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1.
Spine (Phila Pa 1976) ; 47(3): 277-285, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34919077

RESUMO

STUDY DESIGN: Histological, immunohistochemical, and suspension array analyses of cytokine expression in human cervical ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: The aim of this study was to determine whether changes in the cytokine profile reflect the maturation of chondrocytes and osteoblasts are associated with OPLL development. SUMMARY OF BACKGROUND DATA: OPLL progresses gradually over a prolonged period and may lead to serious spinal cord complications. However, treatment methods only include conservative therapy for neurological symptoms or surgical decompression, whereas preventive therapy for OPLL remains nonexistent. METHODS: Ligamentous samples were harvested from 24 patients with OPLL who underwent spinal surgery, and five control samples from cervical spondylotic myelo/radiculopathy patients without OPLL. Tissue sections were used for immunohistochemical studies and primary cells were cultured from the ligamentous samples for cytokine profiling. Using a suspension array system, concentrations of 27 inflammatory cytokines or growth factors were measured to generate the cytokine profiles. RESULTS: Suspension array and immunoblot analysis revealed significant increments in the levels of interleukin (IL)-6, IL-1α, basic fibroblast growth factor, and RANTES in patients with OPLL. Immunohistochemical analysis further revealed that these factors were present in mesenchymal cells within the degenerative portion of the ligamentous matrix. CONCLUSION: Our findings suggest that specific changes in the cytokine profile during ossification promote osteoblast differentiation, thereby providing new insights into OPLL pathogenesis. Moreover, this work supports the development of a new therapeutic method for preventing OPLL progression by regulating the cytokine profiles.Level of Evidence: 3.


Assuntos
Ligamento Amarelo , Ossificação do Ligamento Longitudinal Posterior , Vértebras Cervicais/cirurgia , Citocinas , Descompressão Cirúrgica , Humanos , Ligamento Amarelo/cirurgia , Ligamentos Longitudinais/cirurgia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Osteogênese , Resultado do Tratamento
2.
Pain Res Manag ; 2021: 3971396, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34966472

RESUMO

Objectives: To explore the influencing factors of satisfaction with postoperative treatment in patients diagnosed with thoracic ossification of the ligamentum flavum during different follow-up periods. Methods: This was a retrospective study of 57 patients who were diagnosed with thoracic ossification of ligamentum flavum (TOLF) and treated with laminectomy in the Spine Surgery Department of the Third Hospital of Hebei Medical University from January 2010 to January 2017. The Patient Satisfaction Index (PSI) was collected at discharge and at 6-month, 1-year, and the last follow-up. According to the evaluation results, the patients could be divided into a satisfied group and a dissatisfied group. The patient's Japanese Orthopaedic Association (JOA) score improvement rate was evaluated at the last follow-up. Possible influencing factors of the two groups of patients were compared and the related influencing factors of satisfaction with postoperative treatment in patients during different follow-up periods were summarized. Results: At the time of discharge, the dissatisfied and satisfied groups had significant differences in variables of diabetes mellitus, duration of preoperative symptoms, urination disorder, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, hospital stay, hospitalization expenses, postoperative pain in LE VAS, delayed wound healing, postoperative depression, and intercostal pain (P < 0.05). There were also significant differences in urination disorder, postoperative pain according to the LE VAS, JOA score, and postoperative depression during the 6-month follow-up (P < 0.05). There were no significant differences in other variables between the two groups (P > 0.05). One year after the operation, there were significant differences between the dissatisfied group and the satisfied group in urination disorder, JOA score, and symptom recurrence (P < 0.05). There were also significant differences in the JOA score and symptom recurrence at the final follow-up (P < 0.05). For further analysis, the duration of preoperative symptoms in the satisfied group was less than 24 months and the duration of preoperative symptoms in the dissatisfied group was more than 24 months. The JOA scores of patients in the satisfied group and the dissatisfied group increased gradually with the improvement of neurological function in different follow-up periods, but, at the last follow-up, the JOA scores of patients in the satisfied group were significantly higher than those in the dissatisfied group. Conclusions: In conclusion, for thoracic ossification of ligamentum flavum patients who received laminectomy, dissatisfaction with the early and medium-term postoperative results may be related to diabetes, the duration of preoperative symptoms, hospitalization expenses, delayed wound healing, intercostal pain, and urination disorder, and dissatisfaction with the long-term postoperative results might be related to the low JOA score improvement rate and symptom recurrence.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Estudos Transversais , Seguimentos , Humanos , Laminectomia/efeitos adversos , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/cirurgia , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/cirurgia , Osteogênese , Satisfação do Paciente , Estudos Retrospectivos , Fatores de Risco , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
3.
Zhonghua Wai Ke Za Zhi ; 59(11): 940-946, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34743458

