Ligamentum Flavum Hypertrophy Research Articles

Application of short T1 inversion recovery sequence in increased signal intensity following cervical spondylotic myelopathy

To compare magnetic resonance (MR) short T1 inversion recovery (STIR) sequence with MR T2-weighted (T2W) sequence for detecting increased signal intensity (ISI) and assessing outcomes of ISI in cervical spondylotic myelopathy (CSM). Data of patients with CSM who showed ISI on MR imaging and had undergone cervical spine surgery were retrospectively reviewed. STIR and T2W images were examined to assess signal intensity ratio (SIR), length and grading of the ISI, maximal spinal cord compression (MSCC), canal narrowing ratio (CNR), and ligamentum flavum hypertrophy (LFH). The patients were divided into good and poor groups based on their outcomes. Chi-square tests and variance analysis were used to assess intergroup differences. Univariate and multivariate logistic regression analyses were performed to identify risk factors for poor outcomes, and receiver operating characteristic curves were plotted to detect prognostic effects. SIR and ISI lengths were significantly different between the STIR and T2 images. In the univariate logistic regression analysis, age, diabetes, SIRT2, SIRSTIR, and ISISTIR grading were significant factors. Accordingly, in the multivariate logistic regression analysis, age, diabetes, SIRT2, and SIRSTIR were included in the model. Among patients with diabetes, we observed a significant difference between SIRT2 and SIRSTIR. The STIR sequence demonstrated superior capability to the T2W sequence in detecting ISI; however, there was no obvious difference in predicted outcomes. STIR sequence has a better prognostic value than T2W sequence in patients with diabetes who have CSM. ISI grading based on the STIR sequence may be a clinically valuable indicator.

Evaluation of the Thickness of Ligamentum Flavum at the Level of Lumbosacral Spine (L4-L5, L5-S1) and its Relationship with Degenerative Disc Changes in Patients Undergoing MRI of Lumbosacral Spine

Introduction: Low back pain (LBP) is a very common cause of disability in working-age adults; with degenerative changes being the predominant cause apart from anatomical factors. Degenerative changes in the lumbar spine are associated with the alteration of the thickness of the Ligamentum Flavum (LF), which predisposes to clinical symptoms. Methods: This was a prospective study conducted among ninety symptomatic (LBP) patients who underwent magnetic resonance imaging (MRI) and the images were evaluated to measure the thickness of the LF and evaluate the degree of disc degeneration by the Pfirrmann grading system, according to the spinal levels (L4-L5, L5-S1). An association was sought between LF hypertrophy and disc degeneration, age, sex, and disc height. Results: The result of this study showed that with increasing age thickening of the LF could lead to degeneration of the intervertebral disc. Thickening of the LF was more at the level of L4-L5 level than at the L5-S1 level with right-sided increased thickness more than on the left and is associated with increased grade of disc degeneration. Females had slightly more thickened LF than the males at the L4-L5 level with no gender predominance at the L5-S1 level. Conclusions: Thickening of the ligamentum flavum may be an important factor in the origin of LBP, especially in the adult population. A degenerative process in the ligamentum flavum that occurs with age and also suggests the thickening of LF due to mechanical stress at the lumbar level would ultimately result in degeneration of the disc.

MiR-29b-3p Affects the Hypertrophy of Ligamentum Flavum in Lumbar Spinal Stenosis and its Mechanism.

