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Zhao Y, Xiang Q, Jiang S, Lin J, Li W. Revealing the novel metabolism-related genes in the ossification of the ligamentum flavum based on whole transcriptomic data. JOR Spine 2024; 7:e1357. [PMID: 39011365 PMCID: PMC11247397 DOI: 10.1002/jsp2.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/10/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
Backgrounds The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Previous studies indicated there might be a potential link between metabolic disorder and pathogenesis of OLF. The aim of this study was to determine the potential role of metabolic disorder in the pathogenesis of OLF using the strict bioinformatic workflow for metabolism-related genes and experimental validation. Methods A series of bioinformatic approaches based on metabolism-related genes were conducted to compare the metabolism score between OLF tissues and normal ligamentum flavum (LF) tissues using the single sample gene set enrichment analysis. The OLF-related and metabolism-related differentially expressed genes (OMDEGs) were screened out, and the biological functions of OMDEGs were explored, including the Gene Ontology enrichment analysis, Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and protein-protein interaction. The competing endogenous RNA (ceRNA) network based on pairs of miRNA-hub OMDEGs was constructed. The correlation analysis was conducted to explore the potential relationship between metabolic disorder and immunity abnormality in OLF. In the end, the cell experiments were performed to validate the roles of GBE1 and TNF-α in the osteogenic differentiation of LF cells. Results There was a significant difference of metabolism score between OLF tissues and normal LF tissues. Forty-nine OMDEGs were screened out and their biological functions were determined. The ceRNA network containing three hub OMDEGs and five differentially expressed miRNAs (DEmiRNAs) was built. The correlation analysis between hub OMDEGs and OLF-related infiltrating immune cells indicated that metabolic disorder might contribute to the OLF via altering the local immune status of LF tissues. The cell experiments determined the important roles of GBE1 expression and TNF-α in the osteogenic differentiation of LF cells. Conclusions This research, for the first time, preliminarily illustrated the vital role of metabolic disorder in the pathogenesis of OLF using strict bioinformatic algorithms and experimental validation for metabolism-related genes, which could provide new insights for investigating disease mechanism and screening effective therapeutic targets of OLF in the future.
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Affiliation(s)
- Yongzhao Zhao
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Qian Xiang
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Shuai Jiang
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Jialiang Lin
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
| | - Weishi Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineMinistry of EducationBeijingChina
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Ye J, Guo W, Hu Y, Fan X. Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2024; 49:197-207. [PMID: 37937419 PMCID: PMC10766097 DOI: 10.1097/brs.0000000000004866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/28/2023] [Indexed: 11/09/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE This study systematically reviewed and evaluated the safety and efficacy of spinal endoscopic techniques as a treatment for thoracic ligamentum flavum ossification (TOLF). SUMMARY OF BACKGROUND DATA The use of spinal endoscopic techniques for the treatment of TOLF has increased in recent years. The present study is the first comprehensive systematic review and meta-analysis focused on the use of spinal endoscopic techniques for TOLF. MATERIALS AND METHODS The Cochrane Central, PubMed, Web of Science, and Embase databases were systematically searched for studies focused on patients undergoing spinal endoscopic techniques to treat symptomatic TOLF. RESULTS This meta-analysis included 23 studies. We included 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years, with 304 total recorded lesion locations of which 245 were located in the lower thoracic spine. Complications affected 35/323 patients, and the mean operative duration for 305 patients was 108.15±47.34 minutes. For 187 patients, the mean operative bleeding was 25.13±12.54 mL, while for 87 patients the mean duration of hospitalization was 4.59±1.93 days. At last follow-up, functional assessment was performed for 260 patients, of whom 200 were in excellent condition, visual analog scale (VAS) scores were assessed for 160 patients, with a mean improvement of 4.40 (3.95, 4.86) Japanese Orthopedic Association (JOA) scores were recorded for 115 patients, with a mean improvement of 3.49 (2.79,4.18), and modified Japanese Orthopedic Association (mJOA) scores were recorded for 208 patients, with a mean improvement of 3.62 (2.89,4.35). CONCLUSIONS These results support several advantages of spinal endoscopic techniques for the treatment of symptomatic TOLF. These include low complication rates, rapid postoperative recovery, and good functional recovery when used for single-segment, non-nodular ossification and no combined dural ossification.
