Surgical experience with symptomatic thoracic ossification of the ligamentum flavum

Liao, Cheng-Chih; Chen, Tzu-Yung; Jung, Shih‐Ming; Chen, Lirong

doi:10.3171/spi.2005.2.1.0034

Cited by 84 publications

(84 citation statements)

References 21 publications

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“…In addition, it has been reported Clinical characteristics and surgical outcome of TM caused by OLF Z Li et al that the location of OLF is less vulnerable in mobile segments such as the cervical and lumbar vertebra than in the thoracic vertebrae. 26,30,40,55,56 This phenomenon gives us insight about the pathogenetic mechanism of OLF. On the basis of the literature review, we hypothesized that biomechanical and anatomical factors might have a key role in thoracic OLF progression.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Ren

Zhao

et al. 2015

Spinal Cord

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Study design: A retrospective comparative study. Objectives: To describe the clinical features and radiological findings, to assess the safety and effectiveness of posterior decompressive laminectomy and resection of the ossification of the ligamentum flavum (OLF), and to determine which presurgical and surgical variables were most closely related to postsurgical prognosis of thoracic myelopathy (TM) caused by OLF in China. Methods: Eighty-five patients with the diagnosis of TM caused by OLF received surgical treatment from July 1998 to May 2012. Clinical data were collected from medical and operative records. Correlations between the surgical outcome and various factors were also analyzed. Results: All cases were followed up for a mean of 49.2 months (range, 24-190 months) postoperatively. The mean Japanese Orthopaedic Association score was 3.8 points preoperatively and 8.2 points at the final follow-up, yielding a mean recovery rate of 63.0%. Postoperative complications included transient neurological deficits (9 cases), persistent neurological deficits (4 cases), dural tears (17 cases), cerebrospinal fluid leakage (9 cases), wound dehiscence (2 cases) and wound infection (3 cases). The OLF level (middle thoracic), preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were important predictors of surgical outcome. Conclusions: Biomechanical and anatomical factors may have a key role in thoracic OLF progression. Posterior decompressive laminectomy and resection of the OLF can be considered an effective, reliable and safe alternative procedure. The OLF level, preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were confirmed and significantly correlated with the surgical outcome.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Ren

Zhao

et al. 2015

Spinal Cord

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“…In a survey of radiographic findings conducted in Japan, the prevalence of asymptomatic thoracic and lumbar OLF in adults was as high as 6.2% for men and 4.8% for women [8,10]. The disease usually has an insidious onset and a slow progression [1,9]. However, once symptomatic OLF is diagnosed, it is usually progressive and refractory to conservative management, and surgical decompression is indicated.…”

Section: Discussionmentioning

confidence: 99%

“…TOLF is rare and usually asymptomatic [1]. In a survey of radiographic findings conducted in Japan, the prevalence of asymptomatic thoracic and lumbar OLF in adults was as high as 6.2% for men and 4.8% for women [8,10].…”

Section: Discussionmentioning

confidence: 99%

“…OLF, also known as ossification of the yellow ligament, is a pathological condition that affects the ligament and causes a slow and progressive myeloradiculopathy [1,[7][8][9]. TOLF is rare and usually asymptomatic [1].…”

Section: Discussionmentioning

confidence: 99%

“…Generally, although patients with cervical and lumbar stenosis have symptoms characteristic of the condition, patients with thoracic spinal stenosis rarely experience symptoms [1]. Clinical symptoms of thoracic spinal cord compression usually develop in the canal, which has an anteroposterior diameter of less than 10 mm .…”

Section: Introductionmentioning

confidence: 99%

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Chest Discomfort Secondary to Ossification of the Ligamentum Flavum of the Thoracic Spine: A Case Report

Lee¹,

Kang²,

Lee³

et al. 2017

J Spine

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Symptomatic thoracic ossification of the ligamentum flavum is rare, and a modality for its treatment has not yet been fully established; most reported patients complained of myelopathy. Herein, the authors will report on an extremely rare presentation of thoracic ossification of the ligamentum flavum, along with clinical outcomes. The patient complained of chest discomfort and myelopathy symptoms for 1 year secondary to thoracic ossification of the ligamentum flavum. He underwent one surgical procedure. Postoperatively, his symptoms such as chest discomfort and myelopathy improved completely. As of this report, the patient has had a good postoperative recovery, had good overall health, and adapted well to his social activities.

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Osterix is a key target for mechanical signals in human thoracic ligament flavum cells

Fan

Chen

Wang

et al. 2007

Journal Cellular Physiology

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Mechanical stress is considered to be an important factor in the progression of thoracic ossification of the ligament flavum (TOLF). To elucidate the mechanism underlying mechanical stress-induced TOLF, we investigated the effect of stretching on cultured flavum ligament cells derived from TOLF and non-TOLF patients. We found that the mRNA expression of alkaline phosphatase (ALP), osteocalcin, Runx2, and osterix, but not that of Dlx5 and Msx2, was significantly increased by stretching in TOLF cells. In addition, the effect seems to be finely tuned by stretching-triggered activation of distinct mitogen-activated protein kinase cascades. Specifically, a p38 specific inhibitor, SB203580, significantly inhibited stretching-induced osterix expression as well as ALP activity, whereas a specific inhibitor of ERK1/2, U0126, prevented stretching-induced Runx2 expression. We showed that overexpression of osterix resulted in a significant increase of ALP activity in TOLF cells, and osterix-specific RNAi completely abrogated the stretching-induced ALP activity, indicating that osterix plays a key role in stretching-stimulated osteogenic effect in TOLF cells. These results suggest that mechanical stress plays important roles in the progression of TOLF through induction of osteogenic differentiation of TOLF cells, and our findings support that osterix functions as a molecular link between mechanostressing and osteogenic differentiation.

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Surgical experience with symptomatic thoracic ossification of the ligamentum flavum

Cited by 84 publications

References 21 publications

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Chest Discomfort Secondary to Ossification of the Ligamentum Flavum of the Thoracic Spine: A Case Report

Osterix is a key target for mechanical signals in human thoracic ligament flavum cells

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