To explore the effect of miR-29b-3p on fibrosis and hypertrophy of ligamentum flavum (LF) in lumbar spinal stenosis (LSS) and its underlying mechanism. Patients with LSS and lumbar disc herniation (LDH) (control) undergoing posterior lumbar laminectomy were included in this study. Human LF samples were obtained for LF cell isolation, RNA, and protein extraction. Histomorphological analysis of LF was performed using hematoxylin-eosin (HE) staining. After isolation, culture, and transfection of primary LF cells, different transfection groups were constructed: NC-mimic, miR-29b-3p-mimic, NC-inhibitor, and miR-29b-3p-inhibitor. Quantitative real time polymerase chain reaction (qRT-PCR) was performed to detect the expression of miR-29b-3p in LF and LF cells. Western blot analysis detected the protein expressions of P16 and CyclinD1. ELISA detected the protein expressions of TGF-β1, Smad2, Smad3, TLR4, Type I collagen, and Type III collagen. Finally, LF cell viability was detected using the Cell Counting Kit-8 (CCK8) assay. The thickness of LF was significantly thicker in the LSS group compared to the LDH group (p < 0.05), accompanied by a higher calcification degree, more fibroblasts, and a larger area of collagen fiber proliferation. miR-29b-3p expression was significantly lower in LSS-derived LF tissues and cells than in LDH-derived tissues and cells (both p < 0.05). Compared to the NC-mimic group, the miR-29b-3p-mimic group exhibited significantly higher miR-29b-3p expression, decreased protein expressions of Type I collagen, Type III collagen, TGF-β1, Smad2, Smad3, TLR4, P16, and CyclinD1, and inhibited LF cell proliferation (all p < 0.05). As expected, the miR-29b-3p-inhibitor group displayed contrasting expression patterns (all p < 0.05). Compared to the phosphate buffer saline (PBS) group, the Trimethylamine-N-Oxide (TMAO) group showed significantly increased expressions of TGF-β1, Smad2, Smad3, TLR4, Type I collagen, Type III collagen, P16, and CyclinD1, as well as enhanced LF cell proliferation (all p < 0.05). However, there was no significant difference between the TMAO group and the Ang II group (all p > 0.05). Upregulation of miR-29b-3p expression may play a role in improving LF fibrosis and hypertrophy in LSS by inhibiting P16 expression and suppressing the activation of the TGF-β/Smad signaling pathway. This finding offers new insights into future gene modification therapy for this patient population.

Increased matrix metalloproteinase-2 in ligamentum flavum hypertrophy and the regulation of MMP-2/TIMPs by elastin-derived peptides.

The study aimed to examine matrix metalloproteinase-2 (MMP-2) expression in a rat ligamentum flavum (LF) hypertrophy model in vivo, and the effect of elastin-derived peptides (EDPs) on MMP-2 and tissue inhibitors of metalloproteinases (TIMPs) in rat LF cells in vitro. Surgical destabilization was performed at the rat spinal L3/4 level to induce increased mechanical stress. Rats were killed at 6- and 12-weeks postsurgery for histological staining, immunohistochemical staining, RT-qPCR and western blot. 100 µg/mL EDPs were applied to isolated normal rat LF cells, with or without pretreatment of elastin receptor complex (ERC) inhibitors, to assess the expression of MMP-2, TIMP-1, and TIMP-2. Spinal destabilization led to LF hypertrophy, observed through increased LF thickness and area, along with histological changes of chondrometaplasia and elastic fiber degradation. LF was also stained positively for Col I and Col II, where elastic fiber has broken down. MMP-2 expression was notably elevated in the hypertrophied LF, accompanied by increased TIMP-2 and TIMP-3 levels. EDPs were found to suppress MMP-2 expression and reduce TIMP-1 and TIMP-2 levels in rat LF cells. Interestingly, exposure to EDPs led to a significant rise in MMP-2/TIMP-1 and MMP-2/TIMP-2 ratios, dependent on the ERC. Collectively, the study suggests that increased MMP-2 activity contributes to elastic fiber degradation in hypertrophied LF, generating EDPs that further enhance the MMP-2/TIMPs ratio in LF cells in an ERC-dependent manner. Further research is essential to delve into the mechanisms of EDPs in LF hypertrophy.

COMPREHENSIVE ASSESSMENT OF RADIOLOGICAL AND FUNCTIONAL OUTCOMES FOLLOWING TRANSFORAMINAL LUMBAR INTERBODY FUSION IN LUMBAR CANAL STENOSIS PATIENTS

