PLOS ONE promises fair, rigorous peer review, No, Is the Subject Area "Measurement" applicable to this article? Reasons for exclusion in the low back pain group were prior surgery for back pain, age over 60 years, claustrophobia or other contraindication to MR and CT imaging, severe osteoporosis, severe disc collapse at multiple levels, severe spinal stenosis, destructive process involving the spine, litigation or compensation proceedings, extreme obesity, congenital spine defect, or previous spinal injury. We are proud to help patients for over 15 years and do so without financial gain. (2015) Ligamentum Flavum Hypertrophy in Asymptomatic and Chronic Low Back Pain Subjects. Nevertheless, there have been few reports describing the natural history of the LF. Is the Subject Area "Lower back pain" applicable to this article? Causes Although mechanical stress as a result of spinal instability is known to cause hypertrophy of the ligamentum flavum resulting in degenerative spinal canal stenosis, the mechanism of the ligament hypertrophy is not well understood. Large uniform dorsal disc bulge at L4/5 which coupled with facet joint and ligamentum flavum hypertrophy results in a mild degree of focal canal stenosis here. Direct relationships between increasing age, ligamentum flavum thickness and have been insinuated by others working in the field of spine biomechanics. Medial thickness in grade 3 tended to be larger than that in grade 1 (p = 0.0601). These differences reached statistical significance (p = 0.0018 and p < 0.0031, respectively, Fig 2B). Analysis of variance and t-tests were carried out to evaluate the relationship between ligamentum flavum thickness and patient variables. Das Ligamentum flavum (lat. Pathology. In addition, the effects of disc height and grade of disc degeneration on ligamentum flavum thickness were also analyzed. Ligamentum flavum thickness of more than 4 mm measured on computed tomography (CT) and magnetic resonance imaging is considered hypertrophy, but causes of hypertrophy and distribution characteristics remain poorly understood. Early degeneration: It is a degenerative condition that affects your spine motion segment, which consists of a disc and two facet joints at each level. Using enhanced MR images as well as bilateral medial and lateral measurements of ligamentum flavum thickness, the current study examined ligamentum flavum thickness across different age groups from 20–60 years of age, gender, and lumbar level in individuals with and without low back pain symptoms. Histologic studies have identified inflammatory markers including tissue inhibitors of matrix metalloproteinases [11, 24], microRNA molecules such as miR-155 [25] and increases in connective tissue growth factor [26] to be related to ligamentum flavum hypertrophy and fibrosis. https://doi.org/10.1371/journal.pone.0128321.g002. Even though many studies have shown the significance of ligamentum flavum hypertrophy in patients with spinal stenosis or at the advanced stage of spondylosis, few studies have systematically examined ligamentum flavum thickness and its relation to age and lumbar level at early stages of the degenerative cascade [1, 5, 13–16]. When it becomes inflamed or lax, it can cause or contribute to central spinal stenosis on the posterior side of the vertebral canal. After selection, the MR images were analyzed by custom software written in Visual C++ (Microsoft Foundation Class). The region of interest box (shown as a white square) is selected for analysis. No, Is the Subject Area "Spine" applicable to this article? In (A) the symptomatic medial thickness tended to be larger than in the normal (L1: p = 0.0839, and L2: p = 0.0652, respectively). Ligamentum flavum hypertrophy, also known as ligamentum flavum thickening, is a health condition related to the spine and lower back. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States of America, Current address: Private Practice, Orange, California, United States of America. Previous studies showed that the ligamentum flavum thickness at the segments L 2/3 , L 3/4 , L 4/5 and L 5 /S 1 was positively correlated with age. When we look from another prospective- Snayu treatment is also according to Vata Dosha alone. Compression of the neural elements occurs with changes in the local anatomy. Objective: Degenerative changes in posterior elements of the spine such as thickening or hypertrophy of the ligamentum flavum (LF) may result in spinal stenosis. No, Is the Subject Area "Imaging techniques" applicable to this article? Arrows indicate lateral thickness (LAT) and medial (MED) thickness. In comparison of right versus left-sided ligamentum flavum thickness, differences were not significant by medial or lateral measures at any level. Error bars span one standard deviation. Paired t-tests were used to compare thickness on left and right sides. Intractable Herniated Disc Pain The assigned DOI is as follows: http://dx.doi.org/10.6084/m9.figshare.1301159. Hansson et al. With