RESUMO

Objective: To investigate the safety and clinical efficacy of "zoning" style laminectomy by ultrasonic bone curette in patients with severe thoracic ossification of the ligamentum flavum(TOLF). Methods: The clinical data of 36 patients with severe TOLF treated by "zoning" style laminectomy at Department of Spinal Surgery,Zhengzhou Orthopaedic Hospital from October 2015 to October 2018 were respectively analyzed.There were 17 males and 19 females,aged(57.3±10.2)years(range:43 to 80 years).According to the anatomical characteristics of the thoracic ligamentum flavum and the pathological process of ossionization,each decompression segment was divided into the upper 1/3 area of the lamina,the bilateral area of the ossionum flavum,the transitional area,and the area of close contact between the ossionum flavum and the spinal cord.Different surgical strategies were used for decompression in turn.The modified Japanese Orthopedic Association (mJOA) was used to evaluate the neurological function status before and after surgery,to evaluate the surgical effect of patients,and to observe the surgical complications.Paired sample T test was used for data analysis. Results: All 36 patients successfully completed the operation,the operation time was (88.6±24.6) minutes(range:60 to 150 minutes).The intraoperative blood loss was (426.7±167.4) ml(range:250 to 800 ml).Follow-up time was (27.2±7.7) months(range:12 to 48 months).The mJOA score at the last follow-up was 9.0±1.5,which was statistically significant compared with the preoperative score 5.4±1.8 (t=13.59,P<0.01).The improvement rate of mJOA score was (65.7±22.1) %,of which 17 cases were excellent (47.2%),13 cases were good (36.1%),4 cases were normal (11.1%),2 cases were ineffective (5.6%).Ten patients had cerebrospinal fluid leakage during the separation or removal of dural ossification and were cured after a series of comprehensive conservative treatment.Two patients showed transient neurological deterioration,and the neurological function gradually recovered to the preoperative state after comprehensive treatment such as increasing the mean arterial pressure and using neurotrophic drugs.During the follow-up,no aggravation of neurological dysfunction and segmental kyphosis were found. Conclusions: The ultrasonic bone curette-assisted "zoning" style laminectomy for the treatment of severe TOLF can directly observed the position relationship between ossification of the ligamentum flavum and the spinal canal structure during the operation,and accurately guide the surgical decompression.It has the advantages of safe operation and complete decompression,which provides an important reference for the selection of clinical surgery.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Feminino , Humanos , Laminectomia , Ligamento Amarelo/cirurgia , Masculino , Ossificação Heterotópica/cirurgia , Osteogênese , Estudos Retrospectivos , Vértebras Torácicas/cirurgia , Ultrassom
4.
J Int Med Res ; 49(11): 3000605211059465, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34796768

RESUMO

Both systemic and local factors might influence the development of ossification of the ligamentum flavum (OLF); however, whether specific physical activities play a role in the development of OLF remains unclear. This report presents two cases of thoracic radiculopathy owing to progressive enlargement of thoracic OLF within a few years in Japanese professional baseball pitchers. Two left-handed, Japanese, professional baseball pitchers in their 20s experienced thoracic radiating pain. Mild hypesthesia of the lower thoracic vertebral levels was observed, and an increase in the size of the OLF within a few years was identified in the lower thoracic spine using computed tomography and magnetic resonance imaging. Neither patient exhibited myelopathy and were, therefore, treated conservatively. Both patients were able to return to playing in top condition within 4 months after onset. The findings in these cases suggest that thoracic OLF might increase in size and become exacerbated in certain individuals, such as professional pitchers, who experience repeated, localized, mechanical stress on the thoracic spine, irrespective of age.


Assuntos
Beisebol , Ligamento Amarelo , Ossificação Heterotópica , Humanos , Ligamento Amarelo/diagnóstico por imagem , Ossificação Heterotópica/diagnóstico por imagem , Osteogênese , Vértebras Torácicas/diagnóstico por imagem
5.
BMC Musculoskelet Disord ; 22(1): 929, 2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34736450