Objective: The lumbar spine, a crucial component of the musculoskeletal system, is integral for structural support and mobility. Lumbar canal stenosis (LCS), characterized by spinal canal narrowing, is a growing concern associated with degenerative changes. Transforaminal lumbar interbody fusion (TLIF) has emerged as a surgical intervention for LCS, aiming to achieve decompression and stabilization. This study comprehensively assesses the radiological and functional outcomes post-TLIF in LCS patients.&#x0D; Methods: A cohort of 40 LCS patients undergoing TLIF at Indira Gandhi Medical College was studied. Fifteen were retrospectively assessed operated on before May 2016, and 25 were prospective, operated between May 2016 and May 2017. Demographic data, preoperative ASIA scores, ligamentum flavum hypertrophy, facet joint arthropathy, and Bridwell Fusion Grades were analyzed. Statistical tests included mean calculations, chi-square tests, and Mann-Whitney U tests.&#x0D; Results: The study revealed a significant male predominance (57.5%) and age distribution (32 to 72 y) with a male-to-female ratio of 1.35:1 (p value 0.0049). Preoperative ASIA scores showed 50% ASIA grade D and 25% grade E. Ligamentum flavum hypertrophy and facet joint arthropathy were present in 70% and 67.5% of patients, respectively. Bridwell Fusion Grade indicated 80% achieved grade 1 fusion.&#x0D; Conclusion: This study contributes valuable insights into TLIF outcomes in LCS patients, emphasizing the significance of age, gender, neurological status, and associated pathologies. Favorable fusion outcomes suggest TLIF effectively stabilizes the lumbar spine. Future research with larger cohorts could further validate these findings and refine TLIF's role in LCS management.

Thrombospondin-1 promotes mechanical stress-mediated ligamentum flavum hypertrophy through the TGFβ1/Smad3 signaling pathway

Lumbar spinal canal stenosis is primarily caused by ligamentum flavum hypertrophy (LFH), which is a significant pathological factor. Nevertheless, the precise molecular basis for the development of LFH remains uncertain. The current investigation observed a notable increase in thrombospondin-1 (THBS1) expression in LFH through proteomics analysis and single-cell RNA-sequencing analysis of clinical ligamentum flavum specimens. In laboratory experiments, it was demonstrated that THBS1 triggered the activation of Smad3 signaling induced by transforming growth factor β1 (TGFβ1), leading to the subsequent enhancement of COL1A2 and α-SMA, which are fibrosis markers. Furthermore, experiments conducted on a bipedal standing mouse model revealed that THBS1 played a crucial role in the development of LFH. Sestrin2 (SESN2) acted as a stress-responsive protein that suppressed the expression of THBS1, thus averting the progression of fibrosis in ligamentum flavum (LF) cells. To summarize, these results indicate that mechanical overloading causes an increase in THBS1 production, which triggers the TGFβ1/Smad3 signaling pathway and ultimately results in the development of LFH. Targeting the suppression of THBS1 expression may present a novel approach for the treatment of LFH.

Retracted: Relationship between Severity of Lumbar Spinal Stenosis and Ligamentum Flavum Hypertrophy and Serum Inflammatory Factors.

[This retracts the article DOI: 10.1155/2022/8799240.].

Patient and physician radiation exposure during minimally invasive lumbar decompression: A prospective assessment of X-ray exposure risks.

Minimally invasive lumbar decompression (mild®) is becoming a popular procedure for treating lumbar spinal stenosis (LSS) secondary to hypertrophic ligamentum flavum (LF). The mild® procedure is commonly performed under live fluoroscopic guidance and carries a risk of radiation exposure to the patient and healthcare. One physician performed mild® on 41 patients at the Cleveland Clinic Department of Pain Management from October 2019 to December 2021, while wearing a radiation exposure monitor (Mirion Technologies). Mean fluoroscopy time, mean exposure per case, and mean exposure per unilateral level decompressed were the primary outcomes measured. The secondary outcome was to provide a comparison of radiation exposure during similar fluoroscopically guided procedures. Mean patient fluoroscopy exposure time was 2.1 min ±0.9 (range: 1.1-5.6) fluoroscopy time per unilateral level decompressed. The mean patient radiation skin exposure from mild® was 1.1 ± 0.9 mGym2, and the mean total dose was 142.3 ± 108.6 mGy per procedure. On average, the physician was exposed to an average deep tissue exposure of 4.1 ± 3.2 mRem, 2.9 ± 2.2 mRem estimated eye exposure, and 14.7 ± 11.0 mRem shallow tissue exposure per unilateral level decompressed. An individual physician would exceed the annual exposure limit of 5 Rem after approximately 610 mild® procedures per year. This study is an attempt to quantify the radiation exposure to the physician and patient during the mild® procedure. Compared with other fluoroscopically guided pain management procedures, patient and physician radiation exposure during mild® was low.

Measurement Analysis and Clinical Research of Lumbar Ligamentum Flavum and Lamina

Measurement Analysis and Clinical Research of Lumbar Ligamentum Flavum and Lamina

Transthyretin amyloid deposition in ligamentum flavum (LF) is significantly correlated with LF and epidural fat hypertrophy in patients with lumbar spinal stenosis

Lumbar spinal stenosis (LSS) is a degenerative disease characterized by intermittent claudication and numbness in the lower extremities. These symptoms are caused by the compression of nerve tissue in the lumbar spinal canal. Ligamentum flavum (LF) hypertrophy and spinal epidural lipomatosis in the spinal canal are known to contribute to stenosis of the spinal canal: however, detailed mechanisms underlying LSS are still not fully understood. Here, we show that surgically harvested LFs from LSS patients exhibited significantly increased thickness when transthyretin (TTR), the protein responsible for amyloidosis, was deposited in LFs, compared to those without TTR deposition. Multiple regression analysis, which considered age and BMI, revealed a significant association between LF hypertrophy and TTR deposition in LFs. Moreover, TTR deposition in LF was also significantly correlated with epidural fat (EF) thickness based on multiple regression analyses. Mesenchymal cell differentiation into adipocytes was significantly stimulated by TTR in vitro. These results suggest that TTR deposition in LFs is significantly associated with increased LF hypertrophy and EF thickness, and that TTR promotes adipogenesis of mesenchymal cells. Therapeutic agents to prevent TTR deposition in tissues are currently available or under development, and targeting TTR could be a potential therapeutic approach to inhibit LSS development and progression.

ACSM5 inhibits ligamentum flavum hypertrophy by regulating lipid accumulation mediated by FABP4/PPAR signaling pathway.

Ligamentum flavum (LF) hypertrophy is the main cause of lumbar spinal canal stenosis (LSCS). Previous studies have shown that LF hypertrophy tissue exhibits abnormal lipid accumulation, but the regulatory mechanism remains unclear. The objective of this study was to explore the function and potential mechanism of ACSM5 in LF lipid accumulation. To assess the ACSM5 expression levels, lipid accumulation and triglyceride (TG) level in LF hypertrophy and normal tissue, we utilized RT-qPCR, western blot, oil red O staining, and TG assay kit. The pearson correlation coefficient assay was used to analyze the correlation between ACSM5 levels and lipid accumulation or TG levels in LF hypertrophy tissue. The role of ACSM5 in free fatty acids (FFA)-induced lipid accumulation in LF cells was assessed in vitro, and the role of ACSM5 in LF hypertrophy in mice was verified in vivo. To investigate the underlying mechanisms of ACSM5 regulating lipid accumulation in LF, we conducted the mRNA sequencing, bioinformatics analysis, and rescue experiments. In this study, we found that ACSM5, which was significantly down-regulated in LF tissues, correlated with lipid accumulation. In vitro cell experiments demonstrated that overexpression of ACSM5 significantly inhibited FFA-induced lipid accumulation and fibrosis in LF cells. In vivo animal experiments further confirmed that overexpression of ACSM5 inhibited LF thickening, lipid accumulation, and fibrosis. Mechanistically, ACSM5 inhibited lipid accumulation of LF cells by inhibiting FABP4-mediated PPARγ signaling pathway, thereby improving hypertrophy and fibrosis of LF. our findings elucidated the important role of ACSM5 in the regulation of LF lipid accumulation and provide insight into potential therapeutic interventions for the treatment of LF hypertrophy. This study further suggested that therapeutic strategies targeting lipid deposition may be an effective potential approach to treat LF hypertrophy-induced LSCS.

A Case Report on Cerebellar Ataxia – HIV Induced Chronic Cerebellitis

HIV-induced cerebellar complications, which are often manifested as ataxia, typically occur from cerebellar lesions resulting from opportunistic infections, vasculitis, or neoplastic processes. A 59yrs old male patient known to have HIV infection from past 15 years, presented to our hospital with weakness, ataxic gait, lower back pain and slurred speech since last 2-3 days. He had been receiving anti-retroviral therapy for over 15 years, and there was no family history of such illnesses. The results of examination were notable for dysarthria, dysmetria and dysdiadokokinesia. MRI revealed ligamentum flavum hypertrophy at multiple cervical levels, prominence of bilateral cerebral sulci and sylvian fissure and chronic lacunar infarcts. The final diagnosis was CEREBELLAR ATAXIA-HIV INDUCED CHRONIC CEREBELLITIS.

