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Mualem W, Liu J, Balu A, Chesney K, Nair MN. Biomarkers related to hypertrophy of the ligamentum flavum: a systematic review of the literature. J Neurosurg Spine 2024:1-13. [PMID: 38608299 DOI: 10.3171/2024.2.spine23991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/02/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Spinal stenosis is one of the most common spinal disorders in the elderly. Hypertrophy of the ligamentum flavum (HLF) can contribute to spinal stenosis. The current literature suggests that various biomarkers may play important roles in the pathogenesis of HLF. However, the connection between these biomarkers and the development of HLF is still not well understood. This systematic review aims to explore the current literature on biomarkers related to the development of HLF. METHODS A literature search was conducted using PubMed, Embase, Web of Science, and Cochrane Library. The search strategy looked for the titles, abstracts, and keywords of studies that contained a combination of the following phrases: "ligamentum flavum OR yellow ligament," "biomarkers," and "hypertrophy." Recorded data included study design, demographic characteristics (number of patients of each gender and mean age), study period, country where the study was conducted, biomarkers, and diagnostic modalities used. Risk of bias was assessed using the Newcastle-Ottawa Scale for case-control studies. RESULTS The authors identified 39 studies. After screening, 26 full-text original articles assessing one or more biomarkers related to HLF were included. The included studies were conducted over a 22-year period. The most popular biomarkers studied, in order of frequency reported, were collagen types I and III (n = 10), transforming growth factor β (TGF-β) (n = 8), and interleukin (IL)-6 (n = 6). The authors found that mechanical stretching forces, tissue inhibitor of metalloproteinases 2 (TIMP-2) induction, and TGF-β were associated with increased amounts of collagen I and III. IL-6 expression was increased by microRNA-21, as well as by leptin, through the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway. CONCLUSIONS Biomarkers such as TGF-β, IL-6, and collagen I and III have been consistently correlated with the development of HLF. However, the pathogenesis of HLF remains unclear due to the heterogeneity of the studies, patient populations, and research at the molecular level. Further studies are necessary to better characterize the pathogenesis of HLF and provide a more comprehensive understanding of how these biomarkers may aid in the diagnosis and treatment of HLF.
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Affiliation(s)
- William Mualem
- 1Department of General Surgery, Temple University, Philadelphia, Pennsylvania
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jiaqi Liu
- 2Georgetown University School of Medicine, Washington, DC; and
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Alan Balu
- 2Georgetown University School of Medicine, Washington, DC; and
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Kelsi Chesney
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - M Nathan Nair
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
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2
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Marchi F, Kessler C, Distefano D, Terzi di Bergamo L, Fumagalli L, Averaimo M, Crupi E, Bergamini F, Melli G, Stussi G, Rossi D, Gobbi C, Ripellino P, Pravatà E, Kuhlen DE, Röcken C, Scarone P, Gerber B, Condoluci A. Prevalence of amyloid in ligamentum flavum of patients with lumbar spinal stenosis. Amyloid 2023; 30:416-423. [PMID: 37431662 DOI: 10.1080/13506129.2023.2230516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Transthyretin (ATTR) amyloidosis is often diagnosed in an advanced stage, when irreversible cardiac damage has occurred. Lumbar spinal stenosis (LSS) may precede cardiac ATTR amyloidosis by many years, offering the opportunity to detect ATTR already at the time of LSS surgery. We prospectively assessed the prevalence of ATTR in the ligamentum flavum by tissue biopsy in patients aged >50 years undergoing surgery for LSS. METHODS Ligamentum flavum thickness was assessed pre-operatively on axial T2 magnetic resonance imaging (MRI) slices. Tissue samples from ligamentum flavum were screened centrally by Congo red staining and immunohistochemistry (IHC). RESULTS Amyloid in the ligamentum flavum was detected in 74/94 patients (78.7%). IHC revealed ATTR in 61 (64.9%), whereas amyloid subtyping was inconclusive in 13 (13.8%). Mean thickness of ligamentum flavum was significantly higher at all levels in patients with amyloid (p < .05). Patients with amyloid deposits were older (73.1 ± 9.2 vs. 64.6 ± 10.1 years, p = .01). No differences in sex, comorbidities, previous surgery for carpal tunnel syndrome or LSS were observed. CONCLUSIONS Amyloid, mostly of the ATTR subtype, was found in four out of five patients with LSS and is associated with age and ligamentum flavum thickness. Histopathological work-up of ligamentum flavum might inform future decision making.
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Affiliation(s)
- Francesco Marchi
- Neurosurgical Service, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Chiara Kessler
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Luca Fumagalli
- Neurosurgical Service, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Manuela Averaimo
- Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Emanuele Crupi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Fabio Bergamini
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giorgia Melli
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Georg Stussi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Davide Rossi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Claudio Gobbi
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Paolo Ripellino
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Emanuele Pravatà
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Dominique E Kuhlen
- Neurosurgical Service, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Pietro Scarone
- Neurosurgical Service, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Adalgisa Condoluci
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
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Yuan H, Yi X. Lumbar Spinal Stenosis and Minimally Invasive Lumbar Decompression: A Narrative Review. J Pain Res 2023; 16:3707-3724. [PMID: 37954472 PMCID: PMC10637222 DOI: 10.2147/jpr.s428112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 11/14/2023] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a common pain condition that causes lumbar back pain, radiating leg pain, and possible functional impairment. MILD is an emerging minimally invasive treatment for LSS. It is an image-guided percutaneous procedure designed to debulk hypertrophied ligamentum flavum. However, the exact short- and long-term efficacy, safety profile, indication criteria, and certain procedure details reported in medical literature vary. Objective This narrative review was to elucidate efficacy, safety profile, certain procedure details, advantages, and limitations of MILD. Study Design This is a narrative review. Setting All included articles are clinic trials including analytic studies and descriptive studies. Methods PubMed, Cochrane Library, and Scopus were searched. Only clinical trials of MILD procedure were included. Information of indications, contraindications, VAS scores, ODI scores, effective rate, efficacy durations, and certain procedure details was focused on. Results According to the literature, for the MILD procedure, the VAS score could be reduced from a pre-treatment level of 6.3-9.6 to a post-treatment level of 2.3-5.8. The ODI score could be reduced from a pre-treatment level of 38.8-55.3 to a post-treatment level of 27.4-39.8. The effective rate of the MILD procedure was reported to be 57.1%-88%. A 2-year postoperative stability of efficacy was also supported. One RCT study testified superior efficacy of MILD over epidural steroid injection. Limitations There is few high-quality literature in the review. Moreover, the long-term efficacy of MILD cannot be revealed according to the current literature. Conclusion Based on the reviewed literature, MILD is an effective and safe procedure. MILD can reduce pain intensity and improve functional status significantly. Therefore, it is a preferable option for LSS patients who failed conservative treatments, but not for those who require immediate invasive decompression surgery.
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Affiliation(s)
- Hongjie Yuan
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaobin Yi
- Pain Division, Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
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Awadalla AM, Aljulayfi AS, Alrowaili AR, Souror H, Alowid F, Mahdi AMM, Hussain R, Alzahrani MM, Alsamarh AN, Alkhaldi EA, Alanazi RC. Management of Lumbar Disc Herniation: A Systematic Review. Cureus 2023; 15:e47908. [PMID: 38034203 PMCID: PMC10683841 DOI: 10.7759/cureus.47908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain. This activity reviews the evaluation and management of lumbar disc herniation and discusses the role of the healthcare team in evaluating and improving care for patients with this condition. Data sources were PubMed/Medline and Embase. Our review investigated English-language articles (from 2010 to 2023) according to the PRISMA guidelines. Overall, there were seven articles. Surveys and analyses of national databases were the most widely used methods (n=7). The search identified 777 studies; 7 were eligible for inclusion in the analysis. Further understanding of spinal disc herniation and treatment protocols may help improve evaluation and management in the future. Our research covered a range of management options. Disc herniation is a frequent problem for internists, emergency department doctors, nurse practitioners, and primary care physicians. To manage efficiently, an interprofessional team is needed. The first course of treatment is conservative, with paracetamol and anti-inflammatories being frequently used to relieve pain. A chemist must supervise the use of opioid analgesics in certain situations. Although surgery is sometimes the final option, patients frequently have neurological damage and lingering discomfort. In circumstances where physical treatment is not working, MRI interpretation becomes necessary. Primary care physicians or mental health professionals should handle back pain as it is frequently linked to mental health issues. Results can be enhanced by regular exercise and preserving a healthy body weight.
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Affiliation(s)
- Akram M Awadalla
- Neurological Surgery, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Alaa S Aljulayfi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Hatem Souror
- Medicine and Surgery, University of Jeddah, Jeddah, SAU
| | - Fay Alowid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Remaz Hussain
- Plastic and Reconstructive Surgery, Taibah University, Medina, SAU
| | | | | | | | - Reem C Alanazi
- Family Medicine, Primary Health Care Corporation, Riyadh, SAU
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5
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Burt KG, Viola DC, Lisiewski LE, Lombardi JM, Amorosa LF, Chahine NO. An in vivo model of ligamentum flavum hypertrophy from early-stage inflammation to fibrosis. JOR Spine 2023; 6:e1260. [PMID: 37780823 PMCID: PMC10540830 DOI: 10.1002/jsp2.1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/10/2023] [Accepted: 04/25/2023] [Indexed: 10/03/2023] Open
Abstract
Multi-joint disease pathologies in the lumbar spine, including ligamentum flavum (LF) hypertrophy and intervertebral disc (IVD) bulging or herniation contribute to lumbar spinal stenosis (LSS), a highly prevalent condition characterized by symptomatic narrowing of the spinal canal. Clinical hypertrophic LF is characterized by a loss of elastic fibers and increase in collagen fibers, resulting in fibrotic thickening and scar formation. In this study, we created an injury model to test the hypothesis that LF needle scrape injury in the rat will result in hypertrophy of the LF characterized by altered tissue geometry, matrix organization, composition and inflammation. An initial pilot study was conducted to evaluate effect of needle size. Results indicate that LF needle scrape injury using a 22G needle produced upregulation of the pro-inflammatory cytokine Il6 at 1 week post injury, and increased expression of Ctgf and Tgfb1 at 8 weeks post injury, along with persistent presence of infiltrating macrophages at 1, 3, and 8 weeks post injury. LF integrity was also altered, evidenced by increases in LF tissue thickness and loss of elastic tissue by 8 weeks post injury. Persistent LF injury also produced multi-joint effects in the lumbar IVD, including disc height loss at the injury and adjacent to injury level, with degenerative IVD changes observed in the adjacent level. These results demonstrate that LF scrape injury in the rat produces structural and molecular features of LF hypertrophy and IVD height and histological changes, dependent on level. This model may be useful for testing of therapeutic interventions for treatment of LSS and IVD degeneration associated with LF hypertrophy.
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Affiliation(s)
- Kevin G. Burt
- Department of Orthopedic SurgeryColumbia UniversityNew YorkNew YorkUSA
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Dan C. Viola
- Department of Orthopedic SurgeryColumbia UniversityNew YorkNew YorkUSA
| | - Lauren E. Lisiewski
- Department of Orthopedic SurgeryColumbia UniversityNew YorkNew YorkUSA
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | | | | | - Nadeen O. Chahine
- Department of Orthopedic SurgeryColumbia UniversityNew YorkNew YorkUSA
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
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Kato K, Yabuki S, Otani K, Nikaido T, Otoshi K, Watanabe K, Kobayashi H, Konno SI. A muscle-preserving, spinous process-splitting approach for ossification of the ligamentum flavum in the thoracic spine in professional athletes: a report of three cases. Fukushima J Med Sci 2023; 69:143-150. [PMID: 37045778 PMCID: PMC10480514 DOI: 10.5387/fms.2022-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
A muscle-preserving, spinous process-splitting approach may be a less invasive approach to conventional laminectomy in patients with thoracic ossification of the ligamentum flavum. Few reports have discussed the usefulness of this procedure for thoracic lesions in professional athletes who need highly active thoracic spinal function after surgery. The treatment of thoracic ossification of the ligamentum flavum using a spinous process-splitting approach in 3 professional athletes is presented. In all three cases the patients could return to play within 3 months after surgery without complications, and in two of the cases, there was no spinal deformity or local recurrence of ossification of the ligamentum flavum at the final follow-up at least 8 years after surgery. The spinous process-splitting approach could be a safe procedure for multi-level and all other forms of ossification of the ligamentum flavum and is less invasive to the paraspinal muscles, relieves back symptoms, and restores function for athletes.