RESUMO

BACKGROUND: Involvement in cervical ligamentum flavum is a rare manifestation of the calcium pyrophosphate dihydrate deposition disease. Only few cases of this condition have been reported. We revealed eighteen cases of CPPD in cervical ligamentum flavum that diagnosed at a single medical center. In our case series, clinical characteristics and magnetic resonance imaging findings of patients are described. METHODS: We retrospectively reviewed the medical charts and imaging studies of the eighteen patients with pseudogout attack of the cervical ligamentum flavum. In addition, we discussed the differences between this disease and ossification of ligamentum flavum in image manifestations. RESULTS: There were fourteen men and four women aged between 59 and 87 years. Diabetes mellitus and hypertension were the most common comorbidities. Myelopathy and neck pain were presented in most patients. C4-5 and C5-6 were attacked most frequently, and multiple- rather than single-level involvement could be observed in our series. "Acute on chronic phenomenon" was a specific magnetic resonance image finding in patients whose symptom durations were between 2 to 5 months. Compared to ossification of ligamentum flavum, calcium pyrophosphate dihydrate crystal deposition had different image signs, including morphology, side of the involved ligament, no continuity with the lamina, acute on chronic phenomenon, and presence of retro-odontoid mass. CONCLUSIONS: Nodular calcifications in cervical ligamentum flavum raise highly suspicion for calcium pyrophosphate dihydrate deposition and must be diagnosed by histological examination and polarized light microscopy. This disease is different from ossification of ligamentum flavum, and it could be recognized by specific image features.


Assuntos
Condrocalcinose , Ligamento Amarelo , Doenças da Medula Espinal , Idoso , Idoso de 80 Anos ou mais , Condrocalcinose/diagnóstico por imagem , Feminino , Humanos , Ligamentos , Ligamento Amarelo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Arthritis Res Ther ; 23(1): 251, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593020

RESUMO

BACKGROUND: Hypertrophy of ligamentum flavum (HLF) is a common lumbar degeneration disease (LDD) with typical symptoms of low back pain and limb numbness owing to an abnormal pressure on spinal nerves. Previous studies revealed HLF might be caused by fibrosis, inflammatory, and other bio-pathways. However, a global analysis of HLF is needed severely. METHODS: A genome-wide DNA methylation and single-nucleotide polymorphism analysis were performed from five LDD patients with HLF and five LDD patients without HLF. Comprehensive integrated analysis was performed using bioinformatics analysis and the validated experiments including Sanger sequencing, methylation-specific PCR, qPCR and ROC analysis. Furthermore, the function of novel genes in ligamentum flavum cells (LFCs) was detected to explore the molecular mechanism in HLF through knock down experiment, overexpression experiment, CCK8 assay, apoptosis assay, and so on. RESULTS: We identified 69 SNP genes and 735 661 differentially methylated sites that were enriched in extracellular matrix, inflammatory, and cell proliferation. A comprehensive analysis demonstrated key genes in regulating the development of HLF including ACSM5. Furthermore, the hypermethylation of ACSM5 that was mediated by DNMT1 led to downregulation of ACSM5 expression, promoted the proliferation and fibrosis, and inhibited the apoptosis of LFCs. CONCLUSION: This study revealed that DNMT1/ACSM5 signaling could enhance HLF properties in vitro as a potential therapeutic strategy for HLF.


Assuntos
Ligamento Amarelo , Estenose Espinal , Coenzima A Ligases , DNA (Citosina-5-)-Metiltransferase 1 , Metilação de DNA/genética , Humanos , Hipertrofia/genética , Ligamento Amarelo/metabolismo , Vértebras Lombares , Nucleotídeos/metabolismo , Estenose Espinal/genética , Estenose Espinal/metabolismo
7.
BMC Musculoskelet Disord ; 22(1): 818, 2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556093

RESUMO

BACKGROUND: Fibrosis is an important factor and process of ligamentum flavum hypertrophy. The expression of phosphodiesterase family (PDE) is related to inflammation and fibrosis. This article studied the expression of PDE in hypertrophic ligamentum flavum fibroblasts and investigated whether inhibition of PDE4 activity can play an anti-fibrotic effect. METHODS: Samples of clinical hypertrophic ligamentum flavum were collected and patients with lumbar disc herniations as a control group. The collagenase digestion method is used to separate fibroblasts. qPCR is used to detect the expression of PDE subtypes, type I collagen (Col I), type III collagen (Col III), fibronectin (FN1) and transforming growth factor ß1 (TGF-ß1). Recombinant TGF-ß1 was used to stimulate fibroblasts to make a fibrotic cell model and treated with Rolipram. The morphology of the cells treated with drugs was observed by Sirius Red staining. Scratch the cells to observe their migration and proliferation. WB detects the expression of the above-mentioned multiple fibrotic proteins after drug treatment. Finally, combined with a variety of signaling pathway drugs, the signaling mechanism was studied. RESULTS: Multiple PDE subtypes were expressed in ligamentum flavum fibroblasts. The expression of PDE4A and 4B was significantly up-regulated in the hypertrophic group. Using Rolipram to inhibit PDE4 activity, the expression of Col I and TGF-ß1 in the hypertrophic group was inhibited. Col I recovered to the level of the control group. TGF-ß1 was significantly inhibited, which was lower than the control group. Recombinant TGF-ß1 stimulated fibroblasts to increase the expression of Col I/III, FN1 and TGF-ß1, which was blocked by Rolipram. Rolipram restored the increased expression of p-ERK1/2 stimulated by TGF-ß1. CONCLUSION: The expressions of PDE4A and 4B in the hypertrophic ligamentum flavum are increased, suggesting that it is related to the hypertrophy of the ligamentum flavum. Rolipram has a good anti-fibrosis effect after inhibiting the activity of PDE4. This is related to blocking the function of TGF-ß1, specifically by restoring normal ERK1/2 signal.