Pre-operative magnetic resonance imaging as a predictor of success in lumbar disc herniation patients undergoing laminectomy

Introduction. Lumbar disc herniation is a condition in which annulus fibrosus in the lumbar area is herniated with numerous etiologies, such as degenerative. One of the mainstay treatment for lumbar disc herniation is decompressive laminectomy. Magnetic Resonance Imaging (MRI) with the diagnostic accuracy of 97% also has an excellent resolution for soft tissue. The aim of this study is whether pre-operative MRI may be a predictor of successful clinical outcome in lumbar disc herniation patients undergoing laminectomy surgery. Methods. In this cross-sectional study, we consecutively collected all patients in Radiology Department “Prof. Dr. IGNG Ngoerah” Hospital, Denpasar Bali between January 2021 to December 2022. We enrolled patients with older than 18 years old who had undergone pre-operative lumbosacral MRI and had laminectomy surgery within the sampling time period. The following variables were recorded from each patient: age, gender, Body mass index (BMI), history of diabetes mellitus, hypertension, number of herniated discs, herniation grade, spinal canal stenosis grade, neural foramen stenosis grade, lateral recess stenosis grade, annular tear, disc degeneration, facet disc degeneration, thickening of ligamentum flavum, modic changes, cerebrospinal liquor obstruction, and clinical outcome. Outcomes. We collected 30 patients who underwent laminectomy surgery and had their pre-operative MRI. Patients’ mean age ± SD was 57.7±10.9 years old with 20 male (66.7%) and 10 female (33.3%). There was no significant association between gender, hypertension, diabetes mellitus, body mass index, number of disc herniation, spinal canal stenosis, lateral recess stenosis, neural foramen stenosis, disc degeneration, facet joint degeneration, ligamentum flavum hypertrophy, Modic changes and cerebrospinal liquor obstruction with clinical outcome post laminectomy patients. Conclusion. Pre-operative MRI can reliably diagnose lumbar disc herniation but are not a predictive tool in assessing the clinical outcome of post-laminectomy patients. Laminectomy has an excellent management value for lumbar disc herniation patients especially in reducing the pain, and for them to have better quality of life.

MRI-based evaluation of lower back pain with reference to ligamentum flavum hypertrophy

Introduction The lower back ache or lumbago is a common musculoskeletal complaint patients present with, especially among the elderly. It can be caused mostly by degenerative changes like ligamentum flavum hypertrophy associated with aging and physical strain, first causing spinal canal narrowing and leading to stenosis later. MRI provides excellent high-resolution images of structures including the spinal canal, vertebral body, discs, joints, and other structures. Aim and objective This study aims to bring out the relation between degenerative disc changes and LF hypertrophy in patients presenting with lower back pain and helps in earlier discovery of degeneration and in understanding the underlying pathology better. Methods A descriptive prospective study will be done at Acharya Vinoba Bhave Rural Hospital, Sawangi, involving 30 patients who are referred to the department of Radiodiagnosis, AVBRH, Sawangi with lower back pain will be subjected to the study – purposive sampling. Expected results After an appropriate statistical analysis, we expect to assess the role of MRI which provides excellent high-resolution images of structures including the spinal canal, vertebral body, discs, joints, and other structures. This study aims to bring out the relation between degenerative disc changes and LF hypertrophy in patients presenting with lower back pain and helps in earlier discovery of degeneration and in understanding the underlying pathology better. CTRI registration: REF/2023/05/067795

Prevalence of and factors associated with stenotic thoracic ligamentum flavum hypertrophy

IntroductionStenotic thoracic ligamentum flavum hypertrophy can cause leg and/or low back pain similar to that caused by lumbar spinal stenosis. However, the thoracic spine may occasionally be overlooked in patients...

Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico.

Limited literature exists regarding the differences in demographics, causes, comorbidities, presentation, and structural changes associated with cervical spine degeneration in patients from distinct geographic regions. The authors aimed to evaluate the demographic and clinical characteristics of patients with cervical spine degeneration admitted to a single center in Mexico. This study enrolled patients with degenerative disease of the cervical spine. Clinical data were retrieved from medical records and retrospectively characterized. A total of 50 patients with cervical spine degeneration were included in the analysis. Of these, 26% were men with a median age of 54 years. Hypertension, depression, anxiety, obesity, and alcohol consumption were presented in about a quarter of the participants. In addition, we observed hypertriglyceridemia and hypercholesterolemia in 72% and 46% of participants, respectively. The median duration of symptoms was 11 months, including radicular arm/neck pain (80%), tingling (80%), reduced muscle strength (48%), and gait disturbances (48%). Forty percent of patients had 2 cervical segments radiologically involved, mainly at C5-C6, with changes such as disc herniation (88%), foraminal stenosis with nerve root compression (67%), reduced spinal canal-to-vertebral body ratio (38%), and ligamentum flavum hypertrophy (24%). Also, 22% of patients showed degenerative cervical myelopathy. Strikingly, 48% of enrolled individuals showed cervicolumbar tandem spinal stenosis, mainly in L4-L5 and L5-S1, who were generally older, had a longer duration of symptoms, and had a higher comorbidity burden, including hyperglycemia, hypertension, and depression. The demographic and clinical characteristics of degenerative cervical spine disease in Mexico differ with respect to other geographical regions by a younger age of diagnosis, a high frequency of cardiovascular, metabolic, and mental health comorbidities, and an increased prevalence of concomitant lumbar spinal stenosis. Our findings reveal a considerably high burden of cervicolumbar tandem spinal stenosis as a distinctive feature of Mexican patients with cervical spine degeneration.

GSK-3β and β-Catenin Signaling Pathway is Involved in Myofibroblast Transition of Ligamentum Flavum in Lumbar Spinal Stenosis Patients.

Histologic analysis of the ligamentum flavum (LF) in the lumbar spine. The objective of this study is to investigate the levels of glycogen synthase kinase-3β (GSK-3β) and β-catenin in the LF tissue of patients with lumbar spinal stenosis (LSS). The hypertrophy of the LF is the primary cause of the progression of LSS. Recently, Wnt signaling has been proposed as one of the molecular processes contributing to LF hypertrophy. GSK-3β and β-catenin are recognized to play a crucial part in the control of this signaling pathway. From May 2020 to July 2022, LF from 51 LSS patients (LSS group) and 18 lumbar disc herniation patients (control group) were prospectively collected during surgery. Histologic analysis was investigated to confirm the progression of LF fibrosis. The levels of α-smooth muscle actin, phosphorylation of GSK-3β (p-GSK-3β; inactive form), and β-catenin were analyzed in LF with Western blot analysis to reveal the GSK-3β/β-catenin signaling pathway. Continuous variables are expressed as mean±SD and compared using the student t test. Categorical variables are compared using the χ 2 test or Fisher exact test, as appropriate. To determine the association between p-GSK-3β and LF thickness, the Pearson correlation coefficient was calculated based on the results of Western blot analysis. The LSS group was older and had thicker LF than the controls. The LSS group showed increased collagen fiber and cellularity than the controls. The levels of α-smooth muscle actin, p-GSK-3β, and β-catenin in the LF of the LSS group were significantly higher than that of the control group. There was a strong positive correlation between p-GSK-3β (Ser9) level and LF thickness in LSS patients ( r =0.69, P =0.01). This research proposes a molecular mechanism for the pathogenesis of LF hypertrophy in LSS. Specifically, GSK-3β/β-catenin signaling appears to be related to LF hypertrophy in LSS and a positive correlation exists between p-GSK-3β level and LF thickness. Level 3.

Decorin: a potential therapeutic candidate for ligamentum flavum hypertrophy by antagonizing TGF-β1

Ligamentum flavum hypertrophy (LFH) is the main physiological and pathological mechanism of lumbar spinal canal stenosis (LSCS). The specific mechanism for LFH has not been completely clarified. In this study, bioinformatic analysis, human ligamentum flavum (LF) tissues collection and analysis, and in vitro and in vivo experiments were conducted to explore the effect of decorin (DCN) on LFH pathogenesis. Here, we found that TGF-β1, collagen I, collagen III, α-SMA and fibronectin were significantly upregulated in hypertrophic LF samples. The DCN protein expression in hypertrophic LF samples was higher than that in non-LFH samples, but the difference was not significant. DCN inhibited the expression of TGF-β1-induced fibrosis-associated proteins in human LF cells, including collagen I, collagen III, α-SMA, and fibronectin. ELISAs showed that TGF-β1 can upregulate PINP and PIIINP in the cell supernatant, and this effect was inhibited after DCN administration. Mechanistic studies revealed that DCN suppressed TGF-β1-induced fibrosis by blocking the TGF-β1/SMAD3 signaling pathway. In addition, DCN ameliorated mechanical stress-induced LFH in vivo. In summary, our findings indicated that DCN ameliorated mechanical stress-induced LFH by antagonizing the TGF-β1/SMAD3 signaling pathway in vitro and in vivo. These findings imply that DCN is a potential therapeutic candidate for ligamentum flavum hypertrophy.

Do Cervical Parameters Increase the Risk of Thoracic Spinal Stenosis in Patients with Cervical Spinal Stenosis?

The diagnosis and treatment of tandem stenosis have been widely discussed. However, studies on concurrent cervical and thoracic spinal stenosis are rare in the literature. This study was aimed to investigate the risk factors for thoracic spinal stenosis (TSS) in patients with cervical spinal stenosis (CSS). This retrospective cohort study assessed the risk factors for TSS in 162 patients who were diagnosed with CSS. Patients were divided into TSS (n=45) and non-TSS (n=117) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including age, gender, body mass index, ossification of the cervical posterior longitudinal ligament (OPLLc), hypertrophy of cervical ligamentum flavum (HLFc), cervical stenosis segments, and cervical sagittal parameters. Cervical sagittal parameters were measured on T2-weighted magnetic resonance imaging (MRI), including C2-7 Cobb angle (Cobb), cervical tilt (CT), T1 slope (T1S), thoracic inlet angle (TIA), C2-C7 sagittal vertical axis (C2-C7 SVA) and cervical curvature. Two groups showed significant differences in OPLLc, HLFc, cervical stenosis segments, and TIA. The receiver operating characteristic curves (ROC) demonstrated that the optimal threshold for TIA was 68.25. In multivariate logistic regression analysis, OPLLc (OR=4.403,95% CI=1.782-10.880,P=0.001), HLFc (OR=4.849,95% CI=1.995-11.782,P<0.001) and TIA>68.25 ° (OR=2.555,95%CI=1.044-6.251,p=0.040) were independent risk factors for TSS. Moreover, the multi-index ROC curve demonstrated that the area under the curve for predicted probability was 0.799 (p<0.001). Routine thoracic MRI assessment is strongly recommended in CSS patients with OPLLc, HLFc, and enlarged TIA to screen for neglected but vital thoracic disease.

Prevalence and abnormalities of intervertebral discs (ivd) at various levels in lumbosacral spine magnetic resonance imaging (mri)

Abstract Objectives: To use magnetic resonance imaging to identify the prevalence and various abnormalities inside the intervertebral disc at different levels in the lumbosacral spine. Methodology: Cross-sectional study was conducted in the Radiology Department of Hayatabad Medical Complex Peshawar, Pakistan for six months from January 2023 to June 2023. Patients with Intervertebral disc abnormalities were scanned using standard protocol sagittal T1WI, T2WI, T2W STIR, T2W myelo, and in axial T1WI and T2WI. SPSS version 26 was used for data analysis. Tests of significance were applied and a p-value less than or equal to 0.05 was taken as significant. Results: The most frequently affected levels were L4-L5 and L5-S1, with single-site engagement being 30.0% and multi-site involvement being 69.9%. Numbness was 69.9%, Tingling 30.0%, herniated nucleus pulposus 30%, Protrusion 23.5%, Extrusion 6%, Posterolateral 2.7%, Posterocentral 26.2%, Foraminal 3.1%, Canal stenosis (mild 42.2%, moderate 63.2%, severe 5.5%, Thecal sac 36.4%, Lateral recess 55.5%, Foramen 20.1%, Multiple locations 8.3%, Diffuse disc bulge 96.4% (most common on L4-S1), Asymmetric disc bulge 2.4% and Modic changes 21.1% (grade-I 4.2%, grade-II 15.5%, grade-III 1.4%). Ligamentum flavum hypertrophy was at 20.1%, Facet joint hypertrophy at 22%, High-intensity zone (HIZ) at 29.4%, and Annular tear at 26.8% were all abnormalities that were frequently found on the L4-L5 level. Conclusion: Middle-aged persons are at increased risk, females and older individuals showed higher Intervertebral disc abnormalities, and L4-L5 and L5-S1 are the two most afflicted regions. Keywords: [Annular tear, Disc Bulge, High-Intensity zone, Lumbosacral spine, Modic Changes]