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Affiliation(s)
- Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shoji Yabuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Kenichi Otoshi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shin-ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
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7
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Yang L, Zhou L, Wang G, Qiu M, Liang F, Jia C, Xu W, Fu Q, Yang L, Ba G. Unilateral Bi/Multi-Portal Endoscopy for the Treatment of Complicated Lumbar Degenerative Diseases with Utilization of Uniaxial Spinal Endoscope, Instead of Arthroscope: Technique Note and Clinical Results. Clin Interv Aging 2023; 18:1295-1308. [PMID: 37581123 PMCID: PMC10423581 DOI: 10.2147/cia.s417462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
Objective This article aims to discuss a novel surgical strategy, referred to as unilateral bi/multi-portal endoscopy (UME), which used a uniaxial spinal endoscope instead of an arthroscope in the traditional unilateral biportal endoscopy (UBE) surgical procedure in our study of the treatment of complicated lumbar degenerative diseases. Methods This retrospective study included 42 patients diagnosed with high-migrated lumbar disc herniation and bilateral spinal stenosis who underwent UME surgery from January 2021 to December 2021. Patients included 20 men and 22 women, with an average age of 55.97±14.92 years. The average follow-up period was 13.19 months. The demographic data, operation time (min), and complications were recorded and analyzed. The visual analogue scale (VAS), Oswestry Disability Index (ODI) scores were used to evaluate the surgical outcomes. Three-dimensional CT scans and MRI were conducted to evaluate the radiographic improvement. Results A total of 26 patients were diagnosed with lumbar disc herniation and 16 with lumbar spinal stenosis. All 42 patients underwent UME surgery and achieved satisfactory outcomes. The operation time was 154.46±46.09 min. The average follow-up time was 13.19±1.33 months. The preoperative back pain (VAS-Back) and the last follow-up VAS-Back were 3.84±1.00 and 0.70±0.46, respectively (P < 0.05). The preoperative leg pain (VAS-Leg) and the last follow-up VAS-Leg were 6.46±1.08 and 1.03±0.64, respectively (P <0.05). Significant differences existed between preoperative ODI scores (58.70±11.22%) and the last follow-up ODI scores (9.24±3.04%; P<0.05). All patients achieved significant pain relief and functional improvement after the surgery. No severe complications occurred, except for two cases of postoperative dysesthesia and one case suffered from vertebral compression fractures induced by a postoperative accidental injury. Symptoms of numbness disappeared within one week with treatment using dexamethasone and neurotrophic drugs. The vertebral fracture case recovered with percutaneous kyphoplasty treatment. Conclusion This study suggests that UME is a promising treatment strategy for high-migrated disc herniation and bilateral spinal stenosis.
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Affiliation(s)
- Liyu Yang
- Department of Orthopedic, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Long Zhou
- Department of Orthopedic, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Guanqi Wang
- Rehabilitation Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Min Qiu
- Department of Orthopedic, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Feng Liang
- Department of Orthopedic, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Changqing Jia
- Department of Orthopedic, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Weibing Xu
- Spinal Surgery, Dalian Central Hospital Affiliated to Dalian Medical University, Dalian, Liaoning, People’s Republic of China
| | - Qin Fu
- Department of Orthopedic, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Liqing Yang
- Department of Orthopedic, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Gen Ba
- Department of Orthopedic, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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8
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Mahato NK. Load-Bearing Shifts in Laminar and Ligament Morphology: Comparing Spinal Canal Dimensions Using Supine versus Upright Lumbar MRI in Adults without Back Pain. Indian J Radiol Imaging 2023; 33:344-350. [PMID: 37362360 PMCID: PMC10289849 DOI: 10.1055/s-0043-1768061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Purpose The effects of weight bearing on lumbar spinal canal dimensions are not well reported the low back pain (LBP) literature. Since axial loading induces changes in anatomical configuration of the lumbar spine, supine spine imaging may not uncover dimensional changes associated with physiological weight bearing that could be demonstrated in imaging in the upright position. Methods This study compared anteroposterior spinal canal dimensions measured at the level of the intervertebral discs in the supine and upright lumbar spine magnetic resonance images in adults without a history or current back pain. Additionally, interlaminar distances were measured between the centers of adjacent laminae involving a spinal segment. These parameters were utilized to ascertain the deformation incurred at the ligamentum flavum due to load bearing. Results Within and between-sessions t -tests, factorial and repeated-measures analysis of variance showed significant alterations in canal dimensions at certain levels, secondary to the upright positioning of the spine. Measurement reliability assessed between sessions and scanning positions using intraclass correlation coefficients demonstrated strong agreement. Conclusion Imaging studies involving physiological weight bearing may be useful to understand the potential etiological effects of such changes in mechanical LBP.
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Wang AY, Patel J, Kanter M, Olmos M, Maurer MS, McPhail ED, Patel AR, Arkun K, Kryzanski J, Riesenburger RI. The emerging significance of amyloid deposits in the ligamentum flavum of spinal stenosis patients: A review. World Neurosurg 2023:S1878-8750(23)00802-1. [PMID: 37331471 DOI: 10.1016/j.wneu.2023.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
Spinal stenosis is one of the most common neurosurgical diseases and a leading cause of pain and disability. Wild-type transthyretin amyloid (ATTRwt) has been found in the ligamentum flavum (LF) of a significant subset of spinal stenosis patients who undergo decompression surgery. Histologic and biochemical analyses of ligamentum flavum specimens from spinal stenosis patients, normally discarded as waste, have the potential to help elucidate the underlying pathophysiology of spinal stenosis and possibly allow for medical treatment of stenosis as well screen for other systemic diseases. This review article discusses the utility of analyzing LF specimens following spinal stenosis surgery for wild-type transthyretin amyloid (ATTRwt) deposits. Screening of cardiac ATTRwt amyloidosis (ATTRwt-CM) through LF specimens have led to the early diagnosis and treatment of cardiac amyloidosis in several patients, with more expected to benefit from this process. Emerging evidence in the literature also point to ATTRwt as a contributor to a previously unrecognized subtype of spinal stenosis in patients who may in the future benefit from medical therapy. In this article, we review the current literature with regards to the early detection of ATTRwt-CM via LF screening as well the possible contribution of ATTRwt deposits in the LF to spinal stenosis development.
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Affiliation(s)
- Andy Y Wang
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jainith Patel
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Matthew Kanter
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michelle Olmos
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mathew S Maurer
- Department of Cardiology, Columbia University Irving Medical Center, New York, NY USA
| | - Ellen D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayan R Patel
- CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Knarik Arkun
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
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10
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Endo T, Koike Y, Hisada Y, Fujita R, Suzuki R, Tanaka M, Tsujimoto T, Shimamura Y, Hasegawa Y, Kanayama M, Yamada K, Iwata A, Sudo H, Ishii M, Iwasaki N, Takahata M. Aggravation of Ossified Ligamentum Flavum Lesion Is Associated With the Degree of Obesity. Global Spine J 2023; 13:1325-1331. [PMID: 34615403 PMCID: PMC10416604 DOI: 10.1177/21925682211031514] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVES There is insufficient data on the clinical features of ossification of the ligamentum flavum (OLF) of the thoracic spine and the risk of progression of ossified lesions. The link between obesity and ossification of the posterior longitudinal ligament (OPLL), which frequently coexists with OLF, has been demonstrated. However, the link between obesity and OLF has not been recognized. We aimed to determine the prevalence of obesity in thoracic OLF and whether the severity of OLF is associated with the degree of obesity. METHODS A total of 204 symptomatic Japanese subjects with thoracic OLF and 136 subjects without spinal ligament ossification as controls were included. OLF subjects were divided into 3 groups: 1) localized OLF (OLF <2-intervertebral regions); 2) multilevel OLF (OLF ≥3-intervertebral regions); and 3) OLF + OPLL. The severity of OLF was quantified using the OLF index using computed tomography imaging of the entire spine. RESULTS The proportion of severely obese subjects (BMI ≥ 30 kg/m2) was significantly higher both in the multilevel OLF group (25.5%) and the OLF + OPLL group (44.3%) than in the localized OLF group (3.6%) and the control group (1.4%) (P < 0.01). BMI, age, and coexistence of cervical OPLL and lumbar OLF were associated with thoracic OLF index in the multiple regression analysis. CONCLUSIONS Our findings demonstrated that obesity is a distinct feature of multilevel OLF in the thoracic spine and that the severity of OLF is associated with the degree of obesity.
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Affiliation(s)
- Tsutomu Endo
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
- Department of Orthopedics, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Yoshinao Koike
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuichiro Hisada
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryo Fujita
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryota Suzuki
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Masaru Tanaka
- Department of Orthopedics, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Takeru Tsujimoto
- Department of Orthopedics, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Yukitoshi Shimamura
- Department of Orthopedics, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Yuichi Hasegawa
- Department of Orthopedics, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Masahiro Kanayama
- Department of Orthopedics, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Katsuhisa Yamada
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Akira Iwata
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hideki Sudo
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Misaki Ishii
- Department of Orthopedics, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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11
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Sugita T, Tomari S, Kitahara D, Ito Y, Kato G. Ligamentum Flavum Hematoma Accompanied by Intraspinal and Extraspinal Hematomas: A Case Report. Cureus 2023; 15:e38250. [PMID: 37252556 PMCID: PMC10225151 DOI: 10.7759/cureus.38250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Studies on ligamentum flavum hematoma (LFH) have been gradually increasing; however, no study has reported an LFH spreading to the intraspinal and extraspinal spaces. The purpose of this report is to discuss this rare condition and report that extraspinal hematoma can be formed by LFH. The authors present the case of a 78-year-old man presented with right L5 radiculopathy caused by a space-occupying lesion with intraspinal and extraspinal expansions at the L4-L5 vertebral levels demonstrated on MRI. We tentatively diagnosed these lesions as intraspinal and extraspinal hematomas originating from the ligamentum flavum based on the chronological changes seen on MRI and computed tomography-based needle biopsy. After the extirpation of these lesions, the symptoms were relieved. Three months later, the patient could walk without a cane. From the intraoperative findings and pathological examination, we concluded that the extraspinal hematoma in paravertebral muscle was caused by an LFH of unknown etiology. This case report describes the difficulty in diagnosing LFH accompanied by an extraspinal hematoma with wide-spreading expansion and highlights the usefulness of repetitive MRI over time in capturing chronological changes of the hematoma. As far as we know, this is the first study on an LFH accompanied by an extraspinal hematoma in the multifidus.
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Affiliation(s)
- Toshiaki Sugita
- Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
| | - Shinji Tomari
- Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
| | - Daichi Kitahara
- Pathology, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
| | - Yasumasa Ito
- Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
| | - Go Kato
- Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, JPN
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12
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Yabu A, Suzuki A, Hayashi K, Hori Y, Terai H, Orita K, Habibi H, Salimi H, Kono H, Toyoda H, Maeno T, Takahashi S, Tamai K, Ozaki T, Iwamae M, Ohyama S, Imai Y, Nakamura H. Periostin increased by mechanical stress upregulates interleukin-6 expression in the ligamentum flavum. FASEB J 2023; 37:e22726. [PMID: 36583686 DOI: 10.1096/fj.202200917rr] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/13/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
Ligamentum flavum (LF) hypertrophy is a major cause of lumbar spinal canal stenosis. Although mechanical stress is thought to be a major factor involved in LF hypertrophy, the exact mechanism by which it causes hypertrophy has not yet been fully elucidated. Here, changes in gene expression due to long-term mechanical stress were analyzed using RNA-seq in a rabbit LF hypertrophy model. In combination with previously reported analysis results, periostin was identified as a molecule whose expression fluctuates due to mechanical stress. The expression and function of periostin were further investigated using human LF tissues and primary LF cell cultures. Periostin was abundantly expressed in human hypertrophied LF tissues, and periostin gene expression was significantly correlated with LF thickness. In vitro, mechanical stress increased gene expressions of periostin, transforming growth factor-β1, α-smooth muscle actin, collagen type 1 alpha 1, and interleukin-6 (IL-6) in LF cells. Periostin blockade suppressed the mechanical stress-induced gene expression of IL-6 while periostin treatment increased IL-6 gene expression. Our results suggest that periostin is upregulated by mechanical stress and promotes inflammation by upregulating IL-6 expression, which leads to LF degeneration and hypertrophy. Periostin may be a pivotal molecule for LF hypertrophy and a promising therapeutic target for lumbar spinal stenosis.
