The Mysterious Role of Epidural Fat Tissue in Spine Surgery

Study Design: Literature review. Objectives: An increasing number of obese patients requires operative care for degenerative spinal disorders. The aim of this review is to analyze the available evidence regarding the role of obesity on outcomes after spine surgery. Peri-operative complications and clinical results are evaluated for both cervical and lumbar surgery. Furthermore, the contribution of MIS techniques for lumbar surgery to play a role in reducing risks has been analyzed. Methods: Only articles published in English in the last 10 years were reviewed. Inclusion criteria of the references were based on the scope of this review, according to PRISMA guidelines. Moreover, only paper analyzing obesity-related complications in spine surgery have been selected and thoroughly reviewed. Each article was classified according to its rating of evidence using the Sacket Grading System. Results: A total number of 1636 articles were found, but only 130 of them were considered to be relevant after thorough evaluation and according to PRISMA checklist. The majority of the included papers were classified according to the Sacket Grading System as Level 2 (Retrospective Studies). Conclusion: Evidence suggest that obese patients could benefit from spine surgery and outcomes be satisfactory. A higher rate of peri-operative complications is reported among obese patients, especially in posterior approaches. The use of MIS techniques plays a key role in order to reduce surgical risks. Further studies should evaluate the role of multidisciplinary counseling between spine surgeons, nutritionists and bariatric surgeons, in order to plan proper weight loss before elective spine surgery.

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The role of spine surgery in the care of SMA patients

Česká a slovenská neurologie a neurochirurgie ◽

10.48095/cccsnn20202s41 ◽

2020 ◽

Vol 83/116 (Suppl2) ◽

pp. 2S41-2S44

Author(s):

Michal Barna ◽

Jan Štulík

Keyword(s):

Spine Surgery

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Cellular adaptations in fat tissue of exercise-trained miniature swine: role of excess energy intake

Journal of Applied Physiology ◽

10.1152/jappl.2000.88.3.881 ◽

2000 ◽

Vol 88 (3) ◽

pp. 881-887 ◽

Cited By ~ 5

Author(s):

Gale B. Carey

Keyword(s):

Adipose Tissue ◽

Energy Intake ◽

Excess Energy ◽

Fat Tissue ◽

Cellular Mechanisms ◽

Miniature Swine ◽

Extracellular Adenosine

This study examined the influence of energy expenditure and energy intake on cellular mechanisms regulating adipose tissue metabolism. 1 Twenty-four swine were assigned to restricted-fed sedentary, restricted-fed exercise-trained, full-fed sedentary, or full-fed exercise-trained groups. After 3 mo of treatment, adipocytes were isolated and adipocyte size, adenosine A1 receptor characteristics, and lipolytic sensitivity were measured. Swine were infused with epinephrine during which adipose tissue extracellular adenosine, plasma fatty acids, and plasma glycerol were measured. Results revealed that adipocytes isolated from restricted-fed exercised swine had a smaller diameter, a lower number of A1 receptors, and a greater sensitivity to lipolytic stimulation, compared with adipocytes from full-fed exercised swine. Extracellular adenosine levels were transiently increased on infusion of epinephrine in adipose tissue of restricted-fed exercised but not full-fed exercised swine. These results suggest a role for adenosine in explaining the discrepancy between in vitro and in vivo lipolysis findings and underscore the notion that excess energy intake dampens the lipolytic sensitivity of adipocytes to β-agonists and adenosine, even if accompanied by exercise training.

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The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

Journal of Craniovertebral Junction and Spine ◽

10.4103/0974-8237.199873 ◽

2017 ◽

Vol 8 (1) ◽

pp. 39 ◽

Cited By ~ 11

Author(s):

MazdaK Turel ◽

Mena Kerolus ◽

Harel Deutsch

Keyword(s):

Minimally Invasive ◽

Spine Surgery ◽

Minimally Invasive Spine Surgery ◽

Minimally Invasive Spine

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In Lyl1-/- mice, adipose stem cell vascular niche impairment leads to premature development of fat tissues

10.1101/2020.04.24.059683 ◽

2020 ◽

Author(s):

Abid Hussain ◽

Leila El Kebriti ◽

Virginie Deleuze ◽

Yaël Glasson ◽

Nelly Pirot ◽

...