respect to the choice for the mid-image slice, alas, 3.0 mm is still thicker than ideal, but that comes also with the fact that it is practically the only slice available that captures the ligamentum flavum at mid disc. While traditionally the focus of discussion has been on the bulging of the disc leading to compression of the cauda equina, there is growing evidence that identifies ligamentum flavum buckling and hypertrophy as the key pathologic feature of spinal stenosis. In this condition, the ligament attaching vertebrae together is stretched and bended and do not come to its original position even after relaxing. Wrote the paper: AAEO JJM JYBL HSA. Thickness differences between low back pain and asymptomatic subjects were then examined by level. Odd ratio and 95% confidence interval were calculated. The thicker it becomes, the higher the risks of the spinal nerve (foraminal stenosis) or spinal cord compression (spinal stenosis). No, Is the Subject Area "Stenosis" applicable to this article? Herniated Disc Frustration Patient has a congenitally narrowed central canal and moderate to advanced spinal degeneration in addition to ligament hypertrophy. Lateral thickness in symptomatic patients (3.14 ± 0.57 mm) was also shown to be significantly greater than that in asymptomatic subjects (2.91 ± 0.70 mm), with p = 0.0019. https://doi.org/10.1371/journal.pone.0128321.t003. Alejandro A. Espinoza Orías, Lateral recess stenosis, which is a frequent finding in older patients with lumbar radiculopathy, may have an earlier basis with lateral thickening of the ligamentum flavum and low back pain. In a nutshell, this is what spinal ligaments called ligamentum flavum do. Yes I had surgery on my lower back 1 year ago, my MRI Report is saying AT L2-3, there is redemonstration of mild ligamentum flavum hypertrophy and facet arthropathy. Conceived and designed the experiments: HSA NI GBJA. Citation: Munns JJ, Lee JYB, Espinoza Orías AA, Takatori R, Andersson GBJ, An HS, et al. However, the molecular mechanism by which this fibrosis and hypertrophy develop is unknown. Primary and secondary efficacy outcome measures achieved statistical superiority in the MILD group compared to the control group. Asterisks denote significant differences with * p < 0.05. Ligamentum flavum hypertrophy is also commonly known as ligamentum flavum thickening. Treatments Thoracic Discs Percentages are calculated with respect to the total number of subjects. I have seen a few cases in which the ligamentum flavum has become so inflamed or lax that it has actually captured and compressed a nerve root. examined 24 individuals using MRI before and after an external axial load. Go to Top of Page Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information. Yes Nozomu Inoue, Current address: Department of Orthopaedics, Ohio State University, Wexner Medical Center, Columbus, Ohio, United States of America, Affiliation However, no correlation was found between the disc height and the ligamentum flavum thickness in our series. Study Design: Histologic, immunohistochemical (IHC), and enzyme-linked immunosorbent assay analysis of the human ligamentum flavum (LF).. The thickness at the L5/S1 level varied by method but was comparatively thicker using the lateral measurement. 1 doctor answer. ORA L05090801) after providing written informed consent. In contrast, the present study found a low, positive but significant correlation between ligamentum flavum thickness and disc grade (using the Pfirrmann classification system). When the ligament … Competing interests: The authors have declared that no competing interests exist. A retrospective analysis of 40 elderly patients with lumbar spinal stenosis secondary to ligamentum flavum … This statistical trend was confirmed when the gender effects were further examined by level, a similar pattern emerged as male ligamentum flavum thickness was greater than female ligamentum flavum thickness, but without statistical significance: p = 0.4475 for the medial thickness and p = 0.0673 for the lateral thickness, respectively). Degenerative Disc Disease (B) Bilinear interpolation result showing an 800% enlarged image. https://doi.org/10.1371/journal.pone.0128321.g001. Many studies suggest that the ligamentum flavum is a key factor in the pathogenesis of lumbar spinal stenosis [1–6]. While certain studies have utilized an area averaging technique, others have assessed ligamentum flavum thickness using a single measurement located at the approximate “middle” of the ligamentum flavum [2, 5, 13, 15, 16]. Right and left-sided thickness measures were compiled for average thickness, and are summarized in Table 2. Using the lateral measurement, the order of ligamentum flavum thickness from least to greatest was L1, L2, L5, L3, and L4. Lumbar spinal canal stenosis is 1 of the most common spinal disorders in elderly patients. The significance level was α = 0.05. Learn more about us. The current study elegantly shows the role of segmental motion, mechanical stress, and angiogenesis in hypertrophy of the ligamentum flavum. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Risk factors for ligamentum flavum hypertrophy were analyzed using multiple linear regression analysis. However, we have only limited insight into the underlying mechanisms. are some clues that Ligamentum flavum hypertrophy i s associated with diabetes mellitus. Spinal Decompression My Story Ligamentum flavum hypertrophy is also known as ligamentum flavum thickening. Surgery. The AIS causes – aging, injury and sprain- all comes under one Dosha only and that is- Vata Dosha only. The canal and neuroforamina are patent. Ligamentum flavum thickness was assessed using bilateral medial and lateral measurements. Statistical significance varied by measurement method. With the medial measurement, thickness was smallest at L1 and L5, and increased caudally from L2 to L4; statistical significance was found between all levels except L1 and L5 (p = 0.13). PLoS ONE 10(5): Contribution of mechanical stresses to ligamentum flavum thickening has been reported in the literature. A post hoc analysis was completed to reveal a power of (1-ß) = 0.87. Justin J. Munns, Furthermore, attempts to quantify the thickness of the ligamentum flavum have used single measurements, ignoring possible differences in laterality and location of stenosis, i.e. Partial spinal stenosis is rarely anything of consequence and is actually a completely normal part of aging for the cervical and lumbar spinal regions. Ligamentum flavum are the ligaments present in spine. This website is provided as a gift by The Cure Back Pain Network. These findings of our study, together with the current literature, support the idea that early changes in the ligamentum flavum may play a key role in chronic low back pain symptoms. Die Ligamenta flava sind jeweils zwischen den Wirbelbögen ausgespannt und wurden deshalb früher auch als Ligamenta interarcualia bezeichnet. Sleep Position for Herniated Disc. Injury, poor posture and longstanding spine conditions are the leading cause of Hypertrophy of Ligamentum Flavum. Lumbar Discs Our study confirmed an increase in ligamentum flavum thickness both medially and laterally as age increased and as lumbar level increased (caudally), through the L4/5 level. Since axial loading causes disc height loss [23], this study probed any possible correlations between disc height and the ligamentum flavum thickness. However, one of the intended contributions to the field via this report, is communicating the development and use of this new method to quantify the thickness of the ligamentum flavum using clinically-available image sets. Chronic Disc Pain A total of 63 individuals were studied, with 36 in the asymptomatic group, and 27 in the symptomatic group (mean age 31.9 ± 8.6 years and 41.2 ± 10.1 years, respectively). It is a degenerative disease which involves the compression of nerves. „gelbes Band“) ist ein jeweils zwischen zwei Wirbeln gelegenes, die Wirbelsäule stabilisierendes Band.. More importantly, few studies exist that examine the possible correlation between ligamentum flavum thickness and other factors such as disc height and grade of disc degeneration. Folding the ligamentum flavum when standing will give compression to the spinal canal so that it worsens the stenosis that occurs, the complaint may improve when the patient bends down so that the ligamentum flavum is stretched again. Lumbar spinal stenosis represents a significant cause of pain and disability in the aging population. Given that disc height loss associated with disc degeneration is a slow process, bulging of the ligamentum flavum may not occur under a gradual loss of disc height due to the elastic nature of the ligamentum flavum. 00042801; study no. Statistical significance was achieved at fewer levels than with the medial ligamentum flavum measure, with L1 thickness being significantly less than L3, L4, and L5; and L2 significantly less than L4. Gunnar B. J. Andersson, Patient has drastic osteoarthritic change which has closed off much of the anterior central canal and is finished off by the ligamentum hypertrophy. Exercises; Relief; Cure Pain Program; Ligamentum Flavum Hypertrophy. Dimensions of the bony spinal canal are preserved, structurally the vertebral bodies and neural arches are intact. https://doi.org/10.1371/journal.pone.0128321.g003. Ligamentum flavum thickness was measured at two different locations in the present study. Yes Ligamentum Flavum Hematoma granulomatous change of the ligamentum flavum. Yes The calcification, the elastic/collagenous fibre ratio as well as the configuration of the fibres were evaluated with an image analyzing computer. The condition is actually very simple once it is explained, and luckily is rarely the exclusive source of symptoms. However, ligament inflammation can be causative or contributory to pain or neurological dysfunction in particular circumstances. 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