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Affiliation(s)
- Akito Yabu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Hayashi
- Department of Orthopedic Surgery, Osaka City Juso Hospital, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kumi Orita
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hasibullah Habibi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hamidullah Salimi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kono
- Department of Orthopedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takafumi Maeno
- Department of Orthopedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tomonori Ozaki
- Department of Orthopedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shoichiro Ohyama
- Department of Orthopedic Surgery, Nishinomiya Watanabe Hospital, Nishinomiya, Japan
| | - Yuuki Imai
- Division of Integrative Pathophysiology, Proteo-Science Center, Ehime University, Toon, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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13
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Millhuff A, Haddad H, Draper MS, Motzko M, Glueck E, Holland B, Wright B. The midline interlaminar ligament of the spine: An anatomical study. Clin Anat 2023; 36:618-623. [PMID: 36598006 DOI: 10.1002/ca.24003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/16/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION During routine cadaveric dissection, Simonds et al. in 2019 found a previously undocumented ligament, which they termed the midline interlaminar ligament (MIL), in 24 out of 36 (76.5%) lumbar spinal levels. The MIL is an unpaired ligament located between and distinctly separate from the right and left ligamenta flava (LF). The purpose of this study was to identify the presence or absence of the MIL in the cervical, thoracic, and lumbar spinal regions and obtain detailed measurements of the ligaments' toughness (R) and elastic modulus (E). MATERIALS AND METHODS Intact preserved cadaveric vertebrae from C2 to the upper sacral region were dissected. Presence or absence of the MIL was documented, and length and width of each MIL were measured in situ. The R and E of the LFs from corresponding spinal segments were found for comparison. RESULTS At least one MIL was observed in 90.3% (28) of specimens. Eighty-eight MIL's were observed out of 186 cervical intervertebral levels (0.5%), 371 thoracic intervertebral levels (5.9%), and 101 lumbar intervertebral levels (63.4%). The mean width and length of the MIL were 1.21 ± 0.36 and 16.37 ± 2.17 mm, respectively. The mean R of the MIL and the LF were 1390.27 and 2068.04 J m-2 , respectively. The mean E of the MILs and LFs was 46.78 ± 16.65 and 51.15 ± 21.68 MPa, respectively. CONCLUSIONS Based on our findings, the MIL was present in the majority of vertebrae in our cadaveric population with a predominance for the lumbar region.
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Affiliation(s)
- Alexandra Millhuff
- Department of Anatomy, Kansas City University, Kansas City, Missouri, USA
| | - Hannah Haddad
- Department of Anatomy, Kansas City University, Kansas City, Missouri, USA
| | - M Scott Draper
- Department of Anatomy, Kansas City University, Kansas City, Missouri, USA
| | - Micaela Motzko
- Department of Anatomy, Kansas City University, Kansas City, Missouri, USA
| | - Edwin Glueck
- Department of Anatomy, Kansas City University, Kansas City, Missouri, USA
| | - Brandalynn Holland
- Department of Anatomy, Kansas City University, Kansas City, Missouri, USA
| | - Barth Wright
- Department of Anatomy, Kansas City University, Kansas City, Missouri, USA
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14
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Cavazos DR, Schultz R, Higginbotham DO, Vaidya R. Thoracic Spinal Stenosis From Calcified Ligamentum Flavum. Ochsner J 2023; 23:172-175. [PMID: 37323522 PMCID: PMC10262948 DOI: 10.31486/toj.23.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background: Calcification of the ligamentum flavum is a rare cause of spinal stenosis. The process can occur at any level in the spine, often presents with local pain or radicular symptoms, and is a distinct process from ossification of the spinal ligaments in pathogenesis and treatment approach. Few case reports have described multiple level involvement in the thoracic spine that results in sensorimotor deficits and myelopathy. Case Report: A 37-year-old female presented with progressive sensorimotor deficits from T3 distally that resulted in complete sensory deficits and diminished lower extremity strength. Computed tomography and magnetic resonance imaging demonstrated calcification of the ligamentum flavum from T2-T12 with severe spinal stenosis at T3-T4. She underwent T2-T12 posterior laminectomy with ligamentum flavum resection. Postoperatively, she had complete motor strength return and was discharged home for outpatient therapy. Her residual sensory deficits continued to improve with time after decompression and excision of the calcified ligamentum flavum. Conclusion: This case is unique in that the calcific process involved nearly the entire thoracic spine. The patient had dramatic improvement in her symptoms following resection of the involved levels. The case adds a severe manifestation of calcification of the ligamentum flavum with a surgical outcome to the literature.
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Affiliation(s)
- Daniel R. Cavazos
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI
- School of Medicine, Wayne State University, Detroit, MI
| | | | - Devan O. Higginbotham
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI
- School of Medicine, Wayne State University, Detroit, MI
| | - Rahul Vaidya
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI
- School of Medicine, Wayne State University, Detroit, MI
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15
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Rho JH, Yoon CD, Kim G, Kang HY. A new technique for controlling intractable pain in lumbar spinal stenosis using steroid injection to ligamentum flavum: A case series. Pain Pract 2023; 23:123-126. [PMID: 35638334 DOI: 10.1111/papr.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lumbar spinal stenosis is a common degenerative disease that causes low back and lower-extremity pain that increases with age. The treatment of lumbar spinal stenosis is either conservative or surgical. ESI is a commonly performed conservative treatment, but evidence of its effectiveness in lumbar spinal stenosis is limited. CASE SERIES We encountered the three patients with back pain and claudication due to lumbar spinal stenosis, which could not be controlled by conservative therapy including ESIs. Trimacinolone acetonide was injected into the patients' ligamentum flavum. All patients experienced dramatic improvement in their symptoms. CONCLUSIONS Trimacinolone acetonide injection into the ligamentum flavum may be effective for lumbar spinal stenosis that does not improve with ESIs.
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Affiliation(s)
- Jeong Ho Rho
- Spine and Pain Center, Okcheon St. Mary's Hospital, Okcheon, South Korea
| | - Chung Dae Yoon
- Department of Radiology, Okcheon St. Mary's Hospital, Okcheon, South Korea
| | - Gahee Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
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16
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Huang S, Wang Z, Xu L, Bu J, He B, Xia M, Chen T, Gao J, Liu G, Niu R, Ma C, Liu G. Percutaneous endoscopic lumbar discectomy via the medial foraminal and interlaminar approaches: A comparative study with 2-year follow-up. Front Surg 2022; 9:990751. [PMID: 36406379 PMCID: PMC9666386 DOI: 10.3389/fsurg.2022.990751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/06/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the clinical effect of percutaneous endoscopic medial foraminal discectomy (PEMFD) in the treatment of lumbar disc herniation (LDH). METHODS We retrospectively examined and compared clinical data from 39 single-level LDH patients who underwent PEID and 47 who underwent PEMFD. All the patients were diagnosed with single-level LDH and were treated in Xuzhou Central Hospital for single-segmental lumbar disc herniation between June 2017 and December 2019. Collect and count surgical-related indicators, intraoperative bleeding volume and 24-hour postoperative drainage volume, lower extremity numbness Visual Analogue Scale (VAS), the pain VAS and lumbar Oswestry Disability Index (ODI) scores. RESULTS Intraoperative bleeding volume and 24-hour postoperative drainage volume were significantly lower in the PEMFD group (p < 0.05). Operation time and length of hospital stay did not significantly differ between the groups. Transient spinal cord injury and surgical site infection did not occur. Recurrence occurred in two patients in each group. Repeat surgery in these patients demonstrated remarkable epidural scarring in the PEID group patients; no scarring was evident in the PEMFD group patients. The numbness VAS score 72 h after surgery and the pain VAS and ODI scores 1 month after surgery significantly differed between groups; however, pain VAS and ODI scores 6, 12, and 24 months after surgery did not. At last follow-up, the modified MacNab criteria outcome did not significantly differ between the groups. CONCLUSION PEMFD and PEID have similar short- and medium-term outcomes. However, PEMFD has several advantages: simplicity, lower bleeding volume, and preservation of the LF.
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Affiliation(s)
- Sen Huang
- Department of Emergency Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China,Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Zhenfei Wang
- Department of Orthopedic Surgery, Graduate School of Bengbu Medical College, Bengbu, China
| | - Long Xu
- Department of Orthopedic Surgery, Graduate School of Bengbu Medical College, Bengbu, China
| | - Jinhui Bu
- Department of Orthopedic Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Bo He
- Department of Orthopedic Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Mengjiao Xia
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Tao Chen
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Juan Gao
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Guangpu Liu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Ru Niu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Chao Ma
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China,Correspondence: Chao Ma Guangwang Liu
| | - Guangwang Liu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China,Correspondence: Chao Ma Guangwang Liu
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17
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Kim J, Kwon WK, Cho H, Lee S, Lee JB, Park JY, Jin DU, Jung EY, Hur JW. Ligamentum flavum hypertrophy significantly contributes to the severity of neurogenic intermittent claudication in patients with lumbar spinal canal stenosis. Medicine (Baltimore) 2022; 101:e30171. [PMID: 36086706 PMCID: PMC10980470 DOI: 10.1097/md.0000000000030171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
Ligamentum flavum hypertrophy (LFH) is a known contributor to lumbar spinal canal stenosis (LSCS). However, the clinical significance and quantitative role of LFH compared to other components, such as disc bulging and facet hypertrophy, have not yet been examined. We investigated the correlation between the quantitative radiological factors, clinical symptoms, and outcomes in patients with LSCS. In total, 163 patients diagnosed with single-level (L4-L5) stenosis were included. The patients were divided into 2 groups according to claudication severity: >100 m for mild (n = 92) and < 100 m for severe (n = 71). The visual analog scale (VAS) was used to quantify back and leg pain, and the Oswestry Disability Index (ODI) and Short form-36 (SF-36) physical component summary (PCS) scores, and Macnab criteria were evaluated as clinical factors 6 months after treatment. We measured the baseline canal cross-sectional area, ligamentum flavum (LF) area, disc herniation area, dural sac area, fat area, and LF thickness using MRI. A comparative analysis was performed to evaluate the association between radiologic and clinical factors. Additionally, further comparative analyses between the types of surgeries were performed. Among various radiologic factors, the baseline LF thickness (odds ratio [OR] 1.73; 95% confidence interval [CI] 1.25-2.41) was the only major contributing factor to the severity of claudication in the multivariate logistic regression analysis. The types of surgery (decompression alone vs fusion) did not significantly differ in terms of their clinical outcomes, including back and leg VAS, ODI, SF-36 PCS, and satisfaction with the MacNab classification. LF thickness is a major factor contributing to claudication severity.
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Affiliation(s)
- Joohyun Kim
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyunwook Cho
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Subum Lee
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jang-Bo Lee
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jung-Yul Park
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Dong Uk Jin
- Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Eui Yub Jung
- Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Junseok W. Hur
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
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18
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Wang AY, Kanter M, Olmos M, McPhail ED, Safain MG, Kryzanski J, Arkun K, Riesenburger RI. Lumbar stenosis due to wild-type transthyretin amyloid-induced thickening of the ligamentum flavum: a separate etiology from degeneration of intervertebral discs? J Neurosurg Spine 2022; 37:1-7. [PMID: 35901753 DOI: 10.3171/2022.5.spine22362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wild-type transthyretin amyloid (ATTRwt) is deposited in the ligamentum flavum (LF) of a subset of patients with spinal stenosis who undergo decompressive surgery, although its role in the pathophysiology of spinal stenosis is unknown. It has been theorized that degeneration of intervertebral discs causes increased mechanical stress and inflammatory/degenerative cascades and ultimately leads to LF fibrosis. If ATTRwt deposits contribute to LF thickening and spinal stenosis through a different pathway, then patients with ATTRwt may have less severe disc degeneration than those without it. In this study, the authors compared the severity of disc degeneration between patients with lumbar stenosis with and without amyloid in their LF to test whether ATTRwt is a unique contributor to LF thickening and spinal stenosis. METHODS Of 324 consecutive patients between 2018 and 2019 who underwent decompression surgery for spinal stenosis and had LF samples sent for pathological analysis, 31 harboring ATTRwt were compared with 88 controls. Patient medical records were retrospectively reviewed for demographic and surgical information. Disc degeneration was assessed on preoperative T2-weighted MR images with the modified Pfirrmann grading system at every lumbar disc level. RESULTS Baseline characteristics were similar between the groups, except for a statistically significant increase in age in the ATTRwt group. The crude unadjusted comparisons between the groups trended toward a less severe disc degeneration in the ATTRwt group, although this difference was not statistically significant. A multivariable linear mixed-effects model was created to adjust for the effects of age and to isolate the influence of ATTRwt, the presence of an operation at the level, and the specific disc level (between L1 and S1). This model revealed that ATTRwt, the presence of an operation, and the specific level each had significant effects on modified Pfirrmann scores. CONCLUSIONS Less severe disc degeneration was noted in patients with degenerative spinal stenosis harboring ATTRwt compared with those without amyloid. This finding suggests that ATTRwt deposition may play a separate role in LF thickening from that played by disc degeneration. Future studies should aim to elucidate this potentially novel pathophysiological pathway, which may uncover an exciting potential for the development of amyloid-targeted therapies that may help slow the development of spinal stenosis.
