Analysis of the Relationship between Ligamentum Flavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis.
Analysis of the Relationship between Ligamentum Flavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis.
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DOI：
10.4184/asj.2016.10.6.1132
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发表时间：
2016-12
影响因子：
2.3
通讯作者：
Tsumura H
中科院分区：
文献类型：
--
作者：
Yoshiiwa T;Miyazaki M;Notani N;Ishihara T;Kawano M;Tsumura H
横断面研究。探讨黄韧带（LF）增厚与腰椎节段不稳、椎间盘退变及小关节骨性关节炎的关系。脊柱后部结构，包括LF厚度，在腰椎管狭窄的发病机制中起主要作用。LF增厚的原因是多因素的，包括活动水平、年龄和机械应力。LF增厚的发病机制尚不清楚。我们检查了419例在抱怨临床症状后接受计算机断层扫描（CT）脊髓造影和磁共振成像的患者。为了研究LF肥大，选择了57例腰4 - 5椎间盘高度正常的患者，排除LF屈曲作为肥大的组成部分。研究了LF厚度、屈曲时椎间盘间隙变宽成角、节段性成角、真空现象的存在以及T12-S1腰椎前凸。椎间盘和关节突退变也进行了评估。通过轴向CT扫描测量关节突关节的方向。所有患者L4-5处的平均LF厚度为4.4±1.0 mm。LF厚度与椎间盘退变有显著相关性；重度椎间盘退变和小关节骨性关节炎患者的LF厚度明显增加。矢状面关节比冠状面关节有LF厚度增加的趋势。Logistic回归分析显示，小关节骨性关节炎和节段性成角对LF增厚有影响。患者年龄与LF增厚有关。LF肥大的发展与节段性不稳定、严重的椎间盘退变、严重的小关节骨关节炎和矢状面小关节方向有关。
Cross-sectional study. To investigate the relationship between ligamentum flavum (LF) thickening and lumbar segmental instability and disc degeneration and facet joint osteoarthritis. Posterior spinal structures, including LF thickness, play a major role in lumbar spinal canal stenosis pathogenesis. The cause of LF thickening is multifactorial and includes activity level, age, and mechanical stress. LF thickening pathogenesis is unknown. We examined 419 patients who underwent computed tomography (CT) myelography and magnetic resonance imaging after complaints of clinical symptoms. To investigate LF hypertrophy, 57 patients whose lumbar vertebra had normal disc heights at L4–5 were selected to exclude LF buckling as a hypertrophy component. LF thickness, disc space widening angulation in flexion, segmental angulation, presence of a vacuum phenomenon, and lumbar lordosis at T12–S1 were investigated. Disc and facet degeneration were also evaluated. Facet joint orientation was measured via an axial CT scan. The mean LF thickness in all patients was 4.4±1.0 mm at L4–5. There was a significant correlation between LF thickness and disc degeneration; LF thickness significantly increased with severe disc degeneration and facet joint osteoarthritis. There was a tendency toward increased LF thickness in more sagittalized facet joints than in coronalized facet joints. Logistic regression analysis showed that LF thickening was influenced by segmental angulation and facet joint osteoarthritis. Patient age was associated with LF thickening. LF hypertrophy development was associated with segmental instability and severe disc degeneration, severe facet joint osteoarthritis, and a sagittalized facet joint orientation.