Ossified Ligamentum Flavum: Epidemiology, Treatment, and Outcomes.
Journal
The Journal of the American Academy of Orthopaedic Surgeons
ISSN: 1940-5480
Titre abrégé: J Am Acad Orthop Surg
Pays: United States
ID NLM: 9417468
Informations de publication
Date de publication:
15 Jun 2022
15 Jun 2022
Historique:
received:
14
01
2022
accepted:
13
02
2022
pubmed:
18
3
2022
medline:
7
6
2022
entrez:
17
3
2022
Statut:
ppublish
Résumé
Ossification of the ligamentum flavum (OLF) is an uncommon but potentially serious spinal condition which can cause progressive compression of the spinal canal with associated devastating neurologic compromise. Although debate exists regarding the exact etiology of OLF, overexpression of genes and transcription factors centered around the Notch and Wnt signaling pathways because of increased mechanical stress seems to be related. There are many clinical and radiographic presentations of OLF; however, progressive myelopathy is the most commonly encountered. Radiographic analysis may reveal isolated OLF or OLF combined with ossification of other areas of the spine, such as disk, posterior longitudinal ligament, and dura. When surgery is necessary for OLF, several surgical strategies exist including open laminectomy with excision, endoscopic decompression, Bridge Crane resection, en block resection, and combined anterior and posterior approaches. Resection may be complicated by dural adhesion or dural ossification, and postoperative neurologic deficits are not uncommon.
Identifiants
pubmed: 35298441
doi: 10.5435/JAAOS-D-21-01253
pii: 00124635-202206150-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e842-e851Informations de copyright
Copyright © 2022 by the American Academy of Orthopaedic Surgeons.
Références
Yayama T, Mori K, Okumura N, et al.: Wnt signaling pathway correlates with ossification of the spinal ligament: A microRNA array and immunohistochemical study. J Orthop Sci 2018;23:26-31.
Kong Q, Ma X, Li F, et al.: COL6A1 polymorphisms associated with ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 2007;32:2834-2838.
Fan T, Meng X, Sun C, et al.: Genome-wide DNA methylation profile analysis in thoracic ossification of the ligamentum flavum. J Cell Mol Med 2020;24:8753-8762.
Zhang C, Chen Z, Meng X, Li M, Zhang L, Huang A: The involvement and possible mechanism of pro-inflammatory tumor necrosis factor alpha (TNF-α) in thoracic ossification of the ligamentum flavum. PLoS One 2017;12:1-13.
Yu S, Li Z, Yan N: Mechanical stress affects the osteogenic differentiation of human ligamentum favum cells via the BMP-Smad1 signaling pathway. Mol Med Rep 2017;16:7692-7698.
Kim SI, Ha KY, Lee JW, Kim YH: Prevalence and related clinical factors of thoracic ossification of the ligamentum flavum—A computed tomography-based cross-sectional study. Spine J 2018;18:551-557.
Aizawa T, Sato T, Sasaki H, Kusakabe T, Morozumi N, Kokubun S: Thoracic myelopathy caused by ossification of the ligamentum flavum: Clinical features and surgical results in the Japanese population. J Neurosurg Spine 2006;5:514-519.
Lee BJ, Park JH, Jeon SR, Rhim SC, Roh SW: Clinically significant radiographic parameter for thoracic myelopathy caused by ossification of the ligamentum flavum. Eur Spine J 2019;28:1846-1854.
Feng F, Sun C, Chen ZQ: A diagnostic study of thoracic myelopathy due to ossification of ligamentum flavum. Eur Spine J 2015;24:947-954.
Sohail A, Maan M, Khan M, Masood Q: Isolated ligamentum flavum ossification in primary hypoparathyroidism. Surg Neurol Int 2018;9:9-12.
Gokcen HB, Ozturk C: Ossification of the ligamentum flavum at the thoracic and lumbar region in an achondroplastic patient. World Neurosurg 2019;126:461-465.
Chen Y, Lu XH, Yang LL, Chen DY: Ossification of ligamentum flavum related to thoracic kyphosis after tuberculosis: Case report and review of the literature. Spine (Phila Pa 1976) 2009;34:41-44.
Fujimori T, Watabe T, Iwamoto Y, Hamada S, Iwasaki M, Oda T: Prevalence, concomitance, and distribution of ossification of the spinal ligaments results of whole spine CT scans in 1500 Japanese patients. Spine (Phila Pa 1976) 2016;41:1668-1676.