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Affiliation(s)
- Andy Y Wang
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Matthew Kanter
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Michelle Olmos
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Ellen D McPhail
- 2Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; and
| | - Mina G Safain
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - James Kryzanski
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Knarik Arkun
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
- 3Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Ron I Riesenburger
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
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19
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Yabe Y, Hagiwara Y, Tsuchiya M, Minowa T, Takemura T, Hattori S, Yoshida S, Onoki T, Ishikawa K. Comparative proteome analysis of the ligamentum flavum of patients with lumbar spinal canal stenosis. JOR Spine 2022; 5:e1210. [PMID: 36601375 PMCID: PMC9799084 DOI: 10.1002/jsp2.1210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 01/07/2023] Open
Abstract
Background Thickening of the ligamentum flavum is considered to be the main factor for lumbar spinal canal stenosis (LSCS). Although some mechanisms have been speculated in the thickening of the ligamentum flavum, there are only a few comprehensive approaches to investigate its pathology. The objective of this study was to investigate the pathology of thickened ligamentum flavum in patients with LSCS based on protein expression levels using shotgun proteome analysis. Methods Ligamentum flavum samples were collected from four patients with LSCS (LSCS group) and four patients with lumbar disc herniation (LDH) as controls (LDH group). Protein mixtures were digested and analyzed by liquid chromatography/mass spectrometry analysis. To compare protein expression levels between the LSCS and LDH groups, the mean Mascot score was compared. Biological processes were assessed using Gene Ontology analysis. Results A total of 1151 proteins were identified in some samples of ligamentum flavum. Among these, 145 proteins were detected only in the LSCS group, 315 in the LDH group, and 691 in both groups. The demonstrated biological processes occurring in the LSCS group included: extracellular matrix organization, regulation of peptidase activity, extracellular matrix disassembly, and negative regulation of cell growth. Proteins related to fibrosis, chondrometaplasia, and amyloid deposition were found highly expressed in the LSCS group compared with those in the LDH group. Conclusions Tissue repair via fibrosis, chondrometaplasia, and amyloid deposits may be important pathologies that occur in the thickened ligamentum flavum of patients with LSCS.
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Affiliation(s)
- Yutaka Yabe
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Yoshihiro Hagiwara
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Masahiro Tsuchiya
- Department of Nursing, Faculty of Health ScienceTohoku Fukushi UniversitySendaiJapan
| | - Takashi Minowa
- Nanotechnology Innovation StationNational Institute for Materials ScienceTsukubaJapan
| | - Taro Takemura
- Nanotechnology Innovation StationNational Institute for Materials ScienceTsukubaJapan
| | - Shinya Hattori
- Nanotechnology Innovation StationNational Institute for Materials ScienceTsukubaJapan
| | - Shinichirou Yoshida
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Takahiro Onoki
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Keisuke Ishikawa
- Department of Orthopaedic SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
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20
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Seki S, Iwasaki M, Makino H, Yahara Y, Kondo M, Kamei K, Futakawa H, Nogami M, Watanabe K, Tran Canh Tung N, Hirokawa T, Tsuji M, Kawaguchi Y. Association of Ligamentum Flavum Hypertrophy with Adolescent Idiopathic Scoliosis Progression-Comparative Microarray Gene Expression Analysis. Int J Mol Sci 2022; 23. [PMID: 35563428 DOI: 10.3390/ijms23095038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 12/10/2022] Open
Abstract
The role of the ligamentum flavum (LF) in the pathogenesis of adolescent idiopathic scoliosis (AIS) is not well understood. Using magnetic resonance imaging (MRI), we investigated the degrees of LF hypertrophy in 18 patients without scoliosis and on the convex and concave sides of the apex of the curvature in 22 patients with AIS. Next, gene expression was compared among neutral vertebral LF and LF on the convex and concave sides of the apex of the curvature in patients with AIS. Histological and microarray analyses of the LF were compared among neutral vertebrae (control) and the LF on the apex of the curvatures. The mean area of LF in the without scoliosis, apical concave, and convex with scoliosis groups was 10.5, 13.5, and 20.3 mm2, respectively. There were significant differences among the three groups (p < 0.05). Histological analysis showed that the ratio of fibers (Collagen/Elastic) was significantly increased on the convex side compared to the concave side (p < 0.05). Microarray analysis showed that ERC2 and MAFB showed significantly increased gene expression on the convex side compared with those of the concave side and the neutral vertebral LF cells. These genes were significantly associated with increased expression of collagen by LF cells (p < 0.05). LF hypertrophy was identified in scoliosis patients, and the convex side was significantly more hypertrophic than that of the concave side. ERC2 and MAFB genes were associated with LF hypertrophy in patients with AIS. These phenomena are likely to be associated with the progression of scoliosis.
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21
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Kumar Varma Kalidindi K, Sharma JK, Vishwakarma G, Duggi S, Chhabra HS. Ligamentum Flavum Buckling vs Hypertrophy in Cervical Myelopathy Using Dynamic Imaging: Are Instability and Loss of Disc Height the Culprits? Int J Spine Surg 2022; 16:300-308. [PMID: 35444039 PMCID: PMC9930672 DOI: 10.14444/8221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The literature has not distinguished between LF "hypertrophy" and "buckling" when addressing cervical spondylotic myelopathy. The identification of buckling on dynamic magnetic resonance imaging can determine the levels for decompression more accurately and modify the surgical plan accordingly. No studies have been performed in the cervical spine to analyze the factors affecting LF buckling. PURPOSE Our objective was to investigate the factors affecting static ligamentum flavum (LF) "hypertrophy" and dynamic LF "buckling." STUDY DESIGN Retrospective cohort study. METHODS We conducted a retrospective study of hospital records and imaging database from January 2014 to January 2020. The relation of age, disc height, and intervertebral instability to LF hypertrophy and buckling were assessed. RESULTS Measurements were performed from C2-3 to C7-T1 in 169 patients who satisfied the eligibility criteria, making a total of 1014 levels. The samples were divided into 2 groups: 798 levels with buckling <1 mm (group A) and 216 levels with buckling >1 mm (group B). Of those, 161 levels satisfied the criteria for radiological instability (sagittal translation/rotation). No correlation was observed between age/disc height and buckling. Intervertebral instability showed significant association (P = 0.046) with buckling. No correlation was found between age/intervertebral instability and hypertrophy. CONCLUSION LF buckling but not hypertrophy is related to intervertebral instability in the cervical spine. LF buckling in the cervical spine is not related to age or disc height in the cervical spine. CLINICAL RELEVANCE Intervertebral instability on dynamic x-ray imaging of the cervical spine can be a predictor of ligamentum flavum buckling and can be utilized for surgical planning. LEVEL OF EVIDENCE: 3
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Affiliation(s)
| | - Jeevan Kumar Sharma
- Department of Spine Service, Indian Spinal Injuries Center, Vasant Kunj, New Delhi, Delhi 110070, India
| | - Gayatri Vishwakarma
- Department of Biostatistics, Indian Spinal Injuries Center, Vasant Kunj, New Delhi, Delhi 110070, India
| | - Srinath Duggi
- Department of Orthopaedics, Chalmeda AnandRao Institute of Medical Sciences, Karimnagar, Telangana 505001, India
| | - Harvinder Singh Chhabra
- Department of Spine Service, Indian Spinal Injuries Center, Vasant Kunj, New Delhi, Delhi 110070, India
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22
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Yang K, Chen Y, Xiang X, Lin Y, Fei C, Chen Z, Lai Z, Yu Y, Tan R, Dong J, Zhang J, Li P, Wang L, Zhang Z. EGF Contributes to Hypertrophy of Human Ligamentum Flavum via the TGF-β1/Smad3 Signaling Pathway. Int J Med Sci 2022; 19:1510-1518. [PMID: 36185336 PMCID: PMC9515692 DOI: 10.7150/ijms.76077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The most common spinal disorder in elderly is lumbar spinal canal stenosis (LSCS). Previous studies showed that ligamentum flavum hypertrophy (LFH) with fibrosis as the main pathological change is one of the pathogenic factors leading to LSCS. Epidermal Growth Factor (EGF) is known to have an intimate relationship with fibrosis in various tissues. Nevertheless, currently, there are few studies regarding EGF in LFH. The effect of EGF on the development of LFH is unknown, and the underlying pathomechanism remains unclear. In this study, we investigated the role of EGF in LFH and its potential molecular mechanism. Methods: First, the expression levels of EGF, phosphorylation of EGF receptor (pEGFR), Transforming growth factor-β1 (TGF-β1), Phosphorylated Smad3 (pSmad3), collagen I and collagen III were examined via immunohistochemistry and Western blot in LF tissues from patients with LSCS or Non-LSCS. Second, primary LF cells were isolated from adults with normal LF thickness and were cultured with different concentrations of exogenous EGF with or without erlotinib/TGF-β1-neutralizing antibody. Results: The results showed that EGF, pEGFR, TGF-β1, pSmad3, collagen I and collagen III protein expression in the LSCS group was significantly higher than that in the Non-LSCS group. Meanwhile, pEGFR, TGF-β1, pSmad3, collagen I and collagen III protein expression was significantly enhanced in LF cells after exogenous EGF exposure, which can be notably blocked by erlotinib. In addition, pSmad3, collagen I and collagen III protein expression was blocked by TGF-β1-neutralizing antibody. Conclusions: EGF promotes the synthesis of collagen I and collagen III via the TGF-β1/Smad3 signaling pathway, which eventually contributes to LFH.
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Affiliation(s)
- Kaifan Yang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanlin Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xin Xiang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanling Lin
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chengshuo Fei
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zesen Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhongming Lai
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongpeng Yu
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruiqian Tan
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiale Dong
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junxiong Zhang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Li
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liang Wang
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Zhongmin Zhang
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
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23
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Godara A, Riesenburger RI, Zhang DX, Varga C, Fogaren T, Siddiqui NS, Yu A, Wang A, Mastroianni M, Dowd R, Nail TJ, McPhail ED, Kurtin PJ, Theis JD, Toskic D, Arkun K, Pilichowska M, Kryzanski J, Patel AR, Comenzo R. Association between spinal stenosis and wild-type ATTR amyloidosis. Amyloid 2021; 28:226-233. [PMID: 34263670 DOI: 10.1080/13506129.2021.1950681] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Age-related cardiac amyloidosis results from deposits of wild-type tranthyretin amyloid (ATTRwt) in cardiac tissue. ATTR may play a role in carpal tunnel syndrome (CTS) and in spinal stenosis (SS), indicating or presaging systemic amyloidosis. We investigated consecutive patients undergoing surgery for SS for ATTR deposition in the resected ligamentum flavum (LF) and concomitant risk of cardiac amyloidosis. Each surgical specimen (LF) was stained with Congo red, and if positive, the amyloid deposits were typed by mass spectrometry. Patients with positive specimens underwent standard of care evaluation with fat pad aspirates, serum and urine protein electrophoresis with immunofixation, free light-chain assay, TTR gene sequencing and technetium 99 m-pyrophosphate-scintigraphy. In 2018-2019, 324 patients underwent surgery for SS and 43 patients (13%) had ATTR in the LF with wild-type TTR gene sequences. Two cases of ATTRwt cardiac amyloidosis were diagnosed and received treatment. In this large series, ATTRwt was identified in 13% of the patients undergoing laminectomy for SS. Patients with amyloid in the ligamentum flavum were older and had a higher prevalence of CTS, suggesting a systemic form of ATTR amyloidosis involving connective tissue. Further prospective study of patients with SS at risk for systemic amyloidosis is warranted.
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Affiliation(s)
- Amandeep Godara
- John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Boston, MA, USA.,Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA
| | | | - Diana X Zhang
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Cindy Varga
- John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Boston, MA, USA
| | - Teresa Fogaren
- John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Boston, MA, USA
| | - Nauman S Siddiqui
- John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Boston, MA, USA.,Division of Hematology, Medical Oncology and Palliative Care, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Anthony Yu
- School of Medicine, Tufts University, Boston, MA, USA
| | - Andy Wang
- School of Medicine, Tufts University, Boston, MA, USA
| | | | - Richard Dowd
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Tara J Nail
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Ellen D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Paul J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jason D Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Denis Toskic
- John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Boston, MA, USA
| | - Knarik Arkun
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
| | - Monika Pilichowska
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Ayan R Patel
- Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Raymond Comenzo
- John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Boston, MA, USA
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24
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Sidronio T, Kumar S. Ossification of the Ligamentum Flavum of the Lumbar Spine. Cureus 2021; 13:e19023. [PMID: 34824935 PMCID: PMC8611618 DOI: 10.7759/cureus.19023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/09/2022] Open
Abstract
Ossification of the ligamenta flava (OLF) is a rare and likely multifactorial condition that most commonly affects the lower thoracic spine. It can result in chronic pain and neurological deficits and has a higher prevalence in men of Japanese descent. We present the case of OLF of the lumbar spine in a Caucasian man with a history of multiple sports-related injuries. To treat his severe lumbar spinal stenosis, the patient underwent endoscopic intralaminar laminotomy with partial facetectomy and complete resection of OLF with lateral recess decompression, which immediately resolved his symptoms. We noted signs of OLF based on T1 and T2 signal changes upon re-evaluation of MRI.
