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Samal F, Cerny V, Kujal P, Jezek J, Skala-Rosenbaum J, Sepitka J. Distribution of mechanical properties of native human ligamentum flavum depending on histopathological changes. Biomed Phys Eng Express 2024; 10:065025. [PMID: 39255813 DOI: 10.1088/2057-1976/ad78e2] [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: 05/30/2024] [Accepted: 09/10/2024] [Indexed: 09/12/2024]
Abstract
This study aimed to characterize the mechanical properties of native human ligamentum flavum (LF) and correlate them with histopathological changes. Mechanical property gradients across the cranial, medial, and caudal regions of LF were mapped and compared with histological sections. We also compared lumbar spinal stenosis (LSS) samples with disc herniation (DH) samples as reference material to identify differences in mechanical properties and histopathological features. Our results revealed significant heterogeneity in LF mechanical properties, with local variations correlating with specific histopathological changes such as chondroid metaplasia and loss of elastic fibers. These findings underscore the importance of considering LF heterogeneity in mechanical characterization and provide insights into its behavior under pathological conditions.
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Affiliation(s)
- Filip Samal
- Department of Neurosurgery, Third Medical Faculty of Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Vojtech Cerny
- Faculty of Mechanical Engineering, Czech Technical University in Prague, Technicka 4, 16607 Prague, Czech Republic
| | - Petr Kujal
- Department of Pathology, Third Medical Faculty of Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jakub Jezek
- Department of Orthopedics and Traumatology, Third Medical Faculty of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, Praha, 10, 100 34 Prague, Czech Republic
| | - Jiri Skala-Rosenbaum
- Department of Orthopedics and Traumatology, Third Medical Faculty of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, Praha, 10, 100 34 Prague, Czech Republic
| | - Josef Sepitka
- Faculty of Mechanical Engineering, Czech Technical University in Prague, Technicka 4, 16607 Prague, Czech Republic
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Fang N, Wang Z, Jiang J, Yang A, Mao T, Wang Z, Chen Q. Nonsurgical therapy for lumbar spinal stenosis caused by ligamentum flavum hypertrophy: A review. Medicine (Baltimore) 2024; 103:e38782. [PMID: 38968524 PMCID: PMC11224896 DOI: 10.1097/md.0000000000038782] [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: 05/15/2024] [Accepted: 06/11/2024] [Indexed: 07/07/2024] Open
Abstract
Lumbar spinal stenosis (LSS) can cause a range of cauda equina symptoms, including lower back and leg pain, numbness, and intermittent claudication. This disease affects approximately 103 million people worldwide, particularly the elderly, and can seriously compromise their health and well-being. Ligamentum flavum hypertrophy (LFH) is one of the main contributing factors to this disease. Surgical treatment is currently recommended for LSS caused by LFH. For patients who do not meet the criteria for surgery, symptom relief can be achieved by using oral nonsteroidal anti-inflammatory drugs (NSAIDs) and epidural steroid injections. Exercise therapy and needle knife can also help to reduce the effects of mechanical stress. However, the effectiveness of these methods varies, and targeting the delay in LF hypertrophy is challenging. Therefore, further research and development of new drugs is necessary to address this issue. Several new drugs, including cyclopamine and N-acetyl-l-cysteine, are currently undergoing testing and may serve as new treatments for LSS caused by LFH.