Assuntos
Ligamento Amarelo , Fibroblastos/metabolismo , Fibrose , Humanos , Ligamento Amarelo/patologia , Sistema de Sinalização das MAP Quinases , Rolipram/metabolismo , Rolipram/farmacologia , Fator de Crescimento Transformador beta1/metabolismo
8.
Spine (Phila Pa 1976) ; 46(17): 1129-1138, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34384088

RESUMO

STUDY DESIGN: Western blot, reverse transcription-polymerase chain reaction (RT-PCR), radiological, and histological analyses of the rat ossification of ligamentum flavum (OLF) induced by cyclic tensile stress. OBJECTIVE: The aim of this study was to induce the OLF using cyclic tensile stress to rat thoracolumbar ligamentum flavum, and to investigate the possible molecular mechanism of tension-induced OLF. SUMMARY OF BACKGROUND DATA: Tensile stress has been considered as an important factor leading to the OLF. So far, however, no OLF induced by tension has been reported. METHODS: Forty rats were randomly divided into five equal groups. For control groups, the blank and anesthesia groups were not subjected to tension. For experimental groups, the 4-, 8-, and 12-week groups were subjected to cyclic tensile stress of ligamentum flavum after abdominal anesthesia for 4 weeks, 8 weeks, and 12 weeks, respectively, using an original stress apparatus for rats. The radiological and morphological changes of rat spine, as well as the protein and mRNA expressions of CD44, bone morphogenetic protein-2 (BMP-2), integrin ß3, collagen protein type I (COL1), osteopontin (OPN), runt-related transcription factor 2 (RUNX-2), and vascular endothelial growth factor (VEGF), were concerned. RESULTS: The micro-CT showed OLF in the 4-, 8-, and 12-week group. The axial maximum occupied area of ossifications was 1.42 mm2, 3.35 mm2, and 7.28 mm2, respectively. In histopathology, chondrocytes proliferated in the experimental model; woven bone arose in the 8- and 12-week groups, and was more noticeable in the 12-week group. According to western blot and RT-PCR, the expressions of seven osteogenesis-related molecules were all increased in three experimental groups. CONCLUSION: Cyclic tensile stress to the ligamentum flavum in rats can induce the OLF, and the longer the duration, the more visible the osteogenesis. The upregulation and synergism of osteogenesis-related molecules may contribute to the OLF induced by tensile stress.Level of Evidence: N/A.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Estresse Mecânico , Animais , Condrócitos , Ligamento Amarelo/diagnóstico por imagem , Osteogênese , Ratos , Vértebras Torácicas/diagnóstico por imagem
9.
Spine (Phila Pa 1976) ; 46(17): 1197-1205, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34384098