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Affiliation(s)
- Talles Sidronio
- Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Sanjeev Kumar
- Anesthesiology, University of Florida College of Medicine, Gainesville, USA
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25
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Kato K, Otoshi K, Hakozaki M, Konno SI. Progressive enlargement of thoracic ossification of the ligamentum flavum in professional baseball pitchers: a report of two cases. J Int Med Res 2021; 49:3000605211059465. [PMID: 34796768 PMCID: PMC8661027 DOI: 10.1177/03000605211059465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Both systemic and local factors might influence the development of ossification of the ligamentum flavum (OLF); however, whether specific physical activities play a role in the development of OLF remains unclear. This report presents two cases of thoracic radiculopathy owing to progressive enlargement of thoracic OLF within a few years in Japanese professional baseball pitchers. Two left-handed, Japanese, professional baseball pitchers in their 20s experienced thoracic radiating pain. Mild hypesthesia of the lower thoracic vertebral levels was observed, and an increase in the size of the OLF within a few years was identified in the lower thoracic spine using computed tomography and magnetic resonance imaging. Neither patient exhibited myelopathy and were, therefore, treated conservatively. Both patients were able to return to playing in top condition within 4 months after onset. The findings in these cases suggest that thoracic OLF might increase in size and become exacerbated in certain individuals, such as professional pitchers, who experience repeated, localized, mechanical stress on the thoracic spine, irrespective of age.
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Affiliation(s)
- Kinshi Kato
- Department of Orthopaedic Surgery, 183174Fukushima Medical University School of Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Kenichi Otoshi
- Department of Orthopaedic Surgery, 183174Fukushima Medical University School of Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, 183174Fukushima Medical University School of Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, 183174Fukushima Medical University School of Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
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26
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Khasawneh R, Abu El-Rub E, Allouh M. Human lumbosacral root and ligamentum flavum thicknesses: a magnetic resonance study. Folia Morphol (Warsz) 2021; 82:72-78. [PMID: 34783005 DOI: 10.5603/fm.a2021.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study investigated the lumbosacral plexus (LSP) nerve root thickness and ligamentum flavum (LF) thickness and correlated them with age and sex. These findings provided a useful data for spinal nerve root micro-anastomosis surgery and lumbar decompression surgery. MATERIALS AND METHODS This retrospective study was conducted with 350 individuals with ages ranging from 21 to 80 years under magnetic resonance imaging to evaluate the possible cause of a lower back pain. RESULTS According to the morphometric measurements of the LSP root thickness, the diameter gradually increased from L1 to S1. L1 has the thinnest root (3.9 ± 0.81 mm) while S1 has the thickest root (5.45 ± 0.8 mm). The measurements revealed inconsiderable differences in the LSP thickness in relation to age, sex in the study population. Regarding the LF, the thickness of the LF was found to insignificantly increase with age. Besides, the LF thickness was inconsequentially higher in female. The mean thickness of the right LF at different spinal levels was measured (L2-L3 = 3.19 ± 0.27, L3-L4 = 3.38 ± 0.11 mm, L4-L5 = 3.71 ± 0.29 mm, and L5-S1 = 3.64 ± 0.21 mm). The mean thickness of the left LF was non-significantly higher. CONCLUSIONS The LSP root and LF thicknesses not related to age or sex.
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Affiliation(s)
- R Khasawneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
| | - E Abu El-Rub
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - M Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Jordan.,Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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27
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Sun TC, Schier M, Lau MPY, Martinez-Taboada F. Mathematical Models for the Skin to Lumbosacral Epidural Distance in Dogs: A Cadaveric Computed-Tomography Study. Animals (Basel) 2021; 11:ani11102974. [PMID: 34679993 PMCID: PMC8532872 DOI: 10.3390/ani11102974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to validate previously published computed tomography (CT) derived mathematical equations with the true skin to lumbosacral epidural distance (SLED) in dog cadavers. Phase 1: The lumbar region of 11 dog cadavers were scanned in sternal recumbency to determine the effect of cranial, neutral, and caudal pelvic limb positioning on the CT derived lumbosacral epidural distance (CLED). Phase 2: The epidural space was determined using contrast epidurography, and the SLED was analysed against the mathematical equations using a body condition score (BCS) and either the cadaveric occipital-coccygeal length (OCL) (Equation (1): = 7.3 + 0.05*OCL + 16.45*BCS) or the ilium wing distance (IWD) (Equation (2): = 3.5 + 0.56*IWD + 16.6*BCS). There were no differences detected between the pelvic limb positions and the CLED. Both equations demonstrated strong correlations (Equation (1): r = 0.7196; Equation (2): r = 0.7590) with the SLED. The level of agreement was greater for Equation (1) than with Equation (2) (concordance coefficient 0.6061 and 0.3752, respectively). Equation (1) also demonstrated a closer fit to the concordance line compared with Equation (2) (bias correction factor 0.8422 and 0.4960, respectively). Further studies in live anaesthetised dogs will help to determine the usefulness of the pre-procedural knowledge when performing lumbosacral epidurals.
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28
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Yu X, Zhao J, Feng F, Han Y, Zhong G, Liu Z, Chen J. Inclination of the small laminar slope angle leads to lumbar spinal stenosis due to hypertrophy of the ligamentum flavum. J Orthop Surg (Hong Kong) 2021; 29:23094990211012846. [PMID: 33926334 DOI: 10.1177/23094990211012846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study was designed to investigate the relationship between the laminar slope angle (LSA) and the lumbar disc degenerative grade, the cross-section area (CSA) of multifidus muscle, the muscle-fat index, and the thickness of the ligamentum flavum. METHODS Retrospective analysis of 122 patients who were scheduled to undergo a lumbar operation for diagnoses associated with degenerative lumbar disease between January and December 2017. The L4-L5 disc grade was evaluated from preoperative sagittal T2-weighed magnetic resonance imaging of the lumber region; the CSA of the multifidus and muscle-fat index were measured at the L4 level, while the thickness of the ligamentum flavum was measured at the L4-L5 facet level from axis T2-weighed magnetic resonance imaging. The slope of the laminar was evaluated from preoperative three-dimensional computer tomography at the tip level of the facet joints and selected by the axis plane. Independent-sample T-tests were used to assess the association between age and measurement indices. RESULTS Our results showed that age was positively connected with the LSA of L4 and L5 in different patients, although there was no significant difference between age and the difference of the two segment LSA. Partial correlation analysis, excluding the interference of age, revealed a strong negative relationship between the LSA of L4 and the thickness of the ligamentum flavum, irrespective of whether we considered the left or right. However, there was no correlation with lumbar disc degenerative grade, the CSA of the multifidus, and the muscle-fat index. CONCLUSION The thickness of the ligamentum flavum showed changes with anatomical differences in the LSA, but not the lumbar disc degenerative grade, the CSA of the multifidus, and the muscle-fat index. A small change in LSA may cause large mechanical stress; this may be one of the causative factors responsible for lumbar spinal stenosis.
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Affiliation(s)
- Xiaosheng Yu
- Department of Orthopaedic Surgery, Renji Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junduo Zhao
- Ottawa-Shanghai Joint School of Medicine, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Feng
- Department of Orthopaedic Surgery, Renji Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingchao Han
- Department of Orthopaedic Surgery, Renji Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guibin Zhong
- Medical Department, Baoshan Branch, Renji Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zude Liu
- Department of Orthopaedic Surgery, Renji Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianwei Chen
- Department of Orthopaedic Surgery, Renji Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, China
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29
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Deer T, Kim C, Wahezi SE, Qu H, Sayed D. Objective Real-World Outcomes of Patients Suffering from Painful Neurogenic Claudication Treated with the mild® Procedure: Interim 6-Month Report of a Randomized Controlled Trial. J Pain Res 2021; 14:1687-1697. [PMID: 34140805 PMCID: PMC8203201 DOI: 10.2147/jpr.s312573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/26/2021] [Indexed: 01/17/2023] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a serious degenerative condition of the spine that can cause significant functional disability. Therapies for these patients generally begin with conservative management, since more invasive interventions such as open surgery and spinal implants are associated with higher complication rates. Early in the treatment algorithm for LSS patients, multiple conventional medical management (CMM) therapies are often combined as an initial low-risk treatment strategy. This composite first-line treatment plan may include conservative care together with early interventional treatment options such as epidural steroid injections, radiofrequency ablation and the mild® Procedure. Methods This prospective randomized controlled trial evaluates patients aged 50 to 80 years treated with mild plus CMM, compared to those treated with CMM alone, as the active control. Walking tolerance test outcomes and incidence of subsequent disallowed procedures provided objective real-world outcome data. The incidence of device or procedure-related adverse events was analyzed. Follow-up includes 6-month, 1-year and 2-year assessments, with 1-year being primary. Patients in the mild+CMM group are followed at 3, 4, and 5 years. This is a report of interim 6-month outcomes. Results Of 155 patients enrolled at 19 US interventional pain management centers, 78 were allocated to CMM-Alone, and 77 to mild+CMM. At 6-months, the validated walking tolerance test demonstrated statistical superiority of mild+CMM versus CMM-Alone (p<0.001). The incidence of patients receiving a subsequent disallowed procedure, and thereby considered treatment failures in their study group, was statistically significantly higher in CMM-Alone versus mild+CMM (p<0.001). There were no device or procedure-related adverse events in either group. Conclusion At 6-months, the mild Procedure combined with CMM provided statistically superior objective real-world outcomes versus CMM-Alone. There were no device or procedure-related adverse events reported in either study group. With its excellent safety profile and superior efficacy, mild is uniquely positioned as early first-line therapy.
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Affiliation(s)
- Timothy Deer
- The Spine & Nerve Centers of the Virginias, Charleston, WV, USA
| | - Christopher Kim
- The Spine & Nerve Centers of the Virginias, Charleston, WV, USA
| | | | - Huaguang Qu
- Pennsylvania Pain & Spine Institute, Chalfont, PA, USA
| | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
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Kulcheski ÁL, Stieven-Filho E, Nunes CP, Milcent PAA, Dau L, I-Graells XS. Validation of an endoscopic flavectomy training model. Rev Col Bras Cir 2021; 48:e202027910. [PMID: 33978123 PMCID: PMC10683459 DOI: 10.1590/0100-6991e-20202901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to validate a lumbar spine endoscopic flavectomy simulator using the construct method and to assess the acceptability of the simulator in medical education. METHODS thirty medical students and ten video-assisted surgery experienced orthopedists performed an endoscopic flavectomy procedure in the simulator. Time, look-downs, lost instruments, respect for the stipulated edge of the ligamentum flavum, regularity of the incision, GOALS checklist (Global Operative Assessment of Laparoscopic Skills), and responses to the Likert Scale adapted for this study were analyzed. RESULTS all variables differed between groups. Procedure time was shorter in the physician group (p < 0.001). Look-downs and instrument losses were seven times greater among students than physicians. Half of the students respected the designated incision limits, compared to 80% of the physicians. In the student group, about 30% of the incisions were regular, compared to 100% in the physician group (p < 0.001). The physicians performed better in all GOALS checklist domains. All the physicians and more than 96% of the students considered the activity enjoyable, and approximately 90% believed that the model was realistic and could contribute to medical education. CONCLUSIONS the simulator could differentiate the groups' experience level, indicating construct validity, and both groups reported high acceptability.
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Affiliation(s)
- Álynson Larocca Kulcheski
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Edmar Stieven-Filho
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Carolline Popovicz Nunes
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Paul André Alain Milcent
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Leonardo Dau
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Xavier Soler I-Graells
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
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Ding Y, Lv S, Dong S, Cui J, Cao Z, Chen Y. Relationship between Scheuermann disease and symptomatic thoracic spinal stenosis: A retrospective study. Acta Orthop Traumatol Turc 2021; 55:253-257. [PMID: 34100367 PMCID: PMC10566354 DOI: 10.5152/j.aott.2021.20022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/28/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the possible relationship between Scheuermann disease (SD) and the pathophysiological factors of thoracic spinal stenosis (TSS), including ossification of the ligamentum flavum (OLF), ossification of the posterior longitudinal ligament (OPLL), and thoracic disc herniation (TDH) in patients with symptomatic TSS. METHODS Demographic and radiological data from 66 consecutive patients diagnosed with symptomatic TSS from 2013 to 2018 were retrospectively collected and divided into 3 groups depending on the underlying pathomechanism of TSS: TDH group (18 patients; 6 women; mean age ± standard deviation [Sd] = 59.89 ± 11.34), OPLL group (12 patients; 8 women; mean age ± Sd = 56.08 ± 14.74), and OLF group (36 patients; 20 women; mean age ± Sd = 58.69 ± 9.77). A total of 41 age-matched healthy individuals (19 women; mean age ± Sd = 54.88 ± 13.63) were designated as the control group. In each group, both typical and atypical SD criteria were radiologically examined. The demographic data and presence of SD between the control group and 3 subgroups of TSS pathomechanisms were evaluated. RESULTS SD characteristics were identified in 83.33% (15/18) of patients in the TDH group, 44.44% (16/36) in the OLF group, 25% (3/12) in the OPLL group, and 17.07% (7/41) of the control individuals. When analyzed by the chi-squared test and logistic regression analysis, the presence of SD was significantly associated with TDH (P < 0.01) and OLF (P < 0.05) but not OPLL (P > 0.05). Patients with TDH and OLF showed peak involvement of T10/11, and patients with OPLL did not. Furthermore, we determined that age, sex, body-mass index, and smoking status were not the risk factors for TDH, OPLL, and OLF (P > 0.05). SD was found to be a risk factor for TDH (P < 0.01) and OLF (P < 0.05) but not for OPLL (P > 0.05). CONCLUSION Evidence from this study indicated that SD might be a risk factor for OLF and TDH but not for OPLL.
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Affiliation(s)
- Yan Ding
- Department of Spine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan,
China
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Shiqiao Lv
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Shengjie Dong
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Jinpeng Cui
- Clinical Laboratory, Yantaishan Hospital, Yantai,
China
| | - Zhilin Cao
- Department of Orthopaedics, Yantaishan Hospital, Yantai,
China
| | - Yunzhen Chen
- Department of Spine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan,
China
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Abstract
PURPOSE To assess the natural history of ossification of yellow ligament (OYL) in the thoracic spine and determine risk factors for progression based on a longitudinal population-based cohort. METHODS A prospective, longitudinal cohort study was performed on a population-based cohort of Southern Chinese volunteers. T2-weighted magnetic resonance imaging (MRI) was used at baseline to identify any OYL and was verified with computed tomography. Follow-up MRI was performed 5 years later. Parameters under study included the size of OYL, levels of involvement, morphology (round, triangular, beak), whether it crossed the midline and any disc degeneration. RESULTS A total of 114 (6.1%) individuals were identified to have OYL at baseline out of the 1864 individuals. Size progression occurred predominantly at the lower thoracic region. Majority of the new OYL were also in the lower thoracic spine and was associated with higher body mass index (BMI). Smokers were associated with OYL size progression while patients with higher BMI tended to develop new OYL at follow-up. Progression commonly occurred at the lower thoracic levels and regression occurred mostly at the upper thoracic levels. CONCLUSIONS This is the first population-based series addressing the natural history of OYL. Better understanding of the natural history of OYL may provide incentive to introduce preventive measures such as weight reduction and close monitoring for myelopathy development in those at-risk groups for progression. This is especially important for patients with lower thoracic OYL and who are smokers with higher BMI. LEVEL OF EVIDENCE 1 (prognostic study).
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Affiliation(s)
- Chris Yuk Kwan Tang
- The University of Hong Kong, Pokfulam, Hong Kong, SAR, China,Chris Yuk Kwan Tang and Jason Pui Yin Cheung contributed equally to this study
| | | | - Dino Samartzis
- The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- The University of Hong Kong, Pokfulam, Hong Kong, SAR, China,Chris Yuk Kwan Tang and Jason Pui Yin Cheung contributed equally to this study.,Jason Pui Yin Cheung, Professorial Block, 5th Floor, 102 Pokfulam Road, Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
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Sun TC, Makara M, Martinez-Taboada F. Computed Tomography-Derived Occipital-Coccygeal Length and Ilium Wing Distance Correlates with Skin to Epidural and Intrathecal Depths in Dogs. Vet Sci 2020; 7:E196. [PMID: 33287250 PMCID: PMC7761638 DOI: 10.3390/vetsci7040196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
The current clinical techniques for neuraxial needle placement in dogs are predominantly blind without prior knowledge of the depth required to reach the desired space. This study investigated the correlation and defined the relationship between easily obtainable external landmark variables in the dog; occipital-coccygeal length (OCL) and ilium wings distance (IWD), with the skin to epidural and intrathecal space distances using computed tomography (CT). The CT images of 86 dogs of different breeds were examined in this retrospective observational study. Images of dogs in sternal recumbency were optimized to the sagittal view. The distances between the skin and lumbosacral epidural space (LSE) and skin to sacrococcygeal space (SCE) were measured to the ligamentum flavum surrogate (LFS) line. The distance between the skin and the intrathecal space (ITS) was measured from the skin to the vertebral canal at the interlumbar (L5-L6) space. Measurements of the IWD and OCL were performed on dorsal and scout views, respectively. Linear regression equations and Pearson's correlation coefficients were calculated between variables. Data were reported as mean (standard deviation). Significance was set as alpha < 0.05. After exclusion of four dogs, 82 CT scans were included. The depths were LSE 45 (15) mm, SCE 23 (10) mm, and ITS 50 (15) mm. There was a moderate correlation between OCL with LSE (=14.2 + OCL * 0.05 (r = 0.59, p < 0.0001)), and a strong correlation with ITS (=11.4 + OCL * 0.07 (r = 0.76, p < 0.0001)), while a very weak correlation was found with SCE (=14.0 + OCL * 0.02 (r = 0.27, p < 0.0584)). Similarly, with IWD, there was a moderate correlation with LSE (=10.8 + IWD * 0.56 (r = 0.61, p < 0.0001)), and strong correlation with ITS (=9.2 + IWD * 0.67 (r = 0.75, p < 0.0001)), while a weak correlation was found with SCE (=11.2 + IWD * 0.2 (r = 0.32, p < 0.0033)). Mathematical formulae derived from the multiple regression showed that the body condition score (BCS) improved the relationship between IWD and OCL and the LSE, SCE and ITS, while the addition of body weight was associated with multicollinearity. Further studies are required to determine the accuracy of the algorithms to demonstrate their ability for prediction in a clinical setting.
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Affiliation(s)
- Tsim Christopher Sun
- Department of Anaesthesia, The University Veterinary Teaching Hospital, School of Veterinary Science, The University of Sydney, Sydney, NSW 2050, Australia;
| | - Mariano Makara
- Diagnostic Imaging Unit, The University Veterinary Teaching Hospital, School of Veterinary Science, The University of Sydney, Sydney, NSW 2050, Australia;
| | - Fernando Martinez-Taboada
- Department of Anaesthesia, The University Veterinary Teaching Hospital, School of Veterinary Science, The University of Sydney, Sydney, NSW 2050, Australia;
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ÇAKAR A, ATMACA MM, KOTAN D, DURMUŞ H, DEYMEER F, OFLAZER P, PARMAN Y. Lumbar Spinal Stenosis: A Rare Presentation of Hereditary Transthyretin Amyloidosis. Noro Psikiyatr Ars 2020; 59:77-79. [PMID: 35317495 PMCID: PMC8895807 DOI: 10.29399/npa.26124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/03/2020] [Indexed: 06/14/2023] Open
Abstract
Hereditary transthyretin amyloidosis (hATTR) is caused by the mutations of the transthyretin (TTR) gene. Length dependent sensory-motor neuropathy with autonomic involvement is the hallmark of the disease. However, it can manifest with unusual phenotypes. A 53-year-old man presented with progressive weakness in lower limbs and operated for lumbar spinal stenosis. The progression of weakness restarted after two years with the addition of symptoms related to polyneuropathy. Electrodiagnostic studies revealed sensorimotor polyneuropathy with autonomic involvement. Sural nerve biopsy disclosed amyloid deposits. Genetic testing of TTR gene identified Glu89Gln mutation. Two years after the diagnosis, he had another decompressive surgery for lumbar spinal stenosis. Histopathological examination of ligamentum flavum specimens revealed amyloid deposits. During the follow up, he was diagnosed with laryngeal amyloidosis, which is an unusual manifestation. Seven years after the diagnosis, he died due to cardiac complications. Our patient suggested that hATTR with Glu89Gln may present with atypical symptoms. Clinicians should carefully look for hATTR in recurrent lumbar stenosis.
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Affiliation(s)
- Arman ÇAKAR
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine Istanbul University, İstanbul, Turkey
| | - Murat Mert ATMACA
- Department of Neurology, Istanbul Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Dilcan KOTAN
- Department of Neurology, Faculty of Medicine Sakarya University, Sakarya, Turkey
| | - Hacer DURMUŞ
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine Istanbul University, İstanbul, Turkey
| | - Feza DEYMEER
- Department of Neurology, Memorial Şişli Hospital, İstanbul, Turkey
| | - Piraye OFLAZER
- Department of Neurology, Faculty of Medicine Koç University, İstanbul, Turkey
| | - Yeşim PARMAN
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine Istanbul University, İstanbul, Turkey
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Zhu X, Qiu Z, Liu Z, Shen Y, Zhou Q, Jia Y, Sun X, Li S. CT-Guided Percutaneous Lumbar Ligamentum Flavum Release by Needle Knife for Treatment of Lumbar Spinal Stenosis: A Case Report and Literature Review. J Pain Res 2020; 13:2073-2081. [PMID: 32884333 PMCID: PMC7434627 DOI: 10.2147/jpr.s255249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/27/2020] [Indexed: 11/23/2022] Open
Abstract
Case The patient was a 62-year-old woman presenting with low-back pain of 3 years’ duration and numbness in the right leg. Diagnosis She was diagnosed with lumbar spinal stenosis based on combined magnetic resonance imaging, physical examination, and symptoms. Interventions Treatment with computed tomography–guided percutaneous release of the ligamentum flavum was delivered. Outcomes Relief of symptoms immediately after treatment and complete resolution of symptoms after 1 month were achieved. At follow-up, there was no recurrence of symptoms after 2, 4, 6, and 12 months. Conclusion Lumbar ligamentum flavum hypertrophy is an important cause of degenerative lumbar spinal stenosis. The hypertrophic ligamentum flavum can directly compress the spinal canal, squeeze the cauda equina, and simultaneously lead to a reduction in the anteroposterior diameter of the intervertebral foramen, which compresses the nerve roots and causes numbness and other symptoms of lower extremities. In clinical practice, doctors should combine imaging findings with patient symptoms for diagnosis and an individualized treatment plan for each patient with lumbar spinal stenosis, and conduct gradual stepwise treatment using conservative minimally invasive surgery to prevent excessive surgery. ![]()
Point your mobile at the code above. If you have a QR code-reader, the video abstract will appear. Or use: https://youtu.be/xUgzwLiZT5c
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Affiliation(s)
- Xinyue Zhu
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Department of Rehabilitation Medicine, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
| | - Zuyun Qiu
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Graduate School, Beijing University of Traditional Chinese Medicine, Beijing, People's Republic of China
| | - Zixiang Liu
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yifeng Shen
- Department of Traditional Chinese Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Qiaoyin Zhou
- Chinese Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People's Republic of China
| | - Yan Jia
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Graduate School, Beijing University of Traditional Chinese Medicine, Beijing, People's Republic of China
| | - Xiaojie Sun
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Graduate School, Beijing University of Traditional Chinese Medicine, Beijing, People's Republic of China
| | - Shiliang Li
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People's Republic of China
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Sun C, Zhang H, Wang X, Liu X. Ligamentum flavum fibrosis and hypertrophy: Molecular pathways, cellular mechanisms, and future directions. FASEB J 2020; 34:9854-9868. [PMID: 32608536 DOI: 10.1096/fj.202000635r] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
Hypertrophy of ligamentum flavum (LF), along with disk protrusion and facet joints degeneration, is associated with the development of lumbar spinal canal stenosis (LSCS). Of note, LF hypertrophy is deemed as an important cause of LSCS. Histologically, fibrosis is proved to be the main pathology of LF hypertrophy. Despite the numerous studies explored the mechanisms of LF fibrosis at the molecular and cellular levels, the exact mechanism remains unknown. It is suggested that pathophysiologic stimuli such as mechanical stress, aging, obesity, and some diseases are the causative factors. Then, many cytokines and growth factors secreted by LF cells and its surrounding tissues play different roles in activating the fibrotic response. Here, we summarize the current status of detailed knowledge available regarding the causative factors, pathology, molecular and cellular mechanisms implicated in LF fibrosis and hypertrophy, also focusing on the possible avenues for anti-fibrotic strategies.
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Affiliation(s)
- Chao Sun
- Department of Spine Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Han Zhang
- Department of Spine Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Wang
- Department of Spine Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xinhui Liu
- Department of Spine Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
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Mekhail NA, Costandi SJ, Armanyous S, Vallejo R, Poree LR, Brown LL, Golovac S, Deer TR. The Impact of Age on the Outcomes of Minimally Invasive Lumbar Decompression for Lumbar Spinal Stenosis. Med Devices (Auckl) 2020; 13:151-161. [PMID: 32581602 PMCID: PMC7280254 DOI: 10.2147/mder.s251556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background and Purpose Minimally invasive lumbar decompression (mild®) is an effective long-term therapy for patients with symptomatic lumbar spinal stenosis (LSS) resulting primarily from hypertrophic ligamentum flavum (HLF). Most subjects in clinical studies of the mild procedure have been older adults (age≥65). While the incidence of LSS increases with age, a substantial number of adults (age<65) also suffer from neurogenic claudication secondary to HLF. In this report, outcomes of mild were compared between adults and older adults. Patients and Methods All prospective studies of the mild procedure with a 1-year follow-up completed since the beginning of 2012 that allowed the inclusion of adult patients of all ages were reviewed. Outcomes of visual analog scale (VAS), Oswestry Disability Index (ODI), Pain Disability Index (PDI), Roland Morris Low Back Pain and Disability Questionnaire (RMQ), standing time and walking distance were compared for adults and older adults. Results Four studies met the inclusion criteria, resulting in an analysis of 49 adults and 160 older adults. Patients in both age groups experienced significant mean improvements in all but one outcome measure at 6- and 12-month follow-up. Differences between the two age groups in all scores at 6 and 12 months were not statistically significant. Conclusion Analysis of the four studies indicated that symptom improvements for adults and older adults were significant from baseline, and no statistically significant difference was observed between the two age groups. These results illustrate that mild can be an effective treatment for LSS due primarily to HLF, regardless of the adult patient age.
