Clinical Features of Thoracic Spinal Stenosis-associated Myelopathy

Huang, Xiaofei; Sun, Chuiguo; Liu, Xiaoguang; Liu, Zhongjun; Qi, Qiang; Guo, Zhixin; Li, Weishi; Zeng, Yan; Chen, Zhongqiang

doi:10.1097/bsd.0000000000000081

Cited by 90 publications

(79 citation statements)

References 7 publications

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“…Thoracic ossification of the ligamentum flavum (TOLF) has been considered to be a leading cause of thoracic spinal stenosis and myelopathy [6]. One paper indicates that over 70% of patients suffering from thoracic spinal stenosis have been diagnosed with TOLF [7]. It has been suggested that some related factors are associated with TOLF, such as genetic factors, basic metabolic elements, and mechanical effects [8,9].…”

Section: Introductionmentioning

confidence: 99%

The involvement and possible mechanism of pro-inflammatory tumor necrosis factor alpha (TNF-α) in thoracic ossification of the ligamentum flavum

et al. 2017

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Thoracic ossification of the ligamentum flavum (TOLF) is characterized by ectopic bone formation in the ligamentum flavum and is considered to be a leading cause of thoracic spinal canal stenosis and myelopathy. However, the underlying etiology is not well understood. An iTRAQ proteomics was used to reveal the involvement of inflammation factors in TOLF. TNF-α is a pro-inflammatory cytokine implicated in the pathogenesis of many human diseases. Protein profiling analysis showed that the protein level of TNF-α increased in the ossified ligamentum flavum of TOLF, which was confirmed by western blot. The effects of TNF-α on primary ligamentum flavum cells was examined. Cell proliferation assay demonstrated that primary cells from the ossified ligamentum flavum of TOLF grew faster than the control. Flow cytometry assay indicated that the proportions of cells in S phase of cell cycle of primary cells increased after TNF-α stimulation. To address the effect of TNF-α on gene expression, primary cells were derived from ligamentum flavum of TOLF patients. Culture cells were stimulated by TNF-α. RNA was isolated and analyzed by quantitative RT-PCR. G1/S-specific proteins cyclin D1 and c-Myc were upregulated after TNF-α stimulation. On the other hand, osteoblast differentiation related genes such as Bmp2 and Osterix (Osx) were upregulated in the presence of TNF-α. TNF-α activated Osx expression in a dosedependent manner. Interestingly, a specific mitogen-activated protein kinase ERK inhibitor U0126, but not JNK kinase inhibitor SP600125, abrogated TNF-α activation of Osx expression. This suggests that TNF-α activates Osx expression through the mitogen-activated protein kinase ERK pathway. Taken together, we provide the evidence to support that TNF-α involves in TOLF probably through regulating cell proliferation via cyclin D1 and c-Myc, and promoting osteoblast differentiation via Osx.

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Section: Introductionmentioning

confidence: 99%

The involvement and possible mechanism of pro-inflammatory tumor necrosis factor alpha (TNF-α) in thoracic ossification of the ligamentum flavum

et al. 2017

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“…Thoracic ossification of the ligamentum flavum (OLF), which is the primary cause of thoracic spinal canal stenosis and myelopathy in our previous retrospective review, 1 is reported almost exclusively in East Asian countries 2 such as China, 3 Japan, 4 and Korea. 5 Our previous epidemiological survey revealed a standardized prevalence rate of 63.9% in Chinese people.…”

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Notch signaling pathways in human thoracic ossification of the ligamentum flavum

