Progression of Spinal Ligament Ossification in Patients with Thoracic Myelopathy

Zhai, Jiliang; Guo, Shigong; Li, Jiahao; Chen, Bingrong; Zhao, Yu

doi:10.1111/os.13291

Cited by 8 publications

(10 citation statements)

References 36 publications

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“…Hypertrophy of the ligamentum flavum (HLF), which may or may not have accompanying ossification (OLF), can cause SS by compressing the spinal cord, cauda equina, and nerve roots [ 45 ]. As an independent disease, HLF/OLF often occurs in the thoracic spine followed by the lumbar spine [ 46 ]. HLF/OLF causes central stenosis in both the thoracic and lumbar spine regions ( Figure 3 B).…”

Section: Resultsmentioning

confidence: 99%

Molecular and Genetic Mechanisms of Spinal Stenosis Formation: Systematic Review

Byvaltsev

Калинин

Hernandez

et al. 2022

IJMS

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Spinal stenosis (SS) is a multifactorial polyetiological condition characterized by the narrowing of the spinal canal. This condition is a common source of pain among people over 50 years old. We perform a systematic review of molecular and genetic mechanisms that cause SS. The five main mechanisms of SS were found to be ossification of the posterior longitudinal ligament (OPLL), hypertrophy and ossification of the ligamentum flavum (HLF/OLF), facet joint (FJ) osteoarthritis, herniation of the intervertebral disc (IVD), and achondroplasia. FJ osteoarthritis, OPLL, and HLF/OLFLF/OLF have all been associated with an over-abundance of transforming growth factor beta and genes related to this phenomenon. OPLL has also been associated with increased bone morphogenetic protein 2. FJ osteoarthritis is additionally associated with Wnt/β-catenin signaling and genes. IVD herniation is associated with collagen type I alpha 1 and 2 gene mutations and subsequent protein dysregulation. Finally, achondroplasia is associated with fibroblast growth factor receptor 3 gene mutations and fibroblast growth factor signaling. Although most publications lack data on a direct relationship between the mutation and SS formation, it is clear that genetics has a direct impact on the formation of any pathology, including SS. Further studies are necessary to understand the genetic and molecular changes associated with SS.

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Section: Resultsmentioning

confidence: 99%

Molecular and Genetic Mechanisms of Spinal Stenosis Formation: Systematic Review

Byvaltsev

Калинин

Hernandez

et al. 2022

IJMS

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“…After the decompression and fusion surgery, the JOA scores at follow-up improved compared with the preoperative condition. However, as the DISH often involved the middle and lower thoracic spine, the responsible lesions were often septal, and thus staged surgery should be performed [ 21 ]. However, DISH has been identified as a risk factor for unanticipated second surgery in patients with lumbar degenerative disease, with a revision rate of up to 19% in DISH patients versus 6.9% in non-DISH patients [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracic spondylotic myelopathy in diffuse idiopathic skeletal hyperostosis: a comparative study

Dong

Yang

et al. 2023

J Orthop Surg Res

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Background To explore the characteristics and clinical management of thoracic spinal stenosis with diffuse idiopathic skeletal hyperostosis (DISH). Methods The patients diagnosed with thoracic spondylotic myelopathy who underwent spinal decompression and fusion surgery in a single center between 2012 and 2020 were retrospectively analyzed. All the patients were followed up for at least 2 years. Patients were classified into DISH and non-DISH groups. Demographic, radiographic and clinical parameters were compared between the two groups. Results A total of 100 thoracic spondylotic myelopathy patients were included in the study. 22 patients were diagnosed with DISH. The proportion of male patients in the DISH group was higher, and the average BMI was larger. The incidence of upper thoracic vertebrae with ossification of posterior longitudinal ligament (OPLL) (P < 0.05) and lumbar spine with ossification of ligamentum flavum (OLF) was higher (P < 0.05) in DISH the group. The proportion of patients received staged surgery is higher in the DISH group (P < 0.1). There were no significant differences between the two groups in the amount of surgical bleeding, the ratio of cerebrospinal fluid leakage, the time duration of drainage tube placement and the JOA scores. Conclusion Thoracic spinal stenosis with DISH occurred more in male patients with larger BMI. The posterior decompression and fusion surgery could achieve comparable satisfying clinical outcomes between DISH and non-DISH patients. More proportion of patients received staged surgery in the DISH group; the underline mechanism may be DISH caused more OPLL in the upper thoracic spine and more OLF in the lumbar spine because of mechanical stress.

