Pathomechanism of Ligamentum Flavum Hypertrophy: A Multidisciplinary Investigation Based on Clinical, Biomechanical, Histologic, and Biologic Assessments

Sairyo, Koichi; Biyani, Ashok; Goel, Vijay K.; Leaman, Douglas W.; Booth, Robert; Thomas, J.; Gehling, Daniel J.; Vishnubhotla, Sri Lakshmi; Long, Rebecca A.; Ebraheim, Nabil A.

doi:10.1097/01.brs.0000188117.77657.ee

Cited by 225 publications

(279 citation statements)

References 18 publications

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“…Therefore, the vertebral body anteriorly and LF posteriorly must take a major role in balancing the lower lumbar spine and handling the increased spinal load in these people (due to changes in the position of the line of gravity). The outcome is thickening of LF [78][79][80][81][82][83] and modifications of vertebral bodies, i.e., increasing vertebral body surface and decreasing vertebral height. All these alterations may lead in time to degenerative changes of the osseous and nonosseous tissues around the spinal column causing stenosis.…”

Section: Discussionmentioning

confidence: 99%

Degenerative lumbar spinal stenosis and lumbar spine configuration

et al. 2010

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As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative changes in bony and/or soft tissue elements. The poor correlation between radiological manifestations and the clinical picture emphasizes the fact that more studies are required to determine the natural course of this syndrome. Our aim was to reveal the association between lower lumbar spine configuration and DLSS. Two groups were studied: the first included 67 individuals with DLSS (mean age 66 ± 10) and the second 100 individuals (mean age 63.4 ± 13) without DLSS-related symptoms. Both groups underwent CT images (Philips Brilliance 64) and the following measurements were performed: a crosssection area of the dural sac, vertebral body dimensions (height, length and width), AP diameter of the bony spinal canal, lumbar lordosis and sacral slope angles. All measurements were taken at L3 to S1. Vertebral body lengths were significantly greater in the DLSS group at all levels compared to the control, whereas anterior vertebral body heights (L3, L4, L5) and middle vertebral heights (L3, L5) were significantly smaller in the LSS group. Lumbar lordosis, sacral slope and bony spinal canal were significantly smaller in the DLSS compared to the control. We conclude that the size and shape of vertebral bodies and canals significantly differed between the study groups. A tentative model is suggested to explain the association between these characteristics and the development of degenerative spinal stenosis.

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Section: Discussionmentioning

confidence: 99%

Degenerative lumbar spinal stenosis and lumbar spine configuration

et al. 2010

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“…The study of the instantaneous axis of rotation (IAR) of the vertebral body can be useful to assess the kinematics of the lytic spine [19]. A three-dimensional finite element model [5,6,7,10,11,18] (FEM) of the pediatric lumbar spine was developed as described in Part I of this study. This model was used to predict the path of IAR were in flexion/extension, and stresses on the intact and spondylolytic pediatric spines in response to various loading modes.…”

Section: Introductionmentioning

confidence: 99%

Three dimensional finite element analysis of the pediatric lumbar spine. Part II: biomechanical change as the initiating factor for pediatric isthmic spondylolisthesis at the growth plate

et al. 2006

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“…2,3 During hypertrophy of the ligamentum flavum, there is reduction in the content of elastic fibers and an increase in collagen fibers, calcification, ossification and chondrometaplasia. [4][5][6] Sairyo et al 7,8 have shown a correlation between the hardening of the ligamentum flavum and the degree of fibrosis, resulting in repetitive inflammatory processes due to the mechanical stresses that the ligament suffers during the movements of the spine. Park and collaborators demonstrated that an increase in TGFb (transforming growth factor beta) expression, the protein that controls cell proliferation and acts in the early stages of oncogenesis, is related to hypertrophy of the ligamentum flavum.…”

Section: Introductionmentioning

confidence: 99%

Expression of matrix metalloproteinases 2 and 9 and TGF-b in ligamentum flavum hypertrophy

et al. 2014

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Objective: To evaluate the expression of matrix metalloproteinases and TGFb in patients with spinal stenosis and in younger patients who have herniated disc. Methods: 19 samples of LA were analyzed, nine of them with lumbar canal stenosis and 10 with disc herniation. Of the total, five patients were aged between 15 and 40 years, 10 were between 40 and 65 years and four had more than 65 years. Representative areas of LF were chosen based on the staining of tissues with hematoxylin-eosin. The 3μm-thick sections embedded in paraffin and fixed in formalin were deparaffinized and rehydrated. All ligaments were incubated overnight at 4 °C with primary antibodies. Results: An increase of TGFb was verified in older individuals, although without statistical significance. Conclusion: Metalloproteinases showed no significant difference between both groups with respect to age and type of abnormality of the spine.

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Pathomechanism of Ligamentum Flavum Hypertrophy: A Multidisciplinary Investigation Based on Clinical, Biomechanical, Histologic, and Biologic Assessments

Cited by 225 publications

References 18 publications

Degenerative lumbar spinal stenosis and lumbar spine configuration

Degenerative lumbar spinal stenosis and lumbar spine configuration

Three dimensional finite element analysis of the pediatric lumbar spine. Part II: biomechanical change as the initiating factor for pediatric isthmic spondylolisthesis at the growth plate

Expression of matrix metalloproteinases 2 and 9 and TGF-b in ligamentum flavum hypertrophy

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