Ligamentum Flavum Research Articles

Neglected Alkaptonuric Patients Presented with Symptomatic Degenerative Disc Disorders: Report of Two Cases and Review of Literature

Alkaptonuria (AKU) is a rare autosomal disorder characterized by the accumulation of excess homogentisic acid (HGA) in connective tissues. Herein, we report the uncommon presentation of degenerative lumbar disc disease occurring in two patients with AKU warranting spinal surgery. We report two cases of symptomatic disc herniation and vertebral canal stenosis, presented with radiculopathy and progressive neurogenic claudication, respectively. During spinal surgery, blackened ligamentum flavum and intervertebral disc raised the suspicion of a metabolic disorder. Re-examination of patients revealed nose and ear cartilage discoloration in only one of them, however, histopathological findings and urinalysis were confirmatory for AKU in both. Notwithstanding the rarity of AKU, spine surgeons must be vigilant in their examination and diagnosis, and should not exclude any possible diagnosis without thorough consideration.

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.

Expanding the Horizons of Minimally Invasive Spine Surgery: Experience of the Destandau Technique for the Treatment of Multiple Spinal Diseases

ObjectiveMinimally invasive spine surgery is rapidly gaining popularity owing to its versatile nature. Traditionally prolapsed disc has been the most common pathology targeted using this technique. However, its utility for various other pathologies has also been shown in studies. Here we present our experience of using this technique for various spinal pathologies apart from prolapsed discs. MethodsThis is a retrospective study in which patients operated by a single surgeon from January 2019 to April 2023 were included. Cases which required conversion to open technique were excluded. Intraoperative findings and post-operative courses were obtained from patient records. ResultsA total of 47 cases were included in the study, of which 29 were male and 18 were female. Various pathologies treated include- intradural extramedullary tumors – 23, hypertrophied/ossified ligamentum flavum- 9, arachnoid cysts- 6, dermoid/epidermoid- 4, detethering of cord- 3 and posterior cervical decompression for an ossified posterior longitudinal ligament in 2 patients. The average duration of surgery was 2.1+1.2 hrs and the mean intraoperative blood loss was 138.4+ 59.1 ml. The mean hospital stay was 2.3+0.9 days. Two patients had superficial wound infection and none of the operated patients had cerebrospinal fluid leakage. Re-exploration was not required in any of the operated patients. ConclusionsMinimally invasive techniques for dealing with multiple pathologies involving the spine are as good as traditional open techniques with some additional advantages of lesser tissue trauma, early return to work etc. However, one must overcome the steep learning curve before adopting them in day-to-day practice.

Transforming Growth Factor-β Induces Interleukin-6 Secretion from Human Ligamentum Flavum-Derived Cells through Partial Activation of p38 and p44/42 Mitogen-Activated Protein Kinases.

This experimental study was performed using human ligamentum flavum-derived cells (HFCs). To investigate the intracellular signaling mechanism of interleukin-6 (IL-6) secretion in transforming growth factor-β (TGF- β)-stimulated HFCs. Lumbar spinal stenosis (LSS) is a prevalent disease among the elderly, characterized by debilitating pain in the lower extremities. Although the number of patients with LSS has increased in recent years, the underlying pathomechanism remains unclear. Clinical examinations typically rely on magnetic resonance imaging to diagnose patients, revealing ligamentum flavum hypertrophy. Some studies have suggested an association between ligamentum flavum hypertrophy and inflammation/fibrosis, and expression of TGF-β and IL-6 has been observed in surgically obtained ligamentum flavum samples. However, direct evidence linking TGF-β and IL-6 expression in HFCs is lacking. HFCs were obtained from patients with LSS who had undergone decompression surgery. The cells were stimulated with TGF-β and pretreated with either the p38 mitogen-activated protein (MAP) kinase inhibitor SB203580 or the p44/42 MAP kinase inhibitor FR180204. IL-6 secretion in the cell culture medium and IL-6 messenger RNA (mRNA) expression levels were analyzed using an enzyme-linked immunoassay and real-time polymerase chain reaction, respectively. TGF-β administration resulted in a dose- and time-dependent stimulation of IL-6 release. Treatment with SB203580 and FR180204 markedly suppressed TGF-β-induced IL-6 secretion from HFCs. Moreover, these inhibitors suppressed IL-6 mRNA expression in response to TGF-β stimulation. Our findings indicate that TGF-β induces IL-6 protein secretion and gene expression in HFCs through the activation of p38 or p44/42 MAP kinases. These results suggest a potential association between IL-6-mediated inflammatory response and tissue hypertrophy in LSS, and we provide insights into molecular targets for therapeutic interventions targeting LSS-related inflammation through our analysis of the MAP kinase pathway using HFCs.

Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis. This study systematically reviewed and evaluated the safety and efficacy of spinal endoscopic techniques as a treatment for thoracic ligamentum flavum ossification (TOLF). The use of spinal endoscopic techniques for the treatment of TOLF has increased in recent years. The present study is the first comprehensive systematic review and meta-analysis focused on the use of spinal endoscopic techniques for TOLF. The Cochrane Central, PubMed, Web of Science, and Embase databases were systematically searched for studies focused on patients undergoing spinal endoscopic techniques to treat symptomatic TOLF. This meta-analysis included 23 studies. We included 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years, with 304 total recorded lesion locations of which 245 were located in the lower thoracic spine. Complications affected 35/323 patients, and the mean operative duration for 305 patients was 108.15±47.34 minutes. For 187 patients, the mean operative bleeding was 25.13±12.54 mL,while for 87 patients the mean duration of hospitalization was 4.59±1.93 days. At last follow-up, functional assessment was performed for 260 patients, of whom 200 were in excellent condition, visual analog scale (VAS) scores were assessed for 160 patients, with a mean improvement of 4.40 (3.95, 4.86) Japanese Orthopedic Association (JOA) scores were recorded for 115 patients, with a mean improvement of 3.49 (2.79,4.18), and modified Japanese Orthopedic Association (mJOA) scores were recorded for 208 patients, with a mean improvement of 3.62 (2.89,4.35). These results support several advantages of spinal endoscopic techniques for the treatment of symptomatic TOLF. These include low complication rates, rapid postoperative recovery, and good functional recovery when used for single-segment, non-nodular ossification and no combined dural ossification.

PTGR1 is involved in cell proliferation in thoracic ossification of the ligamentum flavum.

Thoracic ossification of the ligamentum flavum (TOLF) is a heterotopic ossification of spinal ligaments, leading to serious myelopathy. TOLF underlying mechanisms are not well understood. Our iTRAQ analysis have identified ten inflammatory factors related to TOLF, including l. We found that PTGR1 expressions increased in TOLF by RT-PCR and western blot in this study. Both cell proliferation and differentiation are important for the process of bone formation. In our previous study, we demonstrated that TOLF primary cells grew faster than control cells. It was reported that knockdown of PTGR1 inhibited cell proliferation. We hypothesize that PTGR1 may participate in cell proliferation in TOLF. To test this hypothesis, TOLF primary cells were treated for 24h with PTGR1. We observed that PTGR1 increased cell proliferation. The effect of PTGR1 on cell proliferation related genes was examined in TOLF primary cells. Our results showed that PTGR1 was able to activate expressions of c-Myc and CyclinD1. Moreover, blocking JNK pathway by selective JNK inhibitor SP600125 eliminated the positive effect of PTGR1 on c-Myc expression, indicating that PTGR1 activated the expression of c-Myc via JNK pathway. Our new findings suggest that PTGR1 is involved in cell proliferation of TOLF.

Research and application of a teaching platform for combined spinal-epidural anesthesia based on virtual reality and haptic feedback technology

BackgroundIntraspinal anesthesia poses significant teaching challenges and inadequate teaching resources, which ultimately limit students’ opportunities for practice. To address this issue, we aimed to develop a virtual platform for combined spinal-epidural anesthesia that merges virtual reality technology with haptic feedback technology, while assessing its educational impact and learning outcomes.MethodsWe utilized MIMICS, 3Ds MAX, and UNITY 3D software to perform 3D reconstruction based on lumbar CT/MRI data from a standard male volunteer. The haptic coefficients were configured on each layer by 20 experienced anesthesiologists in accordance with the Geomagic Touch X force feedback device. A total of 20 anesthesiology interns completed 30 virtual puncture training sessions. Two experienced anesthetists evaluated the efficacy of the platform and the level of mastery achieved using the Global Rating Scale (GRS) and a Checklist score, respectively. Finally, a questionnaire survey was conducted to gather feedback on the virtual platform.ResultsAfter the 10th session, the puncture time stabilized at 2.4 min. As the number of sessions increased, the Global Rating Scale (GRS) score stabilized by the 8th session, and the Checklist scores tended to stabilize by the 10th session. Results from questionnaires indicated that over half of the anesthesiology interns (70%) believed that the platform, which exhibited strong repeatability, improved their anatomical recognition and provided a strong sense of breakthrough in identifying the ligamentum flavum. The majority of them (80%) expressed satisfaction with the virtual platform.ConclusionsThe platform effectively facilitated the acquisition of basic and accurate puncture skills on a virtual patient.

Outcome of Decompressive Laminectomy with or without Posterior Screw Fixation for Thoracic Ossification of the Ligamentum Flavum with Disc Degeneration

Objective: Thoracic myelopathy caused by the ossification of the ligamentum flavum (OLF) is commonly treated with surgical decompression. This study aimed to compare the clinical and radiological outcomes of surgical decompression without posterior screw fixation (decompressive laminectomy [DL] group) and with posterior screw fixation (laminectomy with screw fixation [LSF] group) for thoracic myelopathy due to OLF with disc degeneration.Methods: A retrospective review of 35 patients (DL group, n = 19; LSF group, n = 16) was conducted. Clinical variables (Japanese Orthopaedic Association scores) and radiological variables (including sagittal vertical axis, pelvic tilt, thoracic kyphosis, sacral slope, lumbar lordosis (LL), segmental Cