Obesity and calcification of the ligaments of the spine: a comprehensive CT analysis of the entire spine in a random trauma population
Obesity and calcification of the ligaments of the spine: a comprehensive CT analysis of the entire spine in a random trauma population
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DOI：
10.1016/j.spinee.2019.03.003
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发表时间：
2019-08-01
期刊：
影响因子：
4.5
通讯作者：
Rahm, Mark D.
中科院分区：
文献类型：
--
作者：
Chaput, Christopher D.;Siddiqui, Mehdi;Rahm, Mark D.
背景背景：肥胖目前在美国激增至流行病水平，与弥漫性特发性骨骼肥厚症（DISH）和后纵韧带骨化（OPLL）等骨质增生有关。过多的脂肪组织和胰岛素抵抗可能导致血清促炎细胞因子水平的全身性增加，这些信号可以影响骨代谢。脊髓韧带和椎间盘可能有接收这些信号分子的受体。该机构的轶事观察表明，有一个临床重要的年轻肥胖和多节段狭窄患者，存在与DISH不同的脊柱韧带异常钙化。目的：确定非老年人躯干肥胖与脊柱钙化之间是否存在关联。研究设计/背景：这是一项对214例年龄在29 - 50岁之间的连续性创伤患者的回顾性分析。评估患者的年龄、性别、躯干肥胖、高血压史和糖尿病与脊柱韧带钙化的关系。患者样本：从我院2006年至2007年的创伤数据库中选择顺序创伤患者。方法：采用全脊柱计算机断层扫描（CT）检查前纵韧带（ALL）及环区、后纵韧带（PLL）及环区、黄韧带（LF）的骨形成情况。内脏和皮下腹部脂肪也被评估。作者报告没有研究资金来源或利益冲突。结果测量：对ALL、PLL和LF的钙化情况在每个级别进行评分，然后合并整个脊柱的总钙化评分（TCS）。通过使用先前验证的CT衍生的躯干总脂肪体积（TAV），使用躯干体重指数（TBMI）估计肥胖。结果：ALL钙化与年龄、男性、高血压和肥胖增加有关。PLL钙化与年龄和高血压显著相关。LF钙化仅与肥胖增加有关。结论：在我们对非老年患者的分析中，LF钙化与躯干肥胖独立相关。这意味着肥胖在钙化中扮演的角色比简单的年龄相关的退化或性别更重要。(C) 2019 Elsevier Inc.版权所有。
BACKGROUND CONTEXT: Obesity, which is currently surging to epidemic levels within the United States, has been linked to hyperostotic conditions like diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL). Excess adipose tissue and insulin-resistance may cause a systemic increase in serum levels of proinflammatory cytokines and these signals can affect bone metabolism. Spinal ligaments and discs may have receptors for these signaling molecules. Anecdotal observations at this institution suggested that there is a clinically important subset of younger patients with obesity and multilevel stenosis in the presence of unusual calcification of the spinal ligaments that is distinct from DISH.PURPOSE: To determine if there is an association between truncal obesity and calcifications of the spine in nonelderly adults.STUDY DESIGN/SETTING: This is a retrospective analysis of 214 sequential trauma patients between the ages of 29 and 50. Patients' age, sex, truncal obesity, history of hypertension, and diabetes were assessed for association with ligamentous calcification of the spine.PATIENT SAMPLE: Sequential trauma patients were chosen from our institution's trauma database between 2006 and 2007.METHODS: Full spine computed tomography (CT) imaging was examined for bone formation in the region of the anterior longitudinal ligament (ALL) and annulus, posterior longitudinal ligament (PLL) and annulus, and the ligamentum flavum (LF). Visceral and subcutaneous abdominal fat were also evaluated. The authors report no study funding sources or conflicts of interest.OUTCOME MEASURES: Calcification of the ALL, PLL, and LF were assigned a score at each level and then combined for a total calcification score (TCS) for the entire spine. Obesity was estimated using a truncal body mass index (TBMI) by using a previously validated CT derived truncal total adiposity volume (TAV).RESULTS: ALL calcification was associated with age, male gender, hypertension, and increased adiposity. PLL calcification was significantly associated with age and hypertension. LF calcification was only associated with increased obesity.CONCLUSIONS: In our analysis of nonelderly patients, LF calcification was independently associated with truncal obesity. This implies obesity plays a greater role in calcification than could be accounted for by simply age-related degeneration or gender. (C) 2019 Elsevier Inc. All rights reserved.