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Affiliation(s)
- Nan Fang
- College of Acupuncture & Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
| | - Zhigang Wang
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
- Department of Orthopedics & Traumatology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Jiecheng Jiang
- College of Acupuncture & Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
| | - Aofei Yang
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
- Department of Orthopedics & Traumatology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Tian Mao
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
- Department of Orthopedics & Traumatology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Zitong Wang
- College of Acupuncture & Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
| | - Qian Chen
- College of Acupuncture & Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
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Goto Y, Kato K, Yagi K, Kawaguchi Y, Yonezu H, Koshimae T, Waguri-Nagaya Y, Murakami H, Suzuki N. Transforming Growth Factor-β Induces Interleukin-6 Secretion from Human Ligamentum Flavum-Derived Cells through Partial Activation of p38 and p44/42 Mitogen-Activated Protein Kinases. Asian Spine J 2023; 17:997-1003. [PMID: 37946333 PMCID: PMC10764132 DOI: 10.31616/asj.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/03/2023] [Accepted: 04/23/2023] [Indexed: 11/12/2023] Open
Abstract
STUDY DESIGN This experimental study was performed using human ligamentum flavum-derived cells (HFCs). PURPOSE To investigate the intracellular signaling mechanism of interleukin-6 (IL-6) secretion in transforming growth factor-β (TGF- β)-stimulated HFCs. OVERVIEW OF LITERATURE Lumbar spinal stenosis (LSS) is a prevalent disease among the elderly, characterized by debilitating pain in the lower extremities. Although the number of patients with LSS has increased in recent years, the underlying pathomechanism remains unclear. Clinical examinations typically rely on magnetic resonance imaging to diagnose patients, revealing ligamentum flavum hypertrophy. Some studies have suggested an association between ligamentum flavum hypertrophy and inflammation/fibrosis, and expression of TGF-β and IL-6 has been observed in surgically obtained ligamentum flavum samples. However, direct evidence linking TGF-β and IL-6 expression in HFCs is lacking. METHODS HFCs were obtained from patients with LSS who had undergone decompression surgery. The cells were stimulated with TGF-β and pretreated with either the p38 mitogen-activated protein (MAP) kinase inhibitor SB203580 or the p44/42 MAP kinase inhibitor FR180204. IL-6 secretion in the cell culture medium and IL-6 messenger RNA (mRNA) expression levels were analyzed using an enzyme-linked immunoassay and real-time polymerase chain reaction, respectively. RESULTS TGF-β administration resulted in a dose- and time-dependent stimulation of IL-6 release. Treatment with SB203580 and FR180204 markedly suppressed TGF-β-induced IL-6 secretion from HFCs. Moreover, these inhibitors suppressed IL-6 mRNA expression in response to TGF-β stimulation. CONCLUSIONS Our findings indicate that TGF-β induces IL-6 protein secretion and gene expression in HFCs through the activation of p38 or p44/42 MAP kinases. These results suggest a potential association between IL-6-mediated inflammatory response and tissue hypertrophy in LSS, and we provide insights into molecular targets for therapeutic interventions targeting LSS-related inflammation through our analysis of the MAP kinase pathway using HFCs.
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Affiliation(s)
- Yuta Goto
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya,
Japan
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya,
Japan
| | - Kiyoshi Yagi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya,
Japan
| | - Yohei Kawaguchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya,
Japan
| | - Hiroki Yonezu
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya,
Japan
| | - Tomoko Koshimae
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya,
Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya,
Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya,
Japan
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya,
Japan
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Aleksić V, Todorović J, Miladinović N, Aleksić N, Bogosavljević V, Đurović M, Kocić S, Aleksić R, Joković M. Ligamentum flavum analysis in patients with lumbar discus hernia and lumbar spinal stenosis. Sci Rep 2023; 13:3804. [PMID: 36882487 PMCID: PMC9992359 DOI: 10.1038/s41598-023-30928-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
The normal ligamentum flavum (LF) is a well-defined elastic structure with specific innervation. Several studies investigated LF in patients with lumbar spinal stenosis (LSS) and used lumbar discus hernia (LDH) patients as control group, only on the presumed thesis that LF in this patients have normal morphology. In patients with LSS thickening of the LF is the main cause of stenosis, which is most often presented with neurogenic claudication, whose pathophysiological mechanism is not completely understood. We conducted observational cohort study of 60 operated patients divided into two groups. The first group of 30 patients underwent micro-discectomy (LSH group), and second group with 30 patients underwent decompression, after which analysis of harvested LF was performed. Patients from the LDH group and LSS group differed significantly in the frequencies of chief complaints, duration of symptoms, physical examination, and specific morphological/radiological parameters. The LF analysis showed that the groups differed significantly in the amount of collagen and elastic fibers, as well as in the histological appearance/architectonics of elastic fibers. Also, groups differ in the presence of LF nerve fibers. Our findings speak in favor of the recently postulated inflammatory theory in the origin of spinal neurogenic claudication's.
