Ossification of the Ligamentum Flavum

Ahn, Dong Ki; Lee, Song; Moon, Sang Ho; Boo, Kyung Hwan; Chang, Byung Kwon; Lee, Jae Il

doi:10.4184/asj.2014.8.1.89

Cited by 102 publications

(100 citation statements)

References 41 publications

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“…Many studies have demonstrated the critical role of mechanical stress in the development of TOLF (7,15,22–25). We previously reported that mechanical stress induced the osteogenic differentiation of ligament cells derived from patients with TOLF, which in turn promoted OLF, leading us to conclude that stress facilitated, but did not initiate the development of TOLF (10).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…However, other techniques such as fenestration, laminoplasty, and hemilaminectomy have been reported as well. 9–14 Even with successful surgical decompression, there can be marked variation in clinical outcomes and the incidence of postoperative complications is not infrequent. 9,11,14–17 …”

mentioning

confidence: 99%

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

Osman

Cheung

Hussain

et al. 2018

Spine

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Study Design. Systematic review and meta-analysis. Objective. Examine the functional outcomes and complications following laminectomy for thoracic myelopathy due to ossification of the ligamentum flavum (OLF). Summary of Background Data. OLF is a rare condition that can cause thoracic myelopathy. Laminectomy is a procedure that can be performed to decompress the spinal cord in patients with thoracic myelopathy due to OLF. Few studies have examined postoperative outcomes and complications following laminectomy for thoracic myelopathy secondary to OLF. Methods. A systematic review and meta-analysis was performed. Literature search yielded six studies that met our selection criteria. Study characteristics and baseline patient demographics were extracted from each study. Primary outcomes included pre- and postoperative Japanese Orthopedic Association (JOA) scores and perioperative complications including dural tears, cerebrospinal fluid (CSF) leaks, neurological deficits, surgical site infections, and other complications. We calculated pooled proportion estimates for JOA scores and complications using a random effects model. Results. A total of 137 patients were included. The pooled pre-and postoperative JOA scores were 5.08 (95% confidence interval [CI], 2.70–7.47; I2 = 98%) and 8.29 (95% CI, 7.73–8.85; I2 = 18%), respectively, with a mean improvement of +3.03 points (95% CI, 1.08–4.98; I2 = 88%). Pooled proportion estimates for dural tears, CSF leaks, infections, and early neurological deficits were 18.4% (95% CI, 12.6–26.1; I2 = 0%), 12.1% (95% CI, 6.6–21.2; I2 = 0%), 5.8% (95% CI, 2.1–15.4; I2 = 0%), and 5.7% (95% CI, 2.2–14.3; I2 = 0%), respectively. Conclusion. Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF.

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“…Imaging in these cases did not show any recurrences of spinal cord compression, and there were no indications for reoperation of the cervical spine. The exact cause was uncertain; however, long-term duration of CSM symptoms and low preoperative JOA scores might have been the main reasons [20]. Previous literatures had reported that degeneration spine disease might contribute to the decrease of cervical ROM and lordosis as measured by CCI [13,21].…”

Section: Discussionmentioning

confidence: 97%

Extensive laminectomy for multilevel cervical stenosis with ligamentum flavum hypertrophy: more than 10 years follow-up

Xue

et al. 2014

Eur Spine J

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Ossification of the Ligamentum Flavum

Cited by 102 publications

References 41 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

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

Extensive laminectomy for multilevel cervical stenosis with ligamentum flavum hypertrophy: more than 10 years follow-up

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