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Affiliation(s)
- Nagy A Mekhail
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, OH, USA
| | - Shrif J Costandi
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, OH, USA
| | - Sherif Armanyous
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, OH, USA
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Ye S, Kwon W, Bae T, Kim S, Lee J, Cho T, Park J, Kim K, Hur JK, Hur JW. CCN5 Reduces Ligamentum Flavum Hypertrophy by Modulating the TGF-β Pathway. J Orthop Res 2019; 37:2634-2644. [PMID: 31334871 PMCID: PMC6899892 DOI: 10.1002/jor.24425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
Ligamentum flavum hypertrophy (LFH) is the most important component of lumbar spinal canal stenosis. Although the pathophysiology of LFH has been extensively studied, no method has been proposed to prevent or treat it. Since the transforming growth factor-β (TGF-β) pathway is known to be critical in LFH pathology, we investigated whether LFH could be prevented by blocking or modulating the TGF-β mechanism. Human LF cells were used for the experiments. First, we created TGF-β receptor 1 (TGFBR1) knock out (KO) cells with CRISPR (clustered regularly interspaced short palindromic repeats)/Cas9 biotechnology and treated them with TGF-β1 to determine the effects of blocking the TGF-β pathway. Subsequently, we studied the effect of CCN5, which has recently been proposed to modulate the TGF-β pathway. To assess the predisposition toward fibrosis, α-smooth muscle actin (αSMA), fibronectin, collagen-1, collagen-3, and CCN2 were evaluated with quantitative real-time polymerase chain reaction, western blotting, and immunocytochemistry. The TGFBR1 KO LF cells were successfully constructed with high KO efficiency. In wild-type (WT) cells, treatment with TGF-β1 resulted in the overexpression of the messenger RNA (mRNA) of fibrosis-related factors. However, in KO cells, the responses to TGF-β1 stimulation were significantly lower. In addition, CCN5 and TGF-β1 co-treatment caused a notable reduction in mRNA expression levels compared with TGF-β1 stimulation only. The αSMA protein expression increased with TGF-β1 but decreased with CCN5 treatment. TGF-β1 induced LF cell transdifferentiation from fibroblasts to myofibroblasts. However, this cell transition dramatically decreased in the presence of CCN5. In conclusion, CCN5 could prevent LFH by modulating the TGF-β pathway. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2634-2644, 2019.
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Affiliation(s)
| | - Woo‐Keun Kwon
- Department of Neurosurgery, College of MedicineKorea University Anam Hospital73, Inchon‐ro, Seongbuk‐guSeoul02841Korea
| | - Taegeun Bae
- Department of Medicine, Graduate SchoolKyung Hee UniversitySeoulKorea
| | - Sunghyun Kim
- Department of Molecular and Computational BiologyUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Jang‐Bo Lee
- Department of Neurosurgery, College of MedicineKorea University Anam Hospital73, Inchon‐ro, Seongbuk‐guSeoul02841Korea
| | - Tai‐Hyoung Cho
- Department of Neurosurgery, College of MedicineKorea University Anam Hospital73, Inchon‐ro, Seongbuk‐guSeoul02841Korea
| | - Jung‐Yul Park
- Department of Neurosurgery, College of MedicineKorea University Anam Hospital73, Inchon‐ro, Seongbuk‐guSeoul02841Korea
| | - Kyoungmi Kim
- Department of Biomedical Sciences and Department of Physiology, College of MedicineKorea UniversitySeoulKorea
| | - Junho K. Hur
- Department of Pathology, College of MedicineKyung Hee University26, Kyungheedae‐ro, Dongdaemun‐guSeoul02447Korea,Department of Biomedical Sciences, Graduate SchoolKyung Hee UniversitySeoulKorea
| | - Junseok W. Hur
- Department of Neurosurgery, College of MedicineKorea University Anam Hospital73, Inchon‐ro, Seongbuk‐guSeoul02841Korea
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Abstract
INTRODUCTION Calcification of ligamentum flavum (CLF) is an important cause of spinal stenosis and spinal cord compression. CLF does not usually induce immediate quadriparesis. Here we describe a rare case of immediate quadriparesis due to a large calcified mass containing liquids in the ligamentum flavum, which was easily confused with gout crystals. PATIENT CONCERNS A 74-year-old Asian male felt progressive bilateral arm and leg weakness. On the fourth day, acute quadriparesis occurred. DIAGNOSIS Coronal and sagittal computerized tomography (CT) and magnetic resonance imaging (MRI) showed a large circular mass in the left posterior part of the cervical 3/4 spinal canal, protruding into the canal, and occupying one-half of the spinal canal. INTERVENTIONS Emergency laminectomy was performed at C3/4 level. The huge cyst was excised and 1 ml of white viscous liquid flowed out. OUTCOMES After operation, CT and MRI showed a full laminectomy of C3/4 and complete decompression of the cervical spinal cord. Hematoxylin-eosin (HE) staining showed that large amounts of calcium was deposited around cystic tissues. Five-year follow-up after laminectomy showed good recovery. CONCLUSION This case of immediate quadriparesis, caused by a large calcified mass containing fluid, is very rare. It should be at the earliest stage of calcification. Laminectomy is an effective treatment. This calcification was deceptive and was easily confused with gout crystals. It can help to understand the exact pathophysiology of CLF.
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Abstract
Surgery for ossification of the ligamentum flavum (OLF) comes with a relatively high risk of dural tear. We report a 50-year-old woman, who presented with symptomatic spinal stenosis from OLF at T11-T12 and lower lumbar spondylosis for which a single stage posterior decompression and instrumented fusion of both sites was done. Removal of the OLF resulted in a small dural tear with intact arachanoid which was covered using a fibrin sealant. In the first post-operative day, the patient's neurology started deteriorating. An MR scan was done to look for hematoma. It showed the spinal cord herniating out of the thecal sac at the operated level. Emergency re-operation was done to reduce the herniation and the dural defect was repaired. The patient gradually recovered to her best functional status. Based on this experience, we advise primary repair of inadvertent durotomies.
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Affiliation(s)
| | - Mark Tan
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital , Singapore
| | | | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital , Singapore
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Sidon E, Shemesh SS, Mor-Yossef Moldovan L, Wiesenfeld Y, Ohana N, Benayahu D. Molecular profile of ultrastructure changes of the ligamentum flavum related to lumbar spinal canal stenosis. J Cell Biochem 2019; 120:11716-11725. [PMID: 30825230 DOI: 10.1002/jcb.28451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 01/24/2023]
Abstract
Lumbar spinal canal stenosis (LSCS) is a degenerative disease observed by hypertrophy of the ligamentum flavum (LF) that cause compression of the lumbar neural content. Diabetes mellitus (DM) is a risk factor for the disease and we have shown previously that DM increases the fibrosis and elastic fiber loss in patients with LSCS. The purpose of this study was to find the proteins that play a role in the development of this clinical pathogenesis and the effect of DM on protein expression. LF tissue retrieved from patients diagnosed with LSCS, some were also diagnosed with DM, were compared with LF from patients diagnosed with herniated nucleus pulposus (HNP). The tissues were analyzed by mass spectrometry for proteins profile alteration. We found that LF of LSCS/DM patients exhibited significantly higher levels of proteoglycan proteins and latent transforming growth factor β-binding protein (LTBP2 and LTBP4). Additionally, an increase of HTRA serine protease 1 and insulin-like growth factor binding protein-5 were noted. The higher fibrosis was also associated with proteins related to inflammation and slower tissue repair. Collagen 6 and transforming growth factor inhibitor are related to activation of the anti-inflammatory M2 pathway that is associated with tissue repair. The decrease of these proteins expression in LSCS/DM is associated with increased levels and activation of M1 pro-inflammatory pathways. Interestingly, C3 and C4b members of the complement complex and mannose receptor-like protein (CLEC18) paralogous proteins were detectable solely at the LSCS/DM patients' samples. Histology analysis shows that inflammatory was induced by the hyperglycemic conditions in diabetic patients involve in altering the matrix compositions. Thus, the protein profiles associated with inflammatory pathways affecting the LF suggested increasing susceptibility of developing the degeneration under hyperglycemic conditions.
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Affiliation(s)
- Eliezer Sidon
- Orthopedic Department, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Department of Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai S Shemesh
- Orthopedic Department, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Department of Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Mor-Yossef Moldovan
- Department of Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yarden Wiesenfeld
- Department of Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Ohana
- Orthopedic Department, Meir Medical Center, Kfar Saba, Israel
| | - Dafna Benayahu
- Department of Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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42
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Lu C, Liu Z, Zhang H, Duan Y, Cao Y. [Mechanism of p38 mitogen activated protein kinase signaling pathway on promoting the hypertrophy of human lumbar ligamentum flavum via transforming growth factor β 1/connective tissue growth factor]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:730-735. [PMID: 31198002 DOI: 10.7507/1002-1892.201811140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the mechanism of p38 mitogen activated protein kinase (MAPK) signaling pathway in regulating the hyperplasia and hypertrophy of human lumbar ligamentum flavum via transforming growth factor β 1 (TGF-β 1)/connective tissue growth factor (CTGF). Methods The lumbar ligamentum flavum tissue taken from patient with lumbar intervertebral disc herniation was isolated by collagenase-predigested explant cultures. The ligamentum flavum cells were treated with the extracellular regulated protein kinase pathway blocker PD98059, c-Jun N-terminal kinase pathway blocker SP600125, and p38 pathway blocker SB203580, and then the mRNA expressions of CTGF, collagen type Ⅰ, and collagen type Ⅲ were detected by real-time fluorescence quantitative PCR (qRT-PCR). The ligamentum flavum cells were divided into 4 groups, and transfected with small interfering RNA (siRNA), p38 siRNA, siRNA+3 ng/mL TGF-β 1, and p38 siRNA+3 ng/mL TGF-β 1 in groups A, B, C, and D, respectively. After 24 hours of transfection, immunofluorescence staining was performed to observe the expressions of p38 and phosphorylation p38 (p-p38); the relative mRNA expressions of CTGF, collagen type Ⅰ, and collagen type Ⅲ in each group were detected by qRT-PCR; the protein expression of CTGF in each group was detected by Western blot. Results p38 pathway blocker SB203580 could significantly reduce the relative mRNA expressions of CTGF, collagen type Ⅰ, and collagen type Ⅲ ( P<0.05). After 24 hours of transfection, immunofluorescence staining showed positive staining with p38 and p-p38 expressions in groups A, C, and D and negative staining in group B. Compared with group A, the relative mRNA expressions of CTGF, collagen type Ⅰ, and collagen type Ⅲ and relative protein expression of CTGF in group B decreased significantly ( P<0.05), while those in groups C and D increased significantly ( P<0.05); and those indicators significantly increased in group C than in group D ( P<0.05). Conclusion TGF-β 1/CTGF based on the p38 MAPK signaling pathway play an important role in the occurance and development of hypertrophy of human lumbar ligamentum flavum.
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Affiliation(s)
- Changhuai Lu
- Department of Spine Disease Area of Orthopedics and Traumatology, No.1 Traditional Chinese Medicine Hospital of Changde, Changde Hospital Affiliated to Hunan University of Traditional Chinese Medicine, Changde Hunan, 415000, P.R.China
| | - Zhijun Liu
- Department of Spine Disease Area of Orthopedics and Traumatology, No.1 Traditional Chinese Medicine Hospital of Changde, Changde Hospital Affiliated to Hunan University of Traditional Chinese Medicine, Changde Hunan, 415000, P.R.China
| | - Hongbo Zhang
- Department of Spine Disease Area of Orthopedics and Traumatology, No.1 Traditional Chinese Medicine Hospital of Changde, Changde Hospital Affiliated to Hunan University of Traditional Chinese Medicine, Changde Hunan, 415000, P.R.China
| | - Yang Duan
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou Guangdong, 510282,
| | - Yanlin Cao
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou Guangdong, 510282, P.R.China
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Benditz A, Sprenger S, Rauch L, Weber M, Grifka J, Straub RH. Increased pain and sensory hyperinnervation of the ligamentum flavum in patients with lumbar spinal stenosis. J Orthop Res 2019; 37:737-743. [PMID: 30747438 DOI: 10.1002/jor.24251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/05/2019] [Indexed: 02/04/2023]
Abstract
Nociceptive sensory nerve fibers have never been investigated in the ligamentum flavum (LF) of patients with LSS. The aim was to analyze nociceptive sensory nerve fibers in the ligamentum flavum (LF) of patients with LSS. A prospective study in patients with lumbar spinal stenosis (LSS) undergoing invasive surgical treatment for lumbar spinal stenosis (LSS) with flavectomy was performed. Patients with LSS were subjected to flavectomy and density of sensory and sympathetic nerve fibers, macrophages, vessels, activated fibroblasts, and cells were investigated by immunostaining techniques. A group of patients with acute disc herniation served as control group. We found a higher density of sensory nerve fibers in LSS patients versus controls. These findings support the role of LF in associated low back pain. Density of sensory nerve fibers in LSS, was positively correlated with typical markers of clinical pain and functional disability, but not with LF density of activated fibroblasts. Inflammation as estimated by macrophage infiltration and higher vascularity does not play a marked role in LF in our LSS patients. In the present study, compared to men with LSS, women with LSS demonstrate more pain and depression, and show a higher density of sensory nerve fibers in LF. This study shed new light on nociceptive nerve fibers, which are increased in LSS compared to controls. The findings speak against a strong inflammatory component in LSS. A higher pain levels in women compared to men can be explained by a higher density of nociceptive nerve fibers. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-7, 2019.