Chen

Fan

et al. 2016

Journal Orthopaedic Research

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This study investigated the pathological process of Notch signaling in the osteogenesis of ligamentum flavum tissues and cells, and the associated regulatory mechanisms. Notch receptors, ligands, and target genes were identified by quantitative polymerase chain reaction (qPCR) in ligamentum flavum cells and immunohistochemistry in ligamentum flavum sections from ossification of the ligamentum flavum (OLF) patients and controls. The temporospatial expression patterns of JAG1/Notch2/HES1 in human ligamentum flavum cells during osteogenic differentiation were determined by qPCR. Lentiviral vectors for Notch2 overexpression and knockdown were constructed and transfected into ligamentum flavum cells before osteogenic differentiation to examine the function of Notch signaling pathways in the osteogenic differentiation of ligamentum flavum cells. Alkaline phosphatase, Runx2, Osterix, osteocalcin, and osteopontin mRNA levels, alkaline phosphatase activity, and Alizarin Red staining were used as indicators of osteogenic differentiation. JAG1/Notch2/ HES1 mRNA levels were up-regulated in ligamentum flavum cells from OLF patients, which increased during osteogenic differentiation. Immunohistochemical analysis suggested positive Notch2 expression at the ossification front. Down-regulation of Notch2 expression decelerated osteogenic differentiation of ligamentum flavum cells, and Notch2 overexpression promoted osteogenic differentiation of ligamentum flavum cells. Expression of Runx2 and Osterix increased in a manner similar to that of Notch2 during osteogenic differentiation of ligamentum flavum cells, and Notch2 knockdown and overexpression influenced their expression levels. Notch signaling plays an important role in OLF, and Notch may affect the osteogenic differentiation of ligamentum flavum cells via interactions with Runx2 and Osterix.ß

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“…Naturally, patients eventually admitted to our department when their symptoms are more serious for severe spinal cord compression. Patients with T-OLF always complain about trunk or lower extremities sensory abnormality, gait disturbance and urinary dysfunction [5].…”

Section: Introductionmentioning

confidence: 99%

“…Since the course of T-OLF is more insidious and slow, when the symptoms are obvious, it means that the spinal cord is severely compressed[16]. Patients with T-OLF may complained about muscle weakness, gait disturbance, numbness and sensory disturbance of the lower limb[5]. So surgical intervention is generally necessary for symptomatic OLF due to ineffective by using conservative treatment.…”

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confidence: 99%

A comparison of clinical outcomes between percutaneous endoscopic laminectomy decompression and traditional laminectomy decompression in Thoracic Ossification of Ligamentum Flavum with CT classification of type unilateral segments.

Wu¹,

Huang²,

He³

et al. 2020

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Background: The aim of this study was to compare the effectiveness and safety of percutaneous endoscopic laminectomy decompression and traditional laminectomy decompression in the treatment of Thoracic Ossification of Ligamentum Flavum (T-OLF) with CT classification of type unilateral segments. Methods: We executed a retrospective study on 24 cases of T-OLF with CT classification of type unilateral segments between May 2015 and January 2018. All the patients were divided into two groups based on the relation to surgical methods. Patients in group A underwent percutaneous endoscopic laminectomy, and in group B underwent traditional laminectomy. According to the selection criteria, there were 10 patients in group A and 14 patients in group B. We mainly analyzed and compared the clinical, radiologic, perioperative outcomes, and surgery-related complications of the two groups of data. Results: Both groups improved significantly in the following projects：the JOA scores, mean JOA recovery rate, leg pain and radiologic results of decompression. However, no significant difference was found between the two groups. One case occurred dural tear in the early phase of percutaneous endoscopic laminectomy group. One patient occurred dural tear in during removal of OLF adhered to the dura mater in traditional laminectomy group. There were no cases of failure or recurrence in both groups. The percutaneous endoscopic laminectomy group have significant advantages in the following areas: back pain recovery, blood loss, hospital stay, hospitalization expenses and return-to-work. No post-laminectomy kyphosis was observed in any patients. Conclusions: Although percutaneous endoscopic laminectomy in thoracic region has a steep learning curve, percutaneous endoscopic laminectomy seemed to be an alternative surgical for T-OLF, type unilateral segments.

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Clinical Features of Thoracic Spinal Stenosis-associated Myelopathy

Cited by 90 publications

References 7 publications

The involvement and possible mechanism of pro-inflammatory tumor necrosis factor alpha (TNF-α) in thoracic ossification of the ligamentum flavum

The involvement and possible mechanism of pro-inflammatory tumor necrosis factor alpha (TNF-α) in thoracic ossification of the ligamentum flavum

Notch signaling pathways in human thoracic ossification of the ligamentum flavum

A comparison of clinical outcomes between percutaneous endoscopic laminectomy decompression and traditional laminectomy decompression in Thoracic Ossification of Ligamentum Flavum with CT classification of type unilateral segments.

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