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“…In addition, QoL and VAS are significantly lower in patients with > 50% spinal canal occupancy on both CT and MRI than in patients with ≤ 50% occupancy, which is consistent with some previous studies that concluded that spinal canal occupancy on MRI showed a significant correlation with anxiety/depression aspects in regression models. 32 Therefore, we still need to care more for patients with severe spinal canal occupancy.…”

Section: Discussionmentioning

confidence: 99%

The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ‐5D‐5L

Li,

Deng,

Wang

et al. 2023

Orthopaedic Surgery

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ObjectiveThere is a lack of studies on the quality of life (QoL) after posterior laminectomy in patients with thoracic ossification of the ligamentum flavum (TOLF), and risk factors associated with poor prognosis remain controversial. Therefore, the present study was conducted to illustrate the QoL for TOLF patients after surgery and determine its relationship with their demographic, surgery‐related, clinical characteristics and imaging data.MethodsOne hundred and eighteen patients diagnosed with thoracic myelopathy because of TOLF were enrolled in this retrospective study. They all underwent posterior decompressive laminectomy from August 2010 to January 2022. The QoL was evaluated based on the EQ‐5D‐5L. Collecting gender, age, number of operations, compressed segments, Frankel grade, complications, body mass index (BMI), symptoms and duration, modified Japanese Orthopaedic Association (mJOA) score (preoperative), follow‐up time and type of ossification, increased signal on Sagittal T2‐weighted Images (ISST2I), occupancy rate and analyzing by Mann–Whitney U‐test, Kruskal–Wallis test, the χ2‐test, and logistic regression tests.ResultsAverage follow‐up 70.8 months (18–149), the mean age was 59.74 ± 9.81 years and the mean score for the QoL based on the EQ‐5D‐5 L and visual analogue scale (VAS) score were 0.71 ± 0.28 and 78.88 ± 10.21 at the final follow‐up. Moderate and severe problems were found in the pain/discomfort in 22.0% of the patients. These mobility and usual activities numbers were slightly higher (24.6% and 30.4%, respectively). The mean scores for QoL and VAS were significantly higher in patients with mild and moderate neurological impairment, normal BMI, <60 years of age, no dural tears, symptom relief at hospital discharge, unilateral and bilateral ossification on axial CT scan, ≤ 50% spinal canal occupancy on CT and MRI, and none or fuzzy on ISST2I.ConclusionQoL after posterior laminectomy in TOLF patients is generally satisfactory compared to preoperative levels. Preoperative mJOA score, Age, comorbid diabetes, the major symptom is activity limitation, BMI, ISST2I, Intraoperative dural tears and spinal canal occupancy rate correlate significantly with the corresponding dimensions and are predictive. Age, spinal canal occupancy rate, ISST2I, preoperative mJOA score, BMI are significantly associated with and have predictive value for overall postoperative QoL.

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Progression of Spinal Ligament Ossification in Patients with Thoracic Myelopathy

Cited by 8 publications

References 36 publications

Molecular and Genetic Mechanisms of Spinal Stenosis Formation: Systematic Review

Molecular and Genetic Mechanisms of Spinal Stenosis Formation: Systematic Review

Thoracic spondylotic myelopathy in diffuse idiopathic skeletal hyperostosis: a comparative study

The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ‐5D‐5L

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