Variables affecting postsurgical prognosis of thoracic myelopathy caused by ossification of the ligamentum flavum

Kawaguchi, Yoshiharu; Yasuda, Taketoshi; Seki, Shoji; Nakano, Masato; Koike, Masahiko; Sumi, Shigeki; Kimura, Takeshi

doi:10.1016/j.spinee.2013.03.001

Cited by 40 publications

(39 citation statements)

References 39 publications

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“…Clinically, multiple-level TOLF differs from single-level lesions in terms of disease progression and clinical outcomes, and multiple-level TOLF has a poor prognosis and may continue to develop after surgical resection (12,39,40), suggesting that the osteogenic potency may be differ between them, which is consistent with our experimental results. There were some limitations to this study.…”

Section: Discussionsupporting

confidence: 89%

Genetic differences in osteogenic differentiation potency in the thoracic ossification of the ligamentum flavum under cyclic mechanical stress

Ning

Chen

Fan

et al. 2016

International Journal of Molecular Medicine

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Mechanical stress and genetic factors play important roles in the occurrence of thoracic ossification of ligament flavum (TOLF), which can occur at one, two, or multiple levels of the spine. It is unclear whether single- and multiple-level TOLF differ in terms of osteogenic differentiation potency and osteogenesis-related gene expression under cyclic mechanical stress. This was addressed in the present study using patients with non-TOLF and single- and multiple-level TOLF (n=8 per group). Primary ligament cells were cultured and osteogenesis was induced by application of cyclic mechanical stress. Osteogenic differentiation was assessed by evaluating alkaline phosphatase (ALP) activity and the mRNA and protein expression of osteogenesis-related genes, including ALP, bone morphogenetic protein 2 (BMP2), Runt-related transcription factor-2 (Runx-2), osterix, osteopontin (OPN) and osteocalcin. The application of cyclic mechanical stress resulted in higher ALP activity in the multiple-level than in the single-level TOLF group, whereas no changes were observed in the non-TOLF group. The ALP, BMP2, OPN and osterix mRNA levels were higher in the multiple-level as compared to the single-level TOLF group, and the levels of all osteogenesis-related genes, apart from Runx2, were higher in the multiple-level as compared to the non-TOLF group. The osterix and ALP protein levels were higher in the multiple-level TOLF group than in the other 2 groups, and were increased with the longer duration of stress. These results highlight the differences in osteogenic differentiation potency between single- and multiple-level TOLF that may be related to the different pathogenesis and genetic background.

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Section: Discussionsupporting

confidence: 89%

Genetic differences in osteogenic differentiation potency in the thoracic ossification of the ligamentum flavum under cyclic mechanical stress

Ning

Chen

Fan

et al. 2016

International Journal of Molecular Medicine

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“…13,19,20,22,33,34,56 Preoperative severity of myelopathy was considered as the most important predictor of the postoperative outcome. 19,20,22,56 In accordance with this finding, our research confirmed that preoperative severity of myelopathy was the most important predictor of the highest postoperative JOA score and the lowest percentage RR in multiple linear regression analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, when the ligamentum flavum is replaced by a mature bone, its osseous morphology should be V-shaped or a part of V shape on CT images. 12 Although thoracic OLF has been reported in several Asian countries, such as Japan, [11][12][13][14] China 3,4,[15][16][17][18][19] and South Korea, [20][21][22] and also in Caucasian and Caribbean ethnic groups, [23][24][25][26][27][28] extensive studies on thoracic OLF including a large number of patients have not yet been reported in the literature. This is partly due to the relatively low mean prevalence of thoracic OLF, which was reported as 3.8% in China and as 6.2% for Japanese men and 4.8% for Japanese women.…”

Section: Introductionmentioning

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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“…Some studies concluded the association has an influence on the surgical outcome [6,18], but other studies reported the opposite conclusion [4, 10, 13, 14,16,19]. Eight out of 9 cases in our report revealed asymptomatic and/or asymptomatic other spinal stenosis; however, the only one patient underwent additional operation during follow-up period (case 5: 24 months later).…”

Section: Discussionmentioning

confidence: 46%

Microendoscopic posterior decompression for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum: a technical report

Baba

Oshima

Iwahori³

et al. 2015

Eur Spine J

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Variables affecting postsurgical prognosis of thoracic myelopathy caused by ossification of the ligamentum flavum

Cited by 40 publications

References 39 publications

Genetic differences in osteogenic differentiation potency in the thoracic ossification of the ligamentum flavum under cyclic mechanical stress

Genetic differences in osteogenic differentiation potency in the thoracic ossification of the ligamentum flavum under cyclic mechanical stress

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

Microendoscopic posterior decompression for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum: a technical report

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