Aggravation of Ossified Ligamentum Flavum Lesion Is Associated With the Degree of Obesity

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.

Strong relationship between dyslipidemia and the ectopic ossification of the spinal ligaments

“…Obesity is more common in symptomatic OLF and T-OPLL, with a strong ossi cation tendency of the entire spinal ligament. [12,13] In addition, OLF and C-OPLL are more likely to occur in men, [6,29] whereas T-OPLL is more likely to occur in women. [5] Our results con rm the previous ndings; however, we would like to emphasize that our results are not necessarily synonymous with the risk of worsening ossi ed lesions, because the present study was based on a risk analysis of an increased prevalence of OLF and OPLL, and included many asymptomatic subjects with relatively small ossi ed lesions.…”

“…[9][10][11] Recent epidemiological studies have reported that obesity is a common aggravating factor in patients with diffuse types of OPLL and OLF, in which the entire spinal ligament tends to ossify. [10][11][12][13][14][15] This suggests that lifestyle-related diseases and visceral obesity may be involved in the development and progression of these conditions. [11][12][13] Dyslipidemia is caused by malnutrition, obesity, sarcopenic obesity, and genetic predisposition and is closely related to metabolic disturbances.…”

“…[10][11][12][13][14][15] This suggests that lifestyle-related diseases and visceral obesity may be involved in the development and progression of these conditions. [11][12][13] Dyslipidemia is caused by malnutrition, obesity, sarcopenic obesity, and genetic predisposition and is closely related to metabolic disturbances. [16][17][18] If dyslipidemia is left untreated, atherosclerosis will develop.…”

“…[20][21][22] In recent years, the association of OPLL/OLF with obesity, malnutrition, genetic factors, and metabolic dysfunction-associated fatty liver disease (MAFLD) has become clear. [10][11][12][13][14][15][23][24][25][26] This suggests that metabolic disturbances related to spinal ligament ossi cation could affect systemic bone metabolism and trigger ectopic ossi cation. Despite the common features of dyslipidemia and spinal ligament ossi cation, no study has investigated their relationship in detail.…”

Deciphering Obesity-Related Gene Clusters Unearths SOCS3 Immune Infiltrates and 5mC/m6A Modifiers in Ossification of Ligamentum Flavum Pathogenesis

“…Additionally, concrete evidence has identified obesity as an independent causal factor for the development of OLF in non-elderly adults ( 8 ). A recent cross-sectional study also demonstrated the aggravation of OLF associated with the degree of obesity ( 9 ). These findings revealed obesity might not only act as a starter but also a facilitator of OLF.…”