Mori K, Kasahara T, Mimura T, et al.: Prevalence, distribution, and morphology of thoracic ossification of the yellow ligament in Japanese; results of CT-based cross-sectional study. Spine (Phila Pa 1976) 2013;38:E1216-E1222.
Moon BJ, Kuh SU, Kim S, Kim KS, Cho YE, Chin DK: Prevalence, distribution, and significance of incidental thoracic ossification of the ligamentum flavum in Korean patients with back or leg pain: MR-based cross sectional study. J Korean Neurosurg Soc 2015;58:112-118.
Guo JJ, Luk KDK, Karppinen J, Yang H, Cheung KMC: Prevalence, distribution, and morphology of ossification of the ligamentum flavum: A population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine (Phila Pa 1976) 2010;35:51-56.
Ohara Y: Ossification of the ligaments in the cervical spine, including ossification of the anterior longitudinal ligament, ossification of the posterior longitudinal ligament, and ossification of the ligamentum flavum. Neurosurg Clin N Am 2018;29:63-68.
Zhou SY, Yuan B, Chen XS, Li XB, Zhu W, Jia LS: Imaging grading system for the diagnosis of dural ossification based on 102 segments of TOLF CT bone-window data. Sci Rep 2017;7:2983.
Zhou SY, Yuan B, Qian C, Chen XS, Jia LS: Evaluation of measuring methods of spinal canal occupation rate in thoracic ossification of ligamentum flavum. World Neurosurg 2018;110:e1025-e1030.
Chen G, Zhang B, Tao L, Chen Z, Sun C: The diagnostic accuracy of CT-based “banner cloud sign” for dural ossification in patients with thoracic ossification of the ligamentum flavum: A prospective, blinded, diagnostic accuracy study protocol. Ann Transl Med 2020;8:1606.
Yu L, Li B, Yu Y, Li W, Qiu G, Zhao Y: The relationship between dural ossification and spinal stenosis in thoracic ossification of the ligamentum flavum. J Bone Joint Surg Am 2019;101:606-612.
Sun XZ, Chen ZQ, Qi Q, et al.: Diagnosis and treatment of ossification of the ligamentum flavum associated with dural ossification: Clinical article. J Neurosurg Spine 2011;15:386-392.
Prasad GL: Thoracic spine ossified ligamentum flavum: Single-surgeon experience of fifteen cases and a new MRI finding for preoperative diagnosis of dural ossification. Br J Neurosurg 2020;34:638-646.
Kawaguchi Y, Nakano M, Yasuda T, et al.: Characteristics of ossification of the spinal ligament; incidence of ossification of the ligamentum flavum in patients with cervical ossification of the posterior longitudinal ligament—Analysis of the whole spine using multidetector CT. J Orthop Sci 2016;21:439-445.
Singh NA, Shetty AP, Jakkepally S, Kumarasamy D, Kanna RM, Rajasekaran S: Ossification of posterior longitudinal ligament in cervical spine and its association with ossified lesions in the whole spine: A cross-sectional study of 2500 CT scans. Glob Spine J 2021. doi: 10.1177/2192568221993440.
doi: 10.1177/2192568221993440
Takagi Y, Yamada H, Ebara H, et al.: Thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis: A case report. J Med Case Rep 2017;11:90.
Sun K, Sun X, Zhu J, et al.: Comparison of surgical results of the bridge crane technique versus laminectomy for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum. Glob Spine J 2021. doi: 10.1177/2192568221996689.
doi: 10.1177/2192568221996689
Wang ZW, Wang Z, Fan XW, et al.: Precise surgical treatment of thoracic ossification of ligamentum flavum assisted by O-arm computer navigation: A retrospective study. World Neurosurg 2020;143:e409-e418.
Tang CYK, Cheung KMC, Samartzis D, Cheung JPY: The natural history of ossification of yellow ligament of the thoracic spine on MRI: A population-based cohort study. Glob Spine J 2021;11:321-330.
Zhao W, Shen C, Cai R, et al.: Minimally invasive surgery for resection of ossification of the ligamentum flavum in the thoracic spine. Wideochirurgia Inne Tech Maloinwazyjne 2017;12:96-105.