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Affiliation(s)
- Achim Benditz
- Department of Orthopedic Surgery, University Hospital Regensburg, Asklepios Clinic Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Germany
| | - Svenja Sprenger
- Department of Orthopedic Surgery, University Hospital Regensburg, Asklepios Clinic Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Germany.,Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Luise Rauch
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Markus Weber
- Department of Orthopedic Surgery, University Hospital Regensburg, Asklepios Clinic Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University Hospital Regensburg, Asklepios Clinic Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Germany
| | - Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, Regensburg, Bayern, Germany
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44
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Salehpour F, Mirzaei F, Rezakhah A, Aeinfar K, Kazemzadeh M, Alavi SAN. Ligamentum Flavum Hematoma Presented with Low Back Pain: A Case Report and Review of the Literature. Int J Spine Surg 2018; 12:337-341. [PMID: 30276090 DOI: 10.14444/5039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A 61-year-old woman with no past medical history presented with low back pain and radicular pain in the right lower extremity. Magnetic resonance imaging of the lumbar spine showed a heterogeneous intensity mass in the lateral recess of the spinal canal at the L4-5 disk level. Postoperatively, her radicular pain resolved within a few days with excellent low back pain relief. Ligamentum flavum hematoma is a rare differential diagnosis for cystic lesions in the lumbar spine that can be removed simply by surgery with excellent relief of symptoms and improvement in strength of the right lower extremity and increased sensitivity.
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Affiliation(s)
- Firooz Salehpour
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Mirzaei
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Rezakhah
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamkar Aeinfar
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Kazemzadeh
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ahmad Naseri Alavi
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Han Y, Hong Y, Li L, Li T, Zhang Z, Wang J, Xia H, Tang Y, Shi Z, Han X, Chen T, Liu Q, Zhang M, Zhang K, Hong W, Xue Y. A Transcriptome-Level Study Identifies Changing Expression Profiles for Ossification of the Ligamentum Flavum of the Spine. Mol Ther Nucleic Acids 2018; 12:872-883. [PMID: 30161026 PMCID: PMC6120750 DOI: 10.1016/j.omtn.2018.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/10/2018] [Accepted: 07/31/2018] [Indexed: 01/09/2023]
Abstract
Ossification of the ligamentum flavum (OLF) is a common spinal disorder that causes myelopathy and radiculopathy. Non-coding RNAs (ncRNAs) are involved in numerous pathological processes; however, very few ncRNAs have been identified to be correlated with OLF. Here we compared the expression of lncRNA, mRNA, circRNA, and microRNA in OLF tissues from OLF patients and healthy volunteers through mRNA, lncRNA, and circRNA microarrays and microRNA sequencing. A total of 2,054 mRNAs, 2,567 lncRNAs, 627 circRNAs, and 28 microRNAs (miRNAs) were altered during the process of OLF. qPCR confirmed the differential expression of selected mRNAs and ncRNAs. An lncRNA-mRNA co-expression network, miRNA-mRNA target prediction network, and competing endogenous RNA (ceRNA) network of circRNA-miRNA-mRNA were constructed based on a correlation analysis of the differentially expressed RNA transcripts. Subsequently, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses for the differentially expressed mRNAs and the predicted miRNAs target genes were performed. In addition, a deregulated miRNA-19b-3p-based miRNA-circRNA-lncRNA-mRNA network was confirmed, by gain-of-function and loss-of-function experiments, to function in the process of ossification. Taken together, this study provides a systematic perspective on the potential function of ncRNAs in the pathogenesis of OLF.
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Affiliation(s)
- Yawei Han
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yuheng Hong
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Liandong Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Tengshuai Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhen Zhang
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Jingzhao Wang
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Han Xia
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Yutao Tang
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhemin Shi
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xiaohui Han
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Ting Chen
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Qi Liu
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Mengxia Zhang
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Kun Zhang
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Wei Hong
- Department of Histology and Embryology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.
| | - Yuan Xue
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China.
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Wani T, Beltran R, Veneziano G, AlGhamdi F, Azzam H, Akhtar N, Tumin D, Majid Y, Tobias JD. Dura to spinal cord distance at different vertebral levels in children and its implications on epidural analgesia: A retrospective MRI-based study. Paediatr Anaesth 2018; 28:338-341. [PMID: 29405534 DOI: 10.1111/pan.13339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The distance from the dura to spinal cord is not uniform at different vertebral levels. The dura to spinal cord distance may be a critical factor in avoiding the potential for neurological injury caused by needle trauma after a dural puncture. Typically, the greater the dura to spinal cord distance, the larger the potential safety margin. The objective of our study is to measure dura to spinal cord distance at two thoracic levels T6 -7 , T9 -10 , and one lumbar level L1 -2 using MRI images. METHODS Eighty-eight children under the age of 8 years old qualified for the study. The distance from dural side of ligamentum flavum to the posterior margin of the spinal cord was defined as dura to spinal cord distance. Sagittal T2 -weighted images of the thoracic and lumbar spine were used to measure the dura to spinal cord distance at the T6-7 , T9-10 , and L1-2 interspaces. Measurements were taken perpendicular to long axis of the vertebral body at each level. RESULTS The dura to spinal cord distance was 5.9 ± 1.6 mm at T6-7 (range: 1.4-9.9 mm), 5.0 ± 1.6 mm at T9-10 (1.2-8.1 mm), and 3.6 ± 1.2 mm at L1-2 (1.2-6.8 mm). There were no evident differences in dura to spinal cord distance by gender, age, height, or weight. CONCLUSION The present study reports that the largest dura to spinal cord distance is found at the T5-6 level, and the shortest dura to spinal cord distance at the L1-2 level. There appears to be substantially more room in the dorsal subarachnoid space at the thoracic level. The risk of spinal cord damage resulting from accidental epidural needle advancement may be greater in the lumbar region due to a more dorsal location of the spinal cord in the vertebral canal compared to the thoracic region.
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Affiliation(s)
- Tariq Wani
- Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ralph Beltran
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Giorgio Veneziano
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Faris AlGhamdi
- Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hatem Azzam
- Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nahida Akhtar
- Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Yasser Majid
- Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Rimmer CT, Adds PJ. The posterior epidural ligament in the thoracic region: a cadaveric and histological study. Folia Morphol (Warsz) 2018; 77:748-751. [PMID: 29569699 DOI: 10.5603/fm.a2018.0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 11/25/2022]
Abstract
The existence of posterior epidural ligaments (PEL) has been established in the lumbar region, but they have hitherto not been shown to exist in the thoracic vertebral column. Their identification is of clinical significance in respect to incidental durotomy and the circulation of cerebrospinal fluid (CSF). Fourteen thoracic spine sections were dissected by cutting through the intervertebral disc and separating the ligamentum flavum from the vertebra above. The dural sheath was gently retracted anteriorly to identify macroscopic connections between the ligamentum flavum and the dura. Macroscopic connections observed were dissected out, retaining some dural sheath and ligamentum flavum. Histological staining with haematoxylin and eosin and Miller's elastin stain was used to investigate cellular connections. Thoracic PELs were positively identified in 5 of the 14 cadavers (35.7%). Histology showed similarities between the thoracic and lumbar PELs. Fifteen separate PELs were identified within these five thoracic sections. The thoracic PEL has sufficient tensile strength to present a risk to the integrity of the dural sheath during surgery, and surgeons should be aware of these connections when operating on the thoracic spine. PELs may also contribute to the circulation of CSF in the spinal subarachnoid space.
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Affiliation(s)
| | - P J Adds
- St George's, University of London, Cranmer Terrace, SW17 0RE London, United Kingdom.
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48
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Abstract
We report a case of high thoracic ossification of the ligamentum flavum (OLF) causing a partial Horner's syndrome. A 57-year-old man developed a walking disorder, as well as right-sided miosis and anhidrosis. Magnetic resonance imaging demonstrated a spinal cord compressing T2-T3 OLF. The patient improved after surgery.
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Affiliation(s)
- Dong Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
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49
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Sohail AH, Maan MAA, Khan MS, Masood Q. Isolated ligamentum flavum ossification in primary hypoparathyroidism. Surg Neurol Int 2018; 9:4. [PMID: 29399376 PMCID: PMC5778726 DOI: 10.4103/sni.sni_364_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/26/2017] [Indexed: 12/27/2022] Open
Abstract
Background: The ligamenta flava can undergo ossification and calcification resulting in myelopathy. Only seven cases of ligamentum flavum ossification in association with hypoparathyroidism have been reported, most of which had concurrent osseous changes in other spinal ligaments. Here, we report a patient with hypoparathyroidism who presented with ligamentum flavum ossification causing both cervical and thoracic myelopathy. Case Description: A 43-year-old male presented with backache, urinary retention, and lower limb weakness for the last few days. Magnetic resonance imaging scan showed ossification of the ligamentum flavum in the cervical and thoracic regions, with severe spinal stenosis. Following spinal decompressive surgery, the patient made a complete recovery. Primary hypoparathyroidism was found to be the underlying cause for ligamentum flavum ossification. Conclusion: Ossification of ligamentum flavum secondary to hypoparathyroidism should be considered as a possible cause of myelopathy in all patients presenting with symptoms of spinal cord compression.
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Affiliation(s)
- Amir H Sohail
- Aga Khan University Medical College, Karachi, Pakistan
| | | | | | - Qamar Masood
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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Mori T, Sakai Y, Kayano M, Matsuda A, Oboki K, Matsumoto K, Harada A, Niida S, Watanabe K. MicroRNA transcriptome analysis on hypertrophy of ligamentum flavum in patients with lumbar spinal stenosis. Spine Surg Relat Res 2017; 1:211-217. [PMID: 31440636 PMCID: PMC6698563 DOI: 10.22603/ssrr.1.2017-0023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/14/2017] [Indexed: 12/22/2022] Open
Abstract
Introduction Molecular pathways involved in ligamentum flavum (LF) hypertrophy are still unclarified. The purpose of this study was to characterize LF hypertrophy by microRNA (miRNA) profiling according to the classification of lumbar spinal stenosis (LSS). Methods Classification of patients with LSS into ligamentous and non-ligamentous cases was conducted by clinical observation and the morphometric parameter adopting the LF/spinal canal area ratio (LSAR) from measurements of magnetic resonance imaging (MRI) T2 weighed images. LF from patients with ligamentous stenosis (n=10) were considered as the degenerative hypertrophied samples, and those from patients with non-ligamentous LSS (n=7) and lumbar disc herniation (LDH, n=3) were used as non-hypertrophied controls. Profiling of miRNA from all samples was conducted by Agilent microarray. Microarray data analysis was performed with GeneSpring GX, and pathway analysis was performed using Ingenuity Pathway Analysis. Results The mean LSAR in the ligamentous group was significantly higher than that in the control group (0.662±0.154 vs 0.301±0.068, p=0.0000171). Ten significantly differentially expressed miRNA were identified and taken as a signature of LF hypertrophy: nine miRNA showed down-regulated expression, and one showed up-regulated expression in the ligamentous LF. Among those, miR-423-5p (rs=-0.473, p<0.05), miR-4306 (rs=-0.628, p<0.01), miR-516b-5p (rs=-0.629, p<0.01), and miR-497-5p (rs=0.461, p<0.05) were correlated to the LSAR. Pathway analysis predicted aryl hydrocarbon receptor signaling (p<0.01), Wnt/β-catenin signaling (p<0.01), and insulin receptor signaling (p<0.05) as canonical pathways associated with the miRNA signature. Conclusions Classification based on quantification of the MRI axial image is useful for studying hypertrophy of the LF. Aryl hydrocarbon receptor and Wnt/β-catenin signaling may be involved in LF hypertrophy.
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Affiliation(s)
- Taiki Mori
- Medical Genome Center, National Center for Geriatrics and Gerontology (NCGG), Aichi, Japan
| | | | - Mitsunori Kayano
- Medical Genome Center, National Center for Geriatrics and Gerontology (NCGG), Aichi, Japan.,Research Center for Global Agromedicine, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Akio Matsuda
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development (NRICHD), Tokyo, Japan
| | - Keisuke Oboki
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development (NRICHD), Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development (NRICHD), Tokyo, Japan
| | | | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology (NCGG), Aichi, Japan
| | - Ken Watanabe
- Department of Bone and Joint Disease, NCGG, Aichi, Japan
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