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Affiliation(s)
- Jingyao Ye
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical School of Medicine,Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenlong Guo
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical School of Medicine,Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Youpeng Hu
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical School of Medicine,Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohong Fan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Bai Y, Gong G, Aierken R, Liu X, Cheng W, Guan J, Jiang Z. A retrospective study investigating the clinical significance of body mass index in acute pancreatitis. PeerJ 2024; 12:e16854. [PMID: 38304193 PMCID: PMC10832621 DOI: 10.7717/peerj.16854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Background Acute pancreatitis is an unpredictable and potentially fatal condition for which no definitive cure is currently available. Our research focused on exploring the connection between body mass index, a frequently overlooked risk factor, and both the onset and progression of acute pancreatitis. Material/Methods A total of 247 patients with acute pancreatitis admitted to Jiangsu Provincial Hospital of Chinese Medicine from January 2021 to February 2023 were retrospectively reviewed. After screening, 117 patients with complete height and body weight data were selected for detailed assessment. Additionally, 85 individuals who underwent physical examinations at our hospital during this period were compiled to create a control group. The study received ethical approval from the ethics committee of Jiangsu Province Hospital of Chinese Medicine (Ref: No.2022NL-114-02) and was conducted in accordance with the China Good Clinical Practice in Research guidelines. Results A significant difference in body mass index (BMI) was observed between the healthy group and acute pancreatitis (AP) patients (p < 0.05), with a more pronounced disparity noted in cases of hyperlipidemic acute pancreatitis (p < 0.01). A potential risk for AP was identified at a BMI greater than 23.56 kg/m2 (AUC = 0.6086, p < 0.05). Being in the obese stage I (95%CI, [1.11-1.84]) or having a BMI below 25.4 kg/m2 (95%CI, [1.82-6.48]) are identified as risk factors for adverse AP progression. Moreover, BMI effectively predicts the onset of acute edematous pancreatitis and acute necrotizing pancreatitis (AUC = 0.7893, p < 0.001, cut-off value = 25.88 kg/m2). A higher BMI correlates with increased recurrence rates within a short timeframe (r = 0.7532, p < 0.01). Conclusions Elevated BMI is a risk factor for both the occurrence and progression of AP, and underweight status may similarly contribute to poor disease outcomes. BMI is crucial for risk prediction and stratification in AP and warrants ongoing monitoring and consideration.
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Affiliation(s)
- Yuanzhen Bai
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guanwen Gong
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Reziya Aierken
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xingyu Liu
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Cheng
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Junjie Guan
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiwei Jiang
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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Li J, Deng Z, Wang L, Wang L, Yang H, Yang X, Song Y. The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ-5D-5L. Orthop Surg 2024; 16:57-71. [PMID: 38010864 PMCID: PMC10782254 DOI: 10.1111/os.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE There is a lack of studies on the quality of life (QoL) after posterior laminectomy in patients with thoracic ossification of the ligamentum flavum (TOLF), and risk factors associated with poor prognosis remain controversial. Therefore, the present study was conducted to illustrate the QoL for TOLF patients after surgery and determine its relationship with their demographic, surgery-related, clinical characteristics and imaging data. METHODS One hundred and eighteen patients diagnosed with thoracic myelopathy because of TOLF were enrolled in this retrospective study. They all underwent posterior decompressive laminectomy from August 2010 to January 2022. The QoL was evaluated based on the EQ-5D-5L. Collecting gender, age, number of operations, compressed segments, Frankel grade, complications, body mass index (BMI), symptoms and duration, modified Japanese Orthopaedic Association (mJOA) score (preoperative), follow-up time and type of ossification, increased signal on Sagittal T2-weighted Images (ISST2I), occupancy rate and analyzing by Mann-Whitney U-test, Kruskal-Wallis test, the χ2 -test, and logistic regression tests. RESULTS Average follow-up 70.8 months (18-149), the mean age was 59.74 ± 9.81 years and the mean score for the QoL based on the EQ-5D-5 L and visual analogue scale (VAS) score were 0.71 ± 0.28 and 78.88 ± 10.21 at the final follow-up. Moderate and severe problems were found in the pain/discomfort in 22.0% of the patients. These mobility and usual activities numbers were slightly higher (24.6% and 30.4%, respectively). The mean scores for QoL and VAS were significantly higher in patients with mild and moderate neurological impairment, normal BMI, <60 years of age, no dural tears, symptom relief at hospital discharge, unilateral and bilateral ossification on axial CT scan, ≤ 50% spinal canal occupancy on CT and MRI, and none or fuzzy on ISST2I. CONCLUSION QoL after posterior laminectomy in TOLF patients is generally satisfactory compared to preoperative levels. Preoperative mJOA score, Age, comorbid diabetes, the major symptom is activity limitation, BMI, ISST2I, Intraoperative dural tears and spinal canal occupancy rate correlate significantly with the corresponding dimensions and are predictive. Age, spinal canal occupancy rate, ISST2I, preoperative mJOA score, BMI are significantly associated with and have predictive value for overall postoperative QoL.