Baba S, Shiboi R, Yokosuka J, et al.: Microendoscopic posterior decompression for treating thoracic myelopathy caused by ossification of the ligamentum flavum: Case series. Medicina (B Aires) 2020;56:684.
An B, Li XC, Zhou CP, et al.: Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum. Eur Spine J 2019;28:492-501.
Cheng XK, Chen B: Percutaneous endoscopic thoracic decompression for thoracic spinal stenosis under local anesthesia. World Neurosurg 2020;139:488-494.
Li X, An B, Gao H, et al.: Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum. Sci Rep 2020;10:1305.
Eun SS, Kumar R, Choi WG, Cho HR, Lee SH: Lamina fenestration technique for treatment of thoracic ossified ligamentum flavum: 2-year follow-up result. J Neurol Surg A Cent Eur Neurosurg 2017;78:286-290.
Zhong ZM, Wu Q, Meng TT, et al.: Clinical outcomes after decompressive laminectomy for symptomatic ossification of ligamentum flavum at the thoracic spine. J Clin Neurosci 2016;28:77-81.
Osman NS, Cheung ZB, Hussain AK, et al.: Outcomes and complications following laminectomy alone for thoracic myelopathy due to ossified ligamentum flavum. Spine (Phila Pa 1976) 2018;43:E842-E848.
Xue YD, Zhang ZC, Ma C, Dai WX: Preliminary report of modified expansive laminoplasty in the treatment of thoracic ossification of the ligamentum flavum. J Int Med Res 2021;49:300060520985383.
Ma J, Lu Z, Zhou X, et al.: Comparing thoracic extensive laminoplasty (TELP) and laminectomy in treating severe thoracic ligamentum flavum ossification: A proposed novel technique and case-control study. Biomed Res Int 2021;2021:8410317.
Zhang HQI, Chen LQ, Liu SH, Zhao D, Guo CF: Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level: Clinical article. J Neurosurg Spine 2010;13:116-122.
Yang J, Ni B, Xie N, Guo Q, Wang L: Surgical treatments of myelopathy caused by cervical ligamentum flavum ossification. World Neurosurg 2011;75:546-550.
Zhang H, Wang C, Wang D, et al.: Predictive risk factors of poor preliminary postoperative outcome for thoracic ossification of the ligamentum flavum. Orthop Surg 2021;13:408-416.
Kim JK, Ryu HS, Moon BJ, Lee JK: Clinical outcomes and prognostic factors in patients with myelopathy caused by thoracic ossification of the ligamentum flavum. Neurospine 2018;15:269-276.
Li Z, Ren D, Zhao Y, et al.: Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: A retrospective analysis of 85 cases. Spinal Cord 2016;54:188-196.
Sun X, Sun C, Liu X, et al.: The frequency and treatment of dural tears and cerebrospinal fluid leakage in 266 patients with thoracic myelopathy caused by ossification of the ligamentum flavum. Spine (Phila Pa 1976) 2012;37:E702-E707.
Hou X, Chen Z, Sun C, Zhang G, Wu S, Liu Z: A systematic review of complications in thoracic spine surgery for ossification of ligamentum flavum. Spinal Cord 2018;56:301-307.
Wu D, Wang H, Hu P, Xu W, Liu J: The postoperative prognosis of thoracic ossification of the ligamentum flavum can be described by a novel method: The thoracic ossification of the ligamentum flavum score. World Neurosurg 2019;130:e47-e53.
Ando K, Imagama S, Kaito T, et al.: Outcomes of surgery for thoracic myelopathy owing to thoracic ossification of the ligamentum flavum in a nationwide multicenter prospectively collected study in 223 patients: Is instrumented fusion necessary? Spine (Phila Pa 1976) 2020;45:E170-E178.
Kanno H, Takahashi T, Aizawa T, Hashimoto K, Itoi E, Ozawa H: Recurrence of ossification of ligamentum flavum at the same intervertebral level in the thoracic spine: A report of two cases and review of the literature. Eur Spine J 2018;27:359-367.
Sampanis N, Gavriilaki E, Paschou E, Kalaitzoglou A, Vasileiou S: Ossification of the cervical ligamentum flavum and osseous brown tumor: Late manifestations of primary hyperparathyroidism misdiagnosed in a case of parathyroid carcinoma. Clin Cases Miner Bone Metab 2016;13:54-56.