Lumbar Ligamentum Flavum: Spatial Relationships to Surrounding Anatomical Structures and Technical Description of En Bloc Resection

Losiniecki, Andrew; Serrone, Joseph C.; Keller, Jeffrey T.; Bohinski, Robert J.

doi:10.1055/s-0033-1348350

Cited by 15 publications

(6 citation statements)

References 9 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ligamentum flavum (LF) is a yellow ligament containing high collagen and elastin fibers. Elastin provides the elasticity, while collagen fiber provides the tensile strength and stability of the spine ( Losiniecki et al, 2013 ; Li, Xia & Han, 2015 ; Yabe et al, 2015 ). With age and degeneration, an increase in collagen and a decreased elastin-to-collagen ratio were evident in hypertrophied LF ( Mobbs & Dvorak, 2007 ); however, the underlying mechanisms remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Relative telomere length and oxidative DNA damage in hypertrophic ligamentum flavum of lumbar spinal stenosis

Dechsupa

Yingsakmongkol

Limthongkul

et al. 2018

PeerJ

View full text Add to dashboard Cite

BackgroundLumbar spinal stenosis (LSS) is a common cause of low back pain with degenerative spinal change in older adults. Telomeres are repetitive nucleoprotein DNA sequences of TTAGGG at the ends of chromosomes. Oxidative stress originates from an imbalance in pro-oxidant and antioxidant homeostasis that results in the production of reactive oxygen species (ROS). The purpose of this study was to investigate relative telomere length (RTL) and oxidative DNA damage in ligamentum flavum (LF) tissue from LSS patients.MethodsForty-eight patients with LSS participated in this study. Genomic DNA from non-hypertrophic and hypertrophic LF tissue were analyzed by real-time polymerase chain reaction for relative telomere length (RTL). 8-hydroxy 2′-deoxygaunosine (8-OHdG) levels were determined by using enzyme-linked immunosorbent assay. We cultivated LF fibroblast cells from patients in different ages (61, 66, and 77 years). After each cultivation cycle, we examined RTL and senescence-associated β-galactosidase (SA-β-gal) expression.ResultsThe hypertrophic LF had significantly lower RTL than non-hypertrophic LF (P = 0.04). The levels of 8-OHdG were significantly higher in hypertrophic LF compared to non-hypertrophic LF (P = 0.02). With advancing cell culture passage, the number of cells in each passage was significantly lower in hypertrophic LF fibroblast cells than non-hypertrophic LF fibroblast cells. When evaluated with SA-β-gal staining, all senescent LF fibroblast cells were observed at earlier passages in hypertrophic LF compared with non-hypertrophic LF fibroblast cells.DiscussionOur results showed that patients with LSS displayed an accelerated RTL shortening and high oxidative stress in hypertrophic LF. These findings implied that telomere shortening and oxidative stress may play roles in the pathogenesis of hypertrophic LF in lumbar spinal stenosis.

show abstract

Section: Introductionmentioning

confidence: 99%

Relative telomere length and oxidative DNA damage in hypertrophic ligamentum flavum of lumbar spinal stenosis

Dechsupa

Yingsakmongkol

Limthongkul

et al. 2018

PeerJ

View full text Add to dashboard Cite

show abstract

“… 12 , 13 However, lateral LFs are gradually thinned and are removed merging with the capsule. 14 With degenerative changes, the capsule is consistently smaller and thinned. If medicines more than the joint capacity in the facet joint are administered, the weakened capsule is ruptured 15 , 16 and the medicines can spread to the epidural space or around the intervertebral foramen.…”

Section: Discussionmentioning

confidence: 99%

The effect of facet joint injection on lumbar spinal stenosis with radiculopathy

et al. 2018

View full text Add to dashboard Cite

Objectives:Facet Joint Injection (FJI) is known to be effective in axial back pain, but the purpose of this study was to assess the effects of FJI on patients treated with it among those with Lumbar Spinal Stenosis (LSS).Methods:We conducted a retrospective database analysis and investigated electronic medical records of 125 LSS patients treated with FJI in the pain clinic of Chungbuk National University Hospital from November 2, 2016 to July 31, 2017. Sex, age, histories of low back surgery, complaining of neurogenic claudication, symptomatic sites of patients, FJI sites, number of sites of FJI, triamcinolone dosage, Numeric Rating Scale (NRS) before and after treatment, facet joint capsule rupture during treatment, and improvement of neurogenic claudication after treatment, were examined.Results:Among 125 patients, we investigated 91 patients who met the criteria. There was significant difference in NRS before and after treatment (p<0.000). Forty one patients with reduction of NRS more than 30% after FJI were allocated to effect group. FJI was more effective in patients who did not have the surgery (p=0.044), as well as those who showed an improved neurogenic claudication after treatment (p=0.001). Other measured values did not show statistical significances.Conclusions:FJI has relatively a lower risk and is simpler in terms of techniques than other interventional treatments performed within the spinal canal. Therefore, FJI may be another interventional treatment option in patients with pain by LSS. In the future, studies for FJI indication in LSS patients should be additionally required.