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Affiliation(s)
- Junhu Li
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Zhipeng Deng
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Linnan Wang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Lei Wang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Hailing Yang
- Program in Cellular and Molecular Physiology, Graduate School of Biomedical Sciences, Tufts UniversityBostonMassachusettsUSA
| | - Xi Yang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Yuemin Song
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
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Liu Y, Li X, Hou Y, Leng X, Yan M, Chen X, Huang H, Xu Y. Surgical outcomes of percutaneous endoscopic thoracic decompression in the treatment of multi-segment thoracic ossification of the ligamentum flavum. Acta Neurochir (Wien) 2023; 165:2131-2137. [PMID: 37166509 DOI: 10.1007/s00701-023-05603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Previous studies have demonstrated satisfactory outcomes of percutaneous endoscopic thoracic decompression (PETD) for single-segment thoracic ossification of the ligamentum flavum (TOLF). However, the clinical outcomes of PETD in patients with multi-segment TOLF (mTOLF) remain unclear. The aim of the present study was to evaluate the efficacy and safety of PETD for patients with multi-segment mTOLF. METHODS Eighteen consecutive patients (41 segments) with mTOLF were treated with PETD between January 2020 and December 2021. The clinical outcomes were evaluated using the modified Japanese Orthopaedic Association (mJOA) score and Visual Analog Scale (VAS), whereas radiographic parameters were measured by cross-section area of the spinal canal and anteroposterior diameter of the spinal cord. RESULTS The follow-up period ranged from 14 to 34 months. The mean operation time and blood loss were 154.06 ± 32.14 min and 61.72 ± 12.72 ml, respectively. Hospital stay after first-stage operation was 10.89 ± 2.42 days. The mJOA score and VAS score significantly improved at the final follow-up, with a mean mJOA recovery rate of 63.3 ± 21.90%. The incidence of complications was 12.2% per level. The radiographic outcomes showed adequate decompression of the spinal cord. CONCLUSIONS The present study demonstrates that PETD is effective and safe as a minimally invasive procedure to treat patients with mTOLF. All patients showed relief of their symptoms and improvement in neurological function.
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Affiliation(s)
- Yunxuan Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xingchen Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
- Changchun University of Chinese Medicine, Changchun, 130117, China.
| | - Yingying Hou
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiangyang Leng
- Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Ming Yan
- The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Changchun, 130118, China
| | - Xiaoxin Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Honghan Huang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yusheng Xu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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Erdani D, Topolovec M, Hero N, Brumat P. Ossification of ligamentum flavum related to progressive thoracic myelopathy and acute paraplegia in a Central-European male with a thoracic kyphoscoliosis. J Surg Case Rep 2023; 2023:rjad070. [PMID: 36846836 PMCID: PMC9950717 DOI: 10.1093/jscr/rjad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
The ossification of the ligamentum flavum (OLF) presents a significant risk factor in the development of spinal cord compression in the (lower) thoracic spine, particularly in eastern Asian elderly males. The definite causes for OLF have not yet been fully uncovered, whereby age, genetics, metabolic disorders and mechanical stress are deemed among the most plausible pathophysiological factors in OLF. Spinal deformities (mostly kyphotic) are associated with an excess in tensile forces, which may lead to hypertrophy and OLF. This unique case of OLF-related acute paraplegia and progressive thoracic myelopathy in a Central-European male patient may indicate the role of a (kyphoscoliotic) spinal deformity in the initiation and progression of the OLF-related (thoracic) myelopathy. Promptly initiated surgical decompression and (partial) deformity correction may, along with proper subsequent intradisciplinary rehabilitation process, greatly improve the clinical outcome post-treatment, especially in terms of quality of life and residual pain.
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Affiliation(s)
- Danijel Erdani
- Department of Spine Surgery, Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Matevž Topolovec
- Department of Spine Surgery, Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia,Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia
| | - Nikša Hero
- Department of Spine Surgery, Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia
| | - Peter Brumat
- Correspondence address. Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia. Tel: +386 5 6696 485; Fax: +386 5 6527 185; E-mail: ;
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