RESUMO

STUDY DESIGN: A retrospective cohort analysis. OBJECTIVE: The aim of this study was to investigate the impact of piecemeal versus en bloc laminectomies on spinal cord in thoracic ossification of ligamentum flavum (TOLF) through intraoperative changes of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs). SUMMARY OF BACKGROUND DATA: Surgical treatment is indicated for symptomatic TOLF, and both piecemeal and en bloc laminectomies are commonly used methods. However, few studies compared both intraoperative interference and prognostic impact of these two laminectomies on spinal cord in TOLF patients. METHODS: MEPs were recorded from abductor hallucis (AH) and tibialis anterior, and SEPs were performed on tibial nerve in 55 TOLF patients (piecemeal vs. en bloc: 23 vs. 32). Patients were categorized based on MEP/SEP improvement, deterioration, and no change, and MEP/SEP improvement rates were measured in the improvement group. Additionally, all patients were assessed by American Spinal Injury Association (ASIA) scores, Ashworth scores, and modified Japanese Orthopedic association (mJOA) scores before and after operation. RESULTS: The incidences of both MEP/SEP improvement and deterioration were similar between the two laminectomy groups (P > 0.05), and no significant difference is noted in both MEP and SEP amplitudes between the baseline and different critical manipulations in both laminectomy groups (P > 0.05). In the improvement group, patients receiving en bloc laminectomy exhibited increased improvement rates of both MEPs in bilateral AH and left-side SEPs compared to piecemeal laminectomy (P < 0.05). Clinically, all functional scales clearly improved in both laminectomy groups after operation (P < 0.05), and postoperative 1-year mJOA improvement rates were highly correlated with MEP improvement rates (P < 0.05). CONCLUSION: Intraoperative changes of MEPs and SEPs potentially provide a valid method for quantitatively evaluating the safety of different intraoperative manipulations and their prognostic impacts on spinal cord. Both laminectomies are safe and effective methods to treat TOLF, and en bloc laminectomy may cause relatively better spinal cord functional recovery.Level of Evidence: 3.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Humanos , Laminectomia , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/cirurgia , Ossificação Heterotópica/cirurgia , Osteogênese , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
10.
BMC Musculoskelet Disord ; 22(1): 701, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404364

RESUMO

BACKGROUND: It is imperative to preoperatively distinguish dural ossification (DO) and thus anticipate the risks and outcome of the surgery for patients with ossification of ligamentum flavum (OLF). However, studies have disagreed as to the efficacy of the radiographic signs or factors to predict DO and surgical outcome. In additon, the association between the cerebrospinal fluid cross-section area ratio (CCAR) and DO or clinical outcome had not been reported. The purpose of this study was to analyse CCAR and its role in prediction of DO and neurological function recovery rate in patients with OLF. METHODS: Fifty-two consecutive patients with OLF, who underwent posterior thoracic decompression and fusion between September 2012 and March 2019 at a single institution, were retrospectively reviewed. Demographic data, radiographic signs of DO, CCAR, pre- and postoperative modified Japanese Orthopedic Association (mJOA) score were recorded. RESULTS: There were 27 patients in the DO group and 25 patients in the non-DO group, with a mean age at surgery of 57.4 years and 53.9 years, respectively. No significant differences were found in sex, age, segment of maximum compression and preoperative mJOA score between the two groups. The receiver operating characteristic curve showed that the value of CCAR had a relatively high value for diagnosis of DO and prediction of neurological function recovery rate (P = .000). According to the value of CCAR, three zones were defined as DO zone (≤14.3%), non-DO zone (≥44.5%), and gray zone (14.3 to 44.5%). When the value of CCAR≤14.3%, the recovery rate was poor or fair, while it had good or excellent recovery when CCAR≥45.2%. CONCLUSION: The value of CCAR had a high diagnostic value for prediction of DO and neurological function recovery rate in patients with OLF.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Descompressão Cirúrgica , Humanos , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/cirurgia , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/epidemiologia , Ossificação Heterotópica/cirurgia , Osteogênese , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(34): e27084, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449510

RESUMO

ABSTRACT: One of major causes of cervical central stenosis (CCS) is thickened change of cervical ligament flavum (CLF). The association of a morphological parameter called cervical ligament flavum thickness (CLFT) with CCS has not been reported yet. Thus, the purpose of this research was to investigate the relationship between CCS and CFJT.Data were obtained from 88 patients with CCS. A total of 87 normal controls also underwent cervical spine magnetic resonance imaging (CSMRI). All subjects underwent axial T2-weighted CSMRI. Using our picture archiving and communications system, thickness of ligament flavum of the cervical spine at C6/7 level was analyzed.The mean CLFT was 1.41 ±â€Š0.24 mm in normal subjects and 2.09 ±â€Š0.39 mm in patients with CCS. The CCS group was found to have significantly (P < .001) higher rate of CLFT than normal subjects. ROC curves were used to assess the usefulness of CLFT as a predictor of CCS. In the CCS group, the best practical cut off-point of CLFT was 1.71 mm (sensitivity = 90.9%; specificity = 90.8%), with AUC of 0.94 (95% confidence interval: 0.90--0.98).Greater CLFT values were associated with greater possibility of CCS. Thus, treating physician should carefully examine CLFT, as it can help diagnose CCS.


