Spinální epidurální lipomatóza (SEL) je stav, při kterém dochází k patologickému nahromadění tuku v epidurálním prostoru páteřního kanálu. Za možnou příčinu bývá považováno užívání kortikosteroidů, obezita, endokrinologické onemocnění (nejčastěji endogenní nadprodukce kortizolu), u části případů však zůstává příčina neobjasněna. SEL se stává symptomatickou zřídka, a to ve chvíli, kdy způsobí kompresi míchy nebo nervových kořenů. Klinická manifestace závisí na úrovni postižení páteřního kanálu. Pro terapii SEL je určující závažnost komprese nervových struktur a tomu odpovídající tíže klinického syndromu. Při hodnocení šíře epidurálního tuku na zobrazovacích vyšetřeních, při volbě terapeutického postupu a při stanovení prognózy mohou být nápomocné nové klasifikace, které vytvořili Borré (pro bederní páteř) a Quint (pro hrudní páteř). Terapeutické možnosti zahrnují konzervativní terapii (redukce tělesné hmotnosti, redukce dávky kortikoidů, léčba endokrinologického onemocnění, analgetika, rehabilitace) a chirurgickou dekompresi. Samotná SEL je však velmi vzácná. U pacientů se často vyskytuje v koincidenci s jinými, hlavně degenerativními změnami páteře. V naší práci uvádíme tři kazuistiky, na kterých demonstrujeme možnou příčinu, průběh a terapii tohoto onemocnění. U prvního pacienta se lipomatóza manifestovala syndromem kaudy, v druhém případě radikulárním syndromem a u třetího pacienta SEL způsobila kompresi hrudní míchy.

Spinal epidural lipomatosis (SEL) is a condition associated with pathological fat accumulation in the epidural area of the spinal canal. The disorder is likely caused by the use of corticosteroids, obesity, endocrinal disorders (especially endogenous overproduction of cortisol), although, in some cases, no cause is immediately evident. SEL rarely becomes symptomatic unless it leads to compression of the spinal cord or nerve roots. Clinical manifestation depends on the level at which the spinal canal is affected. Severity of compression of nerve structures and the corresponding intensity of clinical syndrome are the most important factors in the choice of SEL therapy. Recent classifications for evaluation of epidural fat layer on radiographic images by Borré (for lumbar spine) and Quint (for thoracic spine) can help in guiding the diagnostic and treatment approaches. Therapeutic options include conservative therapy (reduction of body weight, reduction of any corticoid dosage, treatment of the endocrinal disorder, analgesics, rehabilitation) and surgical decompression. However, SEL itself is rare and is frequently found together with other (e.g. degenerative) spinal changes. We report three cases from our own patient base through which we demonstrate possible causes, course and therapy of this disorder. Lipomatosis manifested as cauda equina syndrome in the first patient, as radicular syndrome in the second, and SEL led to compression of the thoracic spinal cord in the third. Key words: spinal epidural lipomatosis – epidural fat – spinal canal – stenosis The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

• MeSH
• Back Pain etiology   MeSH
• Epidural Space pathology   MeSH
• Adrenal Cortex Hormones adverse effects   MeSH
• Body Mass Index MeSH
• Middle Aged MeSH
• Humans MeSH
• Lipomatosis * diagnosis   etiology   complications   pathology   MeSH
• Low Back Pain diagnosis   etiology   therapy   MeSH
• Magnetic Resonance Imaging MeSH
• Spinal Canal pathology   MeSH
• Severity of Illness Index MeSH
• Body Weight MeSH
• Adipose Tissue MeSH
• Outcome and Process Assessment, Health Care MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

• Keywords
• motorické funkce, vyšetření reflexů, kmenové syndromy, korové syndromy, neuromotorický vývoj, primitivní reflexy, časně pohybové vzory, psychomotorický vývoj,
• MeSH
• Gait MeSH
• Dyskinesias MeSH
• Infant MeSH
• Spinal Cord Compression physiopathology   MeSH
• Humans MeSH
• Brain Stem physiopathology   MeSH
• Basal Ganglia Diseases MeSH
• Cerebellar Diseases diagnosis   MeSH
• Peripheral Nervous System Diseases MeSH
• Muscular Diseases diagnosis   MeSH
• Neuromuscular Junction physiology   MeSH
• Infant, Newborn MeSH
• Spinal Cord Injuries physiopathology   MeSH
• Motor Skills Disorders diagnosis   MeSH
• Neuromuscular Junction Diseases MeSH
• Sensation Disorders diagnosis   classification   MeSH
• Posture * MeSH
• Postural Balance MeSH
• Child, Preschool MeSH
• Psychomotor Disorders diagnosis   physiopathology   MeSH
• Trigger Points MeSH
• Standing Position MeSH
• Muscle Strength MeSH
• Muscle Weakness MeSH
• Muscle Spasticity MeSH
• Muscle Tonus * MeSH
• Child Development * MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH

• MeSH
• Conservative Treatment MeSH
• Minimally Invasive Surgical Procedures MeSH
• Orthopedic Procedures MeSH
• Spine surgery   MeSH
• Aged MeSH
• Aging MeSH
• Check Tag
• Aged MeSH

• Conspectus
• Ortopedie. Chirurgie. Oftalmologie
• NML Fields
• ortopedie
• geriatrie
• NML Publication type
• kolektivní monografie

BACKGROUND AIMS: The effect of granulocyte-colony-stimulating factor (G-CSF) and/or the cytokine fms-like thyrosin kinase 3 (Flt3) ligand on functional outcome and tissue regeneration was studied in a rat model of spinal cord injury (SCI). METHODS: Rats with a balloon-induced compression lesion were injected with G-CSF and/or Flt3 ligand to mobilize bone marrow cells. Behavioral tests (Basso-Beattie-Bresnahan and plantar test), blood counts, morphometric evaluation of the white and gray matter, and histology were performed 5 weeks after SCI. RESULTS: The mobilization of bone marrow cells by G-CSF, Flt3 ligand and their combination improved the motor and sensory performance of rats with SCI, reduced glial scarring, increased axonal sprouting and spared white and gray matter in the lesion. The best results were obtained with a combination of G-CSF and Flt3. G-CSF alone or in combination with Flt3 ligand significantly increased the number of white blood cells, but not red blood cells or hemoglobin content, during and after the time-course of bone marrow stimulation. The combination of factors led to infiltration of the lesion by CD11b(+) cells. CONCLUSIONS: The observed improvement in behavioral and morphologic parameters and tissue regeneration in animals with SCI treated with a combination of both factors could be associated with a prolonged time-course of mobilization of bone marrow cells. The intravenous administration of G-CSF and/or Flt3 ligand represents a safe and effective treatment modality for SCI.

• MeSH
• Cell Growth Processes drug effects   MeSH
• Bone Marrow Cells drug effects   metabolism   pathology   MeSH
• Behavior drug effects   MeSH
• Sensation drug effects   MeSH
• Granulocyte Colony-Stimulating Factor administration & dosage   adverse effects   MeSH
• Rats MeSH
• Cells, Cultured MeSH
• Humans MeSH
• Membrane Proteins administration & dosage   adverse effects   MeSH
• Hematopoietic Stem Cell Mobilization MeSH
• Disease Models, Animal MeSH
• Brain drug effects   metabolism   pathology   MeSH
• Motor Activity drug effects   MeSH
• Spinal Cord Injuries pathology   physiopathology   surgery   therapy   MeSH
• Rats, Wistar MeSH
• Guided Tissue Regeneration MeSH
• Drug Synergism MeSH
• Cell Survival drug effects   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Humans MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• Keywords
• motorické funkce, vyšetření reflexů, kmenové syndromy, korové syndromy, neuromotorický vývoj, primitivní reflexy, časně pohybové vzory, psychomotorický vývoj,
• MeSH
• Gait MeSH
• Dyskinesias MeSH
• Infant MeSH
• Spinal Cord Compression physiopathology   MeSH
• Humans MeSH
• Brain Stem physiopathology   MeSH
• Basal Ganglia Diseases MeSH
• Cerebellar Diseases diagnosis   MeSH
• Peripheral Nervous System Diseases MeSH
• Muscular Diseases diagnosis   MeSH
• Neuromuscular Junction physiology   MeSH
• Infant, Newborn MeSH
• Spinal Cord Injuries physiopathology   MeSH
• Motor Skills Disorders diagnosis   MeSH
• Neuromuscular Junction Diseases MeSH
• Sensation Disorders diagnosis   classification   MeSH
• Posture * MeSH
• Postural Balance MeSH
• Child, Preschool MeSH
• Psychomotor Disorders diagnosis   physiopathology   MeSH
• Trigger Points MeSH
• Standing Position MeSH
• Muscle Strength MeSH
• Muscle Weakness MeSH
• Muscle Spasticity MeSH
• Muscle Tonus * MeSH
• Child Development * MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH

• MeSH
• Research Support as Topic MeSH
• Spinal Cord Compression complications   MeSH
• Spinal Cord blood supply   pathology   MeSH
• Recovery of Function MeSH
• Paraplegia etiology   prevention & control   MeSH
• Movement physiology   MeSH
• Ischemic Preconditioning MeSH
• Body Weight MeSH
• Animals MeSH
• Check Tag
• Male MeSH
• Animals MeSH