Ligamentum Flavum Thickness in Normal and Stenotic Lumbar Spines

Abbas, Janan; Hamoud, Kamal; Masharawi, Youssef; May, Hila; Hay, Ori; Medlej, Bahaa; Peled, Nathan; Hershkovitz, Israel

doi:10.1097/brs.0b013e3181bfca15

Cited by 100 publications

(107 citation statements)

References 31 publications

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“…Thus, the dynamic change at L2-3 should be evaluated before surgery in addition to that at L3-4 and L4-5. At L5-S1, motion is stabilised by the iliolumbar ligaments and the large transverse process of the L5 vertebra, which is not the case at L3-4 and L4-5 [18]. Therefore, the rate of dynamic change at L5-S1 may be lower than that at L3-4 and L4-5.…”

Section: Discussionmentioning

confidence: 97%

Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

et al. 2013

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Purpose Some reported studies have evaluated the dural sac in patients with lumbar spinal stenosis (LSS) by computed tomography (CT) after conventional myelography or magnetic resonance imaging (MRI). But they have been only able to evaluate static factors. No reports have described detailed dynamic changes in the dural sac during flexion and extension observed by multidetector-row computed tomography (MDCT). The aim of this study was to elucidate or demonstrate, in detail, the influence of dynamic factors on the severity of stenosis. Methods One hundred patients with LSS were enrolled in this study. All underwent MDCT in both flexion and extension positions after myelography, in addition to undergoing MRI. The anteroposterior diameter (AP-distance) and cross-sectional area of the dural sac (D-area) were measured at each disc level between L1-2 and L5-S1. The dynamic change in the D-area was defined as the absolute value of the difference between flexion and extension. The rate of dynamic change (dynamic change in D-area/D-area at flexion) in the dural sac at each disc level was also calculated. Results The average AP-distance in flexion/extension (mm) was 9.2/7.4 at L3-4 and 8.3/7.4 at L4-5. The average D-area in flexion/extension (mm 2 ) was 96.3/73.6 at L3-4 and 72.3/61.0 at L4-5. The values were significantly lower in extension than in flexion at all disc levels from L1-2 to L5-S1. AP-distance was narrowest and D-area smallest at L4-5 during extension. The rates of dynamic changes at L2-3 and L3-4 were higher than those at L4-5. Conclusions MDCT clearly elucidated the dynamic changes in the lumbar dural sac. Before surgery, MDCT after myelography should be used to evaluate the dynamic change during flexion and extension, especially at L2-3, L3-4, and L4-5.

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Section: Discussionmentioning

confidence: 97%

Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

et al. 2013

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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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“…Also they said that thickening of LF at L4-5 has already started in subjects of 30-39years of age group. They concluded that thickening of LF was not due to the buckling of LF into the spinal canal with disc degeneration.In Abbas et al study 9 , significant changes in LF thickness were observed after the age of 40 years. It was also observed that 22 individuals of < 30 years of age (4.5% to 13.6% of these subjects) showed LF thickness of more than 4mm (depending on the vertebral level).…”

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confidence: 84%

Magnetic resonance imaging assessment of thickened ligamentum flavum in degenerative lumbar spine-corelation with age, gender, degenerative disc, right-left asymmetry in central india population

Kamble¹

2017

Int j curr adv res

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A B S T R A C TBackground: Thickened ligamentum flavum(LF) has been traditionally related to lumbar canal stenosis. Till date many studies has been done to evaluate thickened LF and its association with age, gender, disc degeneration, mean LF thickness, increment in LF thickness at lumbar levels and right-left asymmetry or side dominance. But many discrepancies were found. Present study aimed to study these associations in the central India population. Material and methods: 345 individuals of 20 to 70 years old, with complains of low back ache and/ or leg pain whose Magnetic Resonance Imaging (MRI)of lumbosacral spine was done , were studied retrospectively. LF thickness was measured on axial T1WI of MRI at L3-4,L4-5 and L5-S1 levels. Mean and standard deviations of the parameters and t tests were taken. Significant difference was set at P < 0.05. Results: LF thickness significantly increased with age at all females than males. Increment was larger at L4-5 than at L5 thickness was observed with type IV -V disc degeneration, but was not statistically significant (p>0.05). Mean LF thickness at L5-S1 level on i.e 4.56 mm followed by L4-5(right-4.36 ,left-3.70mm) and L3 2.86mm). Mean thickness at L5-S1level on left side was found to be less i.e 1.28mm. Significant asymmetry was found between LF thickness lumbar level and right sided dominance was found at each level. Conclusion: LF thickness is an age and gender dependent phenomenon. Right sided dominance is found at each lumbar level. LF thickness is increased at L5 levels.The ligamentum flavum originates from the anterior aspect of lamina and inserts on the lamina Ligamentum flavum appearance on sagittal MRI from midline to linear, low signal intensity band that attaches to the superior border of one spinous process and the inferior surface of the spinous process below it. On parasagittal scans, LF is seen as an inhomogenous triangle with broader base near the lamina and (fig 1a and b). On axial MR studies, shaped structure that covers the laminae and facet joint anteriorly. LF is similar to signal But the signal intensity can be variable on MR because ligamentum flavum undergoes age related degenerative changes or become infiltrated with fat. Rarely it may undergo ossification or calcification. The elasticity of LF decreases with age.As a consequence to hypertrophy of ligamentum flavum diameter of the spinal canal gets reduced posteriorly. This reduced diameter of the spinal canal may notably squeeze the dural sac and nerve roots resulting in symptoms and these symptoms are strangely without any herniated or disc protrusion.3 Whenever there is increase LF, a posterior protrusion of th two, they causes nerve root compression. Hypertrophy of the ligament can be unilateral or bilateral and results from either injury or scar tissue. Normal ligaments are composed of yellow elastic fibres and grossly ha elasticity. It appears that during injury rupture of some of the elastic fibres of the ligamentum flava occurs, causing them to expand. Eventually repair takes place an...

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Ligamentum Flavum Thickness in Normal and Stenotic Lumbar Spines

Abstract: LF thickness is an age-dependent and gender-independent phenomenon. LF is significantly thicker on the right side. The borderline between normal and pathologic LF thickness should not be set at 4 mm.

Cited by 100 publications

References 31 publications

Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

Degenerative lumbar spinal stenosis and lumbar spine configuration

Magnetic resonance imaging assessment of thickened ligamentum flavum in degenerative lumbar spine-corelation with age, gender, degenerative disc, right-left asymmetry in central india population

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