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Affiliation(s)
- Vuk Aleksić
- Department of Neurosurgery, Clinical Hospital Center Zemun, Belgrade, Serbia.
| | - Jovana Todorović
- Institute for Social Medicine, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nenad Miladinović
- Department of Pathology, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Nemanja Aleksić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Vojislav Bogosavljević
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurosurgery Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Đurović
- Neurosurgery Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Svetlana Kocić
- Department of Radiology, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Radmila Aleksić
- Department of Neurosurgery, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Miloš Joković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurosurgery Clinic, Clinical Center of Serbia, Belgrade, Serbia
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Jain M, Sable M, Tirpude AP, Sahu RN, Samanta SK, Das G. Histological difference in ligament flavum between degenerative lumbar canal stenosis and non-stenotic group: A prospective, comparative study. World J Orthop 2022; 13:791-801. [PMID: 36189332 PMCID: PMC9516625 DOI: 10.5312/wjo.v13.i9.791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/02/2022] [Accepted: 08/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ligament flavum (LF) hypertropy is the main etiopathogenesis of lumbar canal stenosis (LCS). The purely elastic LF undergoes a morphological adaptation including a reduction in the elastic fibers and a consequent increase in the collagen content, fibrosis, cicatrization, and calcification. However, the morphometric analysis can delineate the LF in patients with LCS from those without LCS, which would help in better understanding LCS pathogenesis.
AIM To compare the histopathological changes in LF between the degenerative LCS and non-stenotic (non-LCS) group.
METHODS The present prospective study was conducted in 82 patients who were divided into two groups, namely LCS and non-LCS. Demographic details of the patients such as duration of symptoms, level of involvement, and number of segments were recorded. The LF obtained from both groups was histopathologically examined for the fibrosis score, elastic fiber degeneration, calcification, and chondroid metaplasia. Morphometrical details included a change in elastin and collagen percentages, elastin/collagen ratio, elastic fiber fragmentation, and ligamentocyte numbers. All parameters were compared between the two groups by using the independent t test, Chi-square test, and Pearson’s correlation test.
RESULTS Out of 82 cases, 74 were analysed, 34 in LCS and 40 in non-LCS group. The mean ± SD age of presentation in LCS and non- LCS group was 49.2 ± 8.9 and 43.1 ± 14.3 respectively. The LCS group (n = 34) exhibited significant differences in fibrosis (P = 0.002), elastic fiber degeneration (P = 0.01), % elastic fragmentation (66.5 ± 16.3 vs 29.5 ± 16.9), % elastic, content (26.9 ± 6.7 vs 34.7 ± 8.4), % collagen content (63.6 ± 10.4 vs 54.9 ± 6.4), reduction of elastic/collagen (0.4 ± 0.1 vs 0.6 ± 0.1), and ligamentocyte number (39.1 ± 19.1 vs 53.5 ± 26.9) as compared to non-LCS group (n = 40). The calcification (P = 0.08) and Pearson’s correlation between duration and loss of elastin was not significant. The difference in LF morphology is consistent in patient’s ≥ 40 years of age among the groups as found in subgroup analysis. Similarly in the patents < 40 and > 40 in the non-LCS group.
CONCLUSION LF is vital in the pathogenesis of LCS. The purely elastic LF undergoes a morphological adaptation that includes a reduction in the elastic fibers with a consequent increase in the collagen content, fibrosis, cicatrization, and calcification. The present study provides a detailed morphometric analysis to semiquantitatively delineate the LF changes in patients with LCS from those in patients without LCS.