show abstract

“…LCSS results from a decrease in the transversal, anteroposterior, or combined diameter secondary to hypertrophy of the facet joints, disc height loss with or without herniation of the intervertebral disc, and the LF hypertrophy (11). The role of the LF is to protect the fat tissue that keeps the dural sac activity and maintains spinal stability and nerves within a certain range (12,13). The thickness of the LF differs significantly between the L2-L3, L3-L4, L4-5, and L5-S1 levels, and it is thickest at the L4-L5 level (8).…”

Section: Discussionmentioning

confidence: 99%

The Role of the Ligamentum Flavum Area as a Morphological Parameter of Lumbar Central Spinal Stenosis

et al. 2017

View full text Add to dashboard Cite

Background: Hypertrophy of the ligamentum flavum (LF) has been considered as a major cause of lumbar central spinal stenosis (LCSS). Previous studies have found that ligamentum flavum thickness (LFT) is correlated with aging, disc degeneration, and lumbar spinal stenosis. However, hypertrophy is different from thickness. Thus, to evaluate hypertrophy of the whole LF, we devised a new morphological parameter, called the ligamentum flavum area (LFA). Objectives: We hypothesized that the LFA is a key morphologic parameter in the diagnosis of LCSS. Study Design: Retrospective observational study. Setting: The single center study in Seoul, Republic of Korea. Methods: LF samples were collected from 166 patients with LCSS, and from 167 controls who underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. T1- weighted axial MR imageswere acquired at the facet joint level from individual patients. We measured the LFA and LFT at the L4-L5 intervertebral level on MRI using a picture archiving and communications system. The LFA was measured as the cross-sectional area of the whole LF at the L4-L5 stenotic level. The LFT was measured by drawing a line along the side of the ligament facing the spinal canal and along the laminar side of the ligament curve and then measuring the thickest point at the L4-L5 level. Results: The average LFA was 96.56 ± 30.74 mm2 in the control group and 132.69 ± 32.68 mm2 in the LCSS group. The average LFT was 3.61 ± 0.72 mm in the control group and 4.24 ± 0.97 mm in the LCSS group. LCSS patients had significantly higher LFA (P < 0.001) and LFT (P < 0.001). Regarding the validity of both LFA and LFT as predictors of LCSS, Receiver Operator Characteristics (ROC) curve analysis showed that the best cut-off point for the LFA was 105.90 mm2 , with 80.1% sensitivity, 76.0% specificity, and area under the curve (AUC) of 0.83 (95% CI, 0.78 – 0.87). The best cut off-point of the LFT was 3.74 mm, with 70.5% sensitivity, 66.5% specificity, and AUC of 0.72 (95% CI, 0.66 – 0.77). Limitations: The principal methodological limitation was the retrospective observational nature. Anatomically, degenerative lumbar spinal stenosis can involve the central canal, foramina, and lateral recess. However, we focused on LCSS only. Conclusions: Although the LFT and LFA were both significantly associated with LCSS, the LFA was a more sensitive measurement parameter. Thus, to evaluate LCSS patients, the treating doctor should more carefully analyze the LFA than LFT. Institutional Review Board (IRB) approval number: S2015-1328-0001 Key words: Ligamentum flavum, ligamentum flavum area, ligamentum flavum thickness, lumbar central spinal stenosis, hypertrophy of the ligamentum flavum, morphological parameter, crosssectional area, optimal cut-off point

show abstract

Lumbar Ligamentum Flavum: Spatial Relationships to Surrounding Anatomical Structures and Technical Description of En Bloc Resection

Cited by 15 publications

References 9 publications

Relative telomere length and oxidative DNA damage in hypertrophic ligamentum flavum of lumbar spinal stenosis

Relative telomere length and oxidative DNA damage in hypertrophic ligamentum flavum of lumbar spinal stenosis

The effect of facet joint injection on lumbar spinal stenosis with radiculopathy

The Role of the Ligamentum Flavum Area as a Morphological Parameter of Lumbar Central Spinal Stenosis

Contact Info

Product

Resources

About