Pathophysiology of Calcification and Ossification of the Ligamentum Flavum in the Cervical Spine

Takahashi, Toshiyuki; Hanakita, Junya; Minami, Manabu

doi:10.1016/j.nec.2017.09.016

Cited by 34 publications

(45 citation statements)

References 29 publications

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“…Calcium deposits mainly occur in the central part of the ligamentum flavum, which is surrounded by degenerated elastic fibers [21]. CT can facilitate the detection of characteristic findings and help distinguish between CLF and OLF [21]. In our study, all patients were diagnosed with thoracic OLF rather than CLF.…”

Section: Discussionmentioning

confidence: 65%

“…However, CLF is a crystal deposition disease that mainly affects the central portion of the ligamentum flavum. Calcium deposits mainly occur in the central part of the ligamentum flavum, which is surrounded by degenerated elastic fibers [21]. CT can facilitate the detection of characteristic findings and help distinguish between CLF and OLF [21].…”

Section: Discussionmentioning

confidence: 99%

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Identification of the molecular mechanism and diagnostic biomarkers in the thoracic ossification of the ligamentum flavum using metabolomics and transcriptomics

Guo

et al. 2020

BMC Mol and Cell Biol

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Background: To establish a metabolite fingerprint of ossification of the thoracic ligamentum flavum (OTLF) patients using liquid chromatography-mass spectrometry (LC-MS) in combination with transcriptomic data and explore the potential molecular mechanism of pathogenesis. Results: The study cohort was composed of 25 patients with OTLF and 23 healthy volunteers as a control group. Thirty-seven metabolites were identified out by UPLC-MS including uric acid and hypoxanthine. Nine metabolites, including uric acid and hypoxanthine, were found with a Variable Importance in Projection (VIP) score over 1 (p < 0.05). Pathway enrichment indicated that purine metabolism pathways and the other four metabolism pathways were enriched. Transcriptomic data revealed that purine metabolism have a substantial change in gene expression of OTLF and that xanthine dehydrogenase (XDH) is the key regulatory factor. Receiver operating characteristic (ROC) analysis indicated that 17 metabolites, including uric acid, were found with an AUC value of over 0.7. Conclusion: Uric acid might be the potential biomarker for OTLF and play an important role within the detailed pathway. XDH could affect purine metabolism by suppressing the expression of hypoxanthine and xanthine leading to low serum levels of uric acid in OTLF, which could be a focal point in developing new therapeutic methods for OTLF.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Identification of the molecular mechanism and diagnostic biomarkers in the thoracic ossification of the ligamentum flavum using metabolomics and transcriptomics

Guo

et al. 2020

BMC Mol and Cell Biol

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“…However, symptomatic OLF in the cervical spine is rarely observed (13). OLF tends to arise from the lateral capsular portion of the ligamentum flavum, whereas OLF characteristically occurs in the thoracic spine of older females (14,15). Miyazawa and Akiyama (4) reviewed 50 cases of OLF in the cervical spine that were reported between 1962 and 2005.…”

Section: Discussionmentioning

confidence: 99%

Ossification of the ligamentum flavum in the upper cervical spine: A report of two cases and literature review

Rui

Huang

2020

Exp Ther Med

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Ossification of the ligamentum flavum (OLF) is rarely observed in the cervical spine, particularly not in the upper cervical spine. The present report describes two cases of OLF combined with cervical myelopathy and provides a literature review with a comparative analysis of previous studies and the present cases. Pre-operative CT, MRI and histological examination were performed to confirm the diagnosis of these patients (A 37-year-old female and 63-year-old male). In both cases, histological examination of surgical specimens revealed OLF. The symptoms of the two patients significantly improved after surgery and no recurrence was observed at 13 months after surgery. Furthermore, the clinical outcomes were satisfactory and the internal fixation was solid in the two cases. Review of the literature suggested that further research is required to reveal the optimal treatment methods for upper cervical OLF.

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“…Various factors, including the aging process, chondrocytic metaplasia, endocrine imbalance, metabolic diseases, and mechanical stress, have been reported as major causes of the development of CLF. [10,11] Pathological change studies speculated that during the early stages, CPPD deposited in the ligamentum flavum, and then during the middle and late stages, CPPD is transferred to a stable final form of hydroxyapatite crystals. [2,11] In our case, immediate quadriparesis was caused by a large calcified mass, and the 15 mm × 20 mm calcified cystic mass contained 1 ml of a white viscous liquid.…”

Section: Discussionmentioning

confidence: 99%

Five years of follow-up of immediate quadriparesis caused by a large calcified mass in the ligamentum flavum

Cao

Li²,

Liu³

et al. 2019

Medicine

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Introduction:Calcification of ligamentum flavum (CLF) is an important cause of spinal stenosis and spinal cord compression. CLF does not usually induce immediate quadriparesis. Here we describe a rare case of immediate quadriparesis due to a large calcified mass containing liquids in the ligamentum flavum, which was easily confused with gout crystals.Patient concerns:A 74-year-old Asian male felt progressive bilateral arm and leg weakness. On the fourth day, acute quadriparesis occurred.Diagnosis:Coronal and sagittal computerized tomography (CT) and magnetic resonance imaging (MRI) showed a large circular mass in the left posterior part of the cervical 3/4 spinal canal, protruding into the canal, and occupying one-half of the spinal canal.Interventions:Emergency laminectomy was performed at C3/4 level. The huge cyst was excised and 1 ml of white viscous liquid flowed out.Outcomes:After operation, CT and MRI showed a full laminectomy of C3/4 and complete decompression of the cervical spinal cord. Hematoxylin-eosin (HE) staining showed that large amounts of calcium was deposited around cystic tissues. Five-year follow-up after laminectomy showed good recovery.Conclusion:This case of immediate quadriparesis, caused by a large calcified mass containing fluid, is very rare. It should be at the earliest stage of calcification. Laminectomy is an effective treatment. This calcification was deceptive and was easily confused with gout crystals. It can help to understand the exact pathophysiology of CLF.

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Pathophysiology of Calcification and Ossification of the Ligamentum Flavum in the Cervical Spine

Cited by 34 publications

References 29 publications

Identification of the molecular mechanism and diagnostic biomarkers in the thoracic ossification of the ligamentum flavum using metabolomics and transcriptomics

Identification of the molecular mechanism and diagnostic biomarkers in the thoracic ossification of the ligamentum flavum using metabolomics and transcriptomics

Ossification of the ligamentum flavum in the upper cervical spine: A report of two cases and literature review

Five years of follow-up of immediate quadriparesis caused by a large calcified mass in the ligamentum flavum

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