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Affiliation(s)
- Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhuabneswar 751019, Odisha, India
| | - Mukund Sable
- Department of Pathology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar 751019, Odisha, India
| | - Amit Purushottam Tirpude
- Department of Anatomy, All India Institute of Medical Sciences Raipur, Raipur 492009, Chattisgarh, India
| | - Rabi Narayan Sahu
- Department of Neurosurgery, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar 751019, Odisha, India
| | - Sudeep Kumar Samanta
- Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhuabneswar 751019, Odisha, India
| | - Gurudip Das
- Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhuabneswar 751019, Odisha, India
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Yang JH, Kim HJ, Chang DG, Suh SW, Nam Y, Song HS. Relationship between degree of separation of endplate cartilage and severity of intervertebral disc herniation. Clin Anat 2021; 35:204-210. [PMID: 34851545 DOI: 10.1002/ca.23816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 01/15/2023]
Abstract
Degeneration of intervertebral disc and fissures in the anulus was caused by compression and distraction, which lead to nucleus pulposus herniation. However, controversy remains regarding the exact mechanism behind disc herniation. The aim of this study is to analyze histologically the differences between the three types of disc herniations in an attempt to infer the underlying mechanism. Disc samples extracted from 49 patients who underwent discectomy of the lumbar region were studied by histological analysis. The severity of disc herniation was classified as bulging, protrusion, extrusion, or sequestration based on preoperative magnetic resonance imaging measurements. For comparative analysis of sequestration characteristics, 49 patients were classified into either the sequestration or the non-sequestration group (i.e., protrusion and extrusion) according to disc herniation type. Forty of the 49 patients had cartilage present in their disc samples upon histological analysis. The endplate cartilage-containing samples included two of four (50%) protruded disc patients, 22 of 29 (75.9%) extruded disc patients, and 16 of 16 (100%) sequestrated disc patients and had statistical significance (p = 0.019). There were no significant differences in age, sex, body mass index, length of hospital stays, injection history, surgical methods, and Visual Analog Scale between the sequestration and non-sequestration group (all p > 0.05). Separation of endplate cartilage increased with the severity of disc herniation. Therefore, the mechanism of disc herniation should consider the connection with endplate cartilage as an initiating link in the mechanical failure of intervertebral discs.
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Affiliation(s)
- Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Hong Jin Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, South Korea
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, South Korea
| | - Seung Woo Suh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Yunjin Nam
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Hyun-Sub Song
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
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Yagi K, Goto Y, Kato K, Suzuki N, Kondo A, Waseda Y, Mizutani J, Kawaguchi Y, Joyo Y, Waguri-Nagaya Y, Murakami H. p38 Mitogen-Activated Protein Kinase Is Involved in Interleukin-6 Secretion from Human Ligamentum Flavum-Derived Cells Stimulated by Tumor Necrosis Factor-α. Asian Spine J 2020; 15:713-720. [PMID: 33355843 PMCID: PMC8696066 DOI: 10.31616/asj.2020.0425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022] Open
Abstract
Study Design Human ligamentum flavum–derived cells (HFCs) were obtained from surgical samples for a basic experimental study. Purpose We sought to evaluate the inflammatory response of human ligamentum flavum cells to investigate hypertrophic changes occurring in the ligamentum flavum. Overview of Literature Lumbar spinal stenosis (LSS) is a disease commonly observed in the elderly. The number of patients with LSS has increased over time, yet the pathomechanisms of LSS still have not been fully elucidated. One of the clinical features of LSS is hypertrophy of the ligamentum flavum, which results in narrowing of the lumbar spinal canal. Some reports have suggested that ligamentum flavum hypertrophy is associated with inflammation and fibrosis; meanwhile, the p38 mitogen-activated protein (MAP) kinase is involved in the hypertrophy of human ligamentum flavum cells. Methods HFCs were obtained from patients with LSS who underwent surgery. HFCs were stimulated by tumor necrosis factor-α (TNF-α) and a p38 MAP kinase inhibitor, SB203580. Phosphorylation of the p38 MAP kinase was analyzed by western blotting. The concentration of interleukin-6 (IL-6) in the conditioned medium was measured by enzyme-linked immunoassay and IL-6 messenger RNA expression levels were determined by real-time polymerase chain reaction. Results TNF-α induced the phosphorylation of p38 MAP kinase in a time-dependent manner, which was suppressed by the p38 MAP kinase inhibitor, SB203580. TNF-α also stimulated IL-6 release in both a time- and dose-dependent manner. On its own, SB203580 did not stimulate IL-6 secretion from HFCs; however, it dramatically suppressed the degree of IL-6 release stimulated by TNF-α from HFCs. Conclusions This is the first report suggesting that TNF-α stimulates the gene expression and protein secretion of IL-6 via p38 MAP kinase in HFCs. A noted association between tissue hypertrophy and inflammation suggests that the p38 MAP kinase inflammatory pathway may be a therapeutic molecular target for LSS.
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Affiliation(s)
- Kiyoshi Yagi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Goto
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akira Kondo
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuya Waseda
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Jun Mizutani
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuji Joyo
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopaedic Surgery, Nagoya City East Medical Center, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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