Keyword(s):

Stem Cell ◽

Lymphoblastic Leukemia ◽

Fat Tissue ◽

Adipose Stem Cell ◽

Adipose Tissues ◽

Vascular Niche ◽

Vascular Structures ◽

Deficient Mice ◽

Vascular Compartment

ABSTRACTLymphoblastic leukemia-derived sequence 1 (Lyl1) encodes a hematopoietic- and endothelial-specific transcriptional factor. Lyl1-deficient mice are viable, but they display mild hematopoietic and vascular defects. Here, we report that young Lyl1-/- mice exhibit transient obesity associated with general expansion of adipose tissues and unrelated to food intake. The increased fat tissue development in Lyl1-/- mice resulted from an earlier adipocyte differentiation of adipose stem cells (ASCs) through non-cell autonomous mechanisms. Specifically, we found that in Lyl1-/- mice, the vascular structures of adipose tissues are unstable, more prone to angiogenesis and, consequently, cannot maintain adipose progenitors in the niche vessel wall. Together, our data show that in Lyl1-/- mice, the impaired vascular compartment of the adipose niche promotes uncontrolled ASC activation and differentiation, leading to early adipocyte expansion and premature depletion of ASCs. Our study highlights the major structural role of the adipose tissue vascular niche in coordinating stem cell self-renewal and differentiation into adipocytes.

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Positioning-Related Peripheral Nerve Injury During Spine Surgery and the Role of Intraoperative Neuromonitoring

Contemporary Spine Surgery ◽

10.1097/01.css.0000802036.45406.16 ◽

2021 ◽

Vol 22 (12) ◽

pp. 6-6

Keyword(s):

Peripheral Nerve ◽

Nerve Injury ◽

Spine Surgery ◽

Peripheral Nerve Injury ◽

Intraoperative Neuromonitoring

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The Role of the Physical Therapist Before and After Lumbar Spine Surgery

Orthopedic Clinics of North America ◽

10.1016/s0030-5898(20)31341-9 ◽

1983 ◽

Vol 14 (3) ◽

pp. 649-659

Author(s):

M. Wayne Sawyer

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Physical Therapist ◽

Lumbar Spine Surgery ◽

Before And After

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Dilated Blood and Lymphatic Microvessels, Angiogenesis, Increased Macrophages, and Adipocyte Hypertrophy in Lipedema Thigh Skin and Fat Tissue

Journal of Obesity ◽

10.1155/2019/8747461 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 23

Author(s):

Sara AL-Ghadban ◽

Walter Cromer ◽

Marisol Allen ◽

Christopher Ussery ◽

Michael Badowski ◽

...

Keyword(s):

Mast Cells ◽

Case Reports ◽

Obese Women ◽

Fat Tissue ◽

Control Groups ◽

Tissue Samples ◽

Vessel Area ◽

Adipocyte Hypertrophy ◽

Imagej Software

Background and Aim. Lipedema is a common painful SAT disorder characterized by enlargement of fat primarily in the legs of women. Case reports of lipedema tissue samples demonstrate fluid and fibrosis in the interstitial matrix, increased macrophages, and adipocyte hypertrophy. The aims of this project are to investigate blood vasculature, immune cells, and structure of lipedema tissue in a cohort of women. Methods. Forty-nine participants, 19 controls and 30 with lipedema, were divided into groups based on body mass index (BMI): Non-Obese (BMI 20 to <30 kg/m2) and Obese (BMI 30 to <40 kg/m2). Histological sections from thigh skin and fat were stained with H&E. Adipocyte area and blood vessel size and number were quantified using ImageJ software. Markers for macrophages (CD68), mast cells (CD117), T cells (CD3), endothelial cells (CD31), blood (SMA), and lymphatic (D2-40 and Lyve-1) vessels were investigated by IHC and IF. Results. Non-Obese Lipedema adipocyte area was larger than Non-Obese Controls (p=0.005) and similar to Obese Lipedema and Obese Controls. Macrophage numbers were significantly increased in Non-Obese (p<0.005) and Obese (p<0.05) Lipedema skin and fat compared to Control groups. No differences in T lymphocytes or mast cells were observed when comparing Lipedema to Control in both groups. SMA staining revealed increased dermal vessels in Non-Obese Lipedema patients (p<0.001) compared to Non-Obese Controls. Lyve-1 and D2-40 staining showed a significant increase in lymphatic vessel area but not in number or perimeter in Obese Lipedema participants (p<0.05) compared to Controls (Obese and Non-Obese). Areas of angiogenesis were found in the fat in 30% of lipedema participants but not controls. Conclusion. Hypertrophic adipocytes, increased numbers of macrophages and blood vessels, and dilation of capillaries in thigh tissue of non-obese women with lipedema suggest inflammation, and angiogenesis occurs independent of obesity and demonstrates a role of altered vasculature in the manifestation of the disease.

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