Assuntos
Vértebras Cervicais/patologia , Ligamento Amarelo/anatomia & histologia , Estenose Espinal/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores Socioeconômicos
12.
Spinal Cord Ser Cases ; 7(1): 69, 2021 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-34333511

RESUMO

INTRODUCTION: Achondroplasia is a rare autosomal dominant condition characterized by stenosis in spinal canal. Multilevel Ossification of the ligamentum flavum in the spine is a rare occurrence which too can contribute to stenosed canal. CASE PRESENTATION: We report a case of an Indian achondroplasic dwarf with multilevel ossification of ligamentum flavum (OLF) at thoracic and lumbar segment. She presented in the outpatient department with bilateral weakness in legs with complete foot drop on the left side and was non-ambulatory. She was managed surgically by instrumentation with multiple interbody fusions with wide decompression and excision of OLF. The patient responded well to the surgery and became a walker after 2-year follow-up. DISCUSSION: Achondroplasic patients may present rarely with multiregional and multilevel OLF. It is important to identify them preoperatively so as to have good surgical outcome. Wide laminectomy, removal of the ossified ligament, and fusion with instrumentation resulted in the improvement of the patient's neurological symptoms and functions.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Feminino , Humanos , Laminectomia , Ligamento Amarelo/cirurgia , Ossificação Heterotópica/complicações , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/cirurgia , Osteogênese , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
13.
BMJ Case Rep ; 14(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253529

RESUMO

Postoperative pseudomeningocele usually has a benign course. We report a rare presentation of postoperative acute neurological deficit caused by compressive thoracic pseudomeningocele. This patient had posterior spinal fusion and decompression surgery for thoracic ossification of posterior longitudinal ligament and ligamentum flavum. Intraoperative incidental durotomy was covered with hydrogel dural sealant. She developed acute neurological deterioration 1 week after index surgery. Emergency decompression surgery was performed. One year after the surgery, she showed good neurological recovery.


Assuntos
Ligamento Amarelo , Ossificação do Ligamento Longitudinal Posterior , Doenças da Medula Espinal , Descompressão Cirúrgica , Feminino , Humanos , Ligamento Amarelo/cirurgia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Doenças da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
14.
Spinal Cord Ser Cases ; 7(1): 57, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34244480

RESUMO

INTRODUCTION: Acute spinal cord injury without tomographic evidence of vertebral fracture or dislocation in patients post trauma can represent a diagnostic challenge for the treating physician. The ossification of thoracic ligamentum flavum has been widely published as a cause of thoracic myelopathy, however its association with acute traumatic spinal cord injury is limited to isolated cases. CASE PRESENTATION: we report a Caucasian 37-year-old man who suffered a high-energy thoracolumbar spine trauma in a motorcycle accident with acute paraplegia. He presented ossification of the ligamentum flavum between the thoracic vertebrae T10 and T11 with a decrease in the diameter of the vertebral canal as the only pathological finding. We treated the patient with early surgical release before 72 h of trauma. We performed a posterior approach with hemilaminectomy and T10-T11 flavectomy. Arthrodesis was done with T10-T11 pedicle screws. Postoperative neurological status improved from ASIA Impairment Scale (AIS) A to C with severe functional dependence. DISCUSSION: Ossification of the ligamentum flavum should be considered in the differential diagnosis in patients presenting with acute traumatic spinal cord injury without tomographic evidence of trauma. A proper diagnosis in time is the key to decision making and treatment of spinal cord injury. Especially in adult patients, we must consider nontraumatic associated factors that could be involved in the spinal cord injury mechanism, such as ossification of the ligamentum flavum.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Traumatismos da Medula Espinal , Adulto , Humanos , Laminectomia , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/cirurgia , Masculino , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/cirurgia , Osteogênese
15.
Eur Spine J ; 30(10): 2782-2790, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34287704

RESUMO

PURPOSE: Genetic factors play a crucial role in thoracic ossification of the ligamentum flavum (TOLF). This study aimed to better understand the association between single nucleotide polymorphisms (SNP) in functional regions of the collagen VI, alpha 1 gene (COL6A1) and TOLF, and to confirm COL6A1 as a TOLF susceptibility gene. METHODS: Ten tag SNPs in COL6A1 were genotyped using the SNaPshot assay, and allele and genotype frequencies were compared between TOLF patients and control individuals. The function of SNPs associated with disease was studied. For COL6A1 promoter SNPs, the transcriptional activity of each haplotype was determined by luciferase reporter assays. For COL6A1 exonic SNPs, the effect of nucleotide substitutions on COL6A1 expression was determined by western blotting. COL6A1 mRNA expression in ligamentum flavum tissues from TOLF patients with different genotypes was examined using reverse transcription real-time PCR. RESULTS: Four SNPs were associated or possibly associated with TOLF, with higher pathogenic allele and genotype frequencies seen in TOLF patients compared with controls. The rs17551710/rs7671-GG/GG genotype appeared to be related to disease severity. Nucleotide substitutions at rs17551710 and rs7671 increased COL6A1 transcriptional activity and nucleotide substitutions at rs1053312 and rs13051496 increased COL6A1 protein expression. COL6A1 mRNA expression was significantly up-regulated in individuals with rs17551710/rs7671-GG/GG and rs1053312/rs13051496-AA+AG/CC genotypes compared with other genotypes. CONCLUSION: SNPs in the COL6A1 promoter and exonic regions are associated with TOLF in the Chinese Han population, and lead to up-regulated COL6A1 expression. We confirmed COL6A1 as a TOLF susceptibility gene that may be involved in TOLF pathology.


