Obesity is a Risk Factor for Epidural Lipomatosis: A Meta-analysis

Background: Many studies have investigated the relationship between spinal epidural lipomatosis and obesity, no meta-analysis of studies have provided definitive evidence. To summarize the evidence of associations between obesity factors and spinal epidural lipomatosis (SEL) and to evaluate the strength and validity of these associations. Methods: Electronic databases such as Wiley Online Library, PubMed, Embase, Cochrane Library were searched and manual retrieval of references, the time limit was from the establishment of the database to May 2020. The included literature was case-control studies that reported body mass index (BMI) and SEL correlation, and excluded any primary and secondary tumors or other compression diseases in the spinal canal. Methodological quality evaluations of the included studies were assessed using the bias risk assessment tool recommended by the Cochrane Guidelines. The RevMan 5.3 software was used for meta-analysis. Results: Finally, ten studies were included for systematic review, all of which were observational studies with mixed bias risk. These studies involved 1,541 patients, with an average age of 54.9 to 73.6 years, and 60.2 percent of the participants were male. The sample sizes for the included studies ranged from 28 to 398. The results of meta-analysis showed that high BMI was one of the factors affecting SEL. All reviews had a high risk of bias, and the most common source of bias was that there was no strict unified case diagnosis standard between researches, and some studies (four items) did not clearly describe the confounders that they controlled. Conclusions: We suggest that physicians should consider obesity as a factor leading to SEL, and to control body mass index actively should be considered as the preferred treatment strategy before surgical intervention is conducted.