only have clinical effect for 3 months, if there is poor documentation of long term benefit of steroids, then it should be "both ways" - if no long term benefit, how can the authors assume there is long term side effect from steroid injection 5-6 months after???

the last bolded point effectively makes this case report useless.

 

[DocMorpheus]

To piggyback off the theme of this thread...I have a patient with moderate/severe spinal stenosis from posterior epidural lipomatosis. Any thoughts on injecting hyaluronic acid in an attempt to some way degrade the fat??
Barring surgery, PT, and steroids...what would you do?

 

[painfree23]

To piggyback off the theme of this thread...I have a patient with moderate/severe spinal stenosis from posterior epidural lipomatosis. Any thoughts on injecting hyaluronic acid in an attempt to some way degrade the fat??
Barring surgery, PT, and steroids...what would you do?

Stim ?

 

[deleted185747]

How about Kybella to shrink fat? I’d love to experiment but need a study etc, unless one of us does it on ourselves like in the olden days of medicine!!!

 

[Ducttape]

when possible, weight loss. most epidural lipomatosis is associated with obesity. not all, but when possible, bariatric surgery..

 

[DocMorpheus]

Patient is not obese and is barely overweight. He has neurogenic clarification symptoms so I don’t think stim would help.

 

[DODOCSS]

endo referral