Assuntos
Ligamento Amarelo , Ossificação do Ligamento Longitudinal Posterior , China , Colágeno Tipo VI/genética , Humanos , Osteogênese , Polimorfismo de Nucleotídeo Único/genética
16.
World Neurosurg ; 153: e290-e299, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34245884

RESUMO

OBJECTIVE: To determine diagnostic value of morphological features of horizontal laminar fracture (HLF) and vertical laminar fracture (VLF) for diagnosis of posterior ligamentous complex (PLC) injury. METHODS: This retrospective review comprised 271 consecutive patients with acute thoracolumbar fractures presenting to a Level 1 trauma center between January 2014 and January 2021. Two reviewers evaluated computed tomography and magnetic resonance imaging. VLFs were subclassified based on length and depth of lamina involved, as follows: type 1, full-length complete; type 2, full-length incomplete; type 3, partial-length complete or incomplete. HLFs were subclassified as follows: bilateral versus unilateral, displaced >2 mm versus nondisplaced, and lamina-only versus laminar and pedicle. We examined the diagnostic accuracy and the univariate and multivariate associations of laminar fracture subtypes with PLC injury as defined by black stripe discontinuity. RESULTS: Bilateral HLFs, laminar and pedicle fractures, displaced HLFs, and type 1 VLFs yielded a high positive predictive value for PLC injury (95%, 91%, 100%, and 86%, respectively). Type 2 and 3 VLFs did not show significant univariate associations with PLC injury. Bilateral HLFs, laminar and pedicle fractures, and displaced HLFs showed independent associations with PLC injury (adjusted odds ratio = 13.6, 8.4, 6, and 10.3, respectively; P < 0.002). Type 1 VLFs did not show a significant association with PLC (adjusted odds ratio = 10.3; P = 0.06). CONCLUSIONS: Bilateral HLFs, laminar and pedicle fractures, and displaced HLFs, but not any VLF subtypes, were independently associated with PLC injury. These findings may improve the reliability of PLC assessment by computed tomography.


Assuntos
Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/lesões , Imageamento por Ressonância Magnética/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas
17.
Clin Interv Aging ; 16: 897-908, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34079239

RESUMO

Purpose: Cervical ossification of ligamentum flavum (COLF) is a rare clinical entity which can occasionally contribute to severe myeloradiculopathy. Many orthopedists are unfamiliar with or underestimate this pathology. Therefore, a comprehensive research is obligatory to reappraise the epidemiological, radiological, clinical and histopathological characteristics of COLF-myeloradiculopathy based on synthesis of individual patient data. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, EMBASE, Scopus and Web of Science databases were searched for studies discussing COLF-myeloradiculopathy from the inception to December 2020. Results: A total of 94 cases from 54 studies were identified. The annual publications demonstrated a steady increase, and most reports were from Japan and China. The mean age was 58.76±13.39 years and nearly 60% of cases occurred in the 55-64 and 65-74 years age group. The male-female ratio was 1.4:1. Most cases belonged to East Asian population (60.64%). COLF predominately appeared in the lower cervical and cervicothoracic spine (76.60%) and mainly affected C4-5 (23.29%) and C5-6 (21.23%). Single-segment type ossification accounted for 62.76 and 45.45% of ossification lesions distributed bilaterally. The majority of COLF (81.1%) were spontaneous, and motor disturbance (76.4%), spinal ataxia (62.5%) and sensory disturbance (58.9%) were the most common manifestations. Histopathologically, it's a metaplastic process of endochondral ossification with the formation of mature lamellar bone which was distinguished from calcification of ligamentum flavum. About 21.28% of concurrent COLF and COPLL cases were identified as a separated group, with unique characteristics. Conclusion: COLF is an underappreciated but potentially growing pathogeny of myeloradiculopathy in aging population, though its distinct epidemiological, radiological, clinical and histopathological features are not fully supported by current evidence. However, our findings will provide several referential data for future researches to shed light on COLF.


Assuntos
Calcinose/diagnóstico por imagem , Ligamento Amarelo/diagnóstico por imagem , Ossificação Heterotópica/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Idoso , Envelhecimento , Calcinose/patologia , China , Feminino , Humanos , Japão , Ligamentos Articulares/diagnóstico por imagem , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/patologia , Compressão da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
19.
World Neurosurg ; 152: e289-e296, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34062297

RESUMO

OBJECTIVE: We assessed the sequential magnetic resonance imaging changes of indirect neural decompression after minimally invasive lumbar lateral interbody fusion (LIF) combined with posterior percutaneous pedicle screw (PPS) fixation for degenerative spondylolisthesis (DS) according to the severity of preoperative lumbar spinal stenosis. METHODS: A total of 43 patients (mean age, 68.7 years; 16 men and 27 women) with DS who had undergone LIF and closed reduction with PPS fixation were enrolled. The intervertebral levels were divided into the moderate stenosis (MS) group (preoperative cross-sectional area [CSA] of the thecal sac >50 mm2) and severe stenosis (SS) group (CSA ≤50 mm2). The CSA, ligamentum flavum thickness, and diameter of the thecal sac at the affected level were measured on cross-sectional magnetic resonance images at baseline, immediately postoperatively, and 2 years postoperatively. RESULTS: For the 31 and 29 intervertebral levels in the MS and SS groups, the mean CSA at baseline, immediately postoperatively, and 2 years postoperatively was 76.9 mm2 and 35.8 mm2, 104.3 mm2 and 81.4 mm2, and 130.9 mm2 and 105.7 mm2, respectively. The mean ligamentum flavum thicknesses at 2 years postoperatively became thinner than that immediately after surgery in both groups (P < 0.01). The mean diameter of the thecal sac at 2 years was longer than that immediately after surgery in both groups (MS group, P < 0.05; SS group, P < 0.01) The expansion ratio of the CSA at 2 years postoperatively was significantly greater in the SS group than that in the MS group (P < 0.01). CONCLUSIONS: Sequential enlargement of the spinal canal was obtained by the thinning of the ligamentum flavum after LIF and PPS fixation in patients with DS with both mild and severe stenosis. The effect of indirect neural decompression was equivalent even in those with severe lumbar spinal stenosis.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/cirurgia , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Resultado do Tratamento
20.
FASEB J ; 35(6): e21676, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34042220

RESUMO

Ligamentum flavum hypertrophy (LFH) leads to lumbar spinal stenosis (LSS) caused by LF tissue inflammation and fibrosis. Emerging evidence has indicated that dysregulated microRNAs (miRNAs) have an important role in inflammation and fibrosis. Mechanical stress (MS) has been explored as an initiating step in LFH pathology progression; the inflammation-related miRNAs induced after mechanical stress have been implicated in fibrosis pathology. However, the pathophysiological mechanism of MS-miRNAs-LFH remains to be elucidated. Using miRNAs sequencing analysis and subsequent confirmation with qRT-PCR assays, we identified the decreased expression of miR-10396b-3p and increased expression of IL-11 (interleukin-11) as responses to the development of LSS in hypertrophied LF tissues. We also found that IL-11 is positively correlated with fibrosis indicators of collagen I and collagen III. The up-regulation of miR-10396b-3p significantly decreased the level of IL-11 expression, whereas miR-10396b-3p down-regulation increased IL-11 expression in vitro. Luciferase reporter assay indicates that IL-11 is a direct target of miR-10396b-3p. Furthermore, cyclic mechanical stress inhibits miR-10396b-3p and induces IL-11, collagen I, and collagen III in vitro. Our results showed that overexpression of miR-10396b-3p suppresses MS-induced LFH by inhibiting collagen I and III via the inhibition of IL-11. These data suggest that the MS-miR-10396b-3p-IL-11 axis plays a key role in the pathological progression of LFH.


Assuntos
Hipertrofia/prevenção & controle , Interleucina-11/antagonistas & inibidores , Ligamento Amarelo/crescimento & desenvolvimento , MicroRNAs/genética , Estenose Espinal/prevenção & controle , Estresse Mecânico , Feminino , Humanos , Hipertrofia/etiologia , Hipertrofia/patologia , Interleucina-11/genética , Interleucina-11/metabolismo , Ligamento Amarelo/metabolismo , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Estenose Espinal/etiologia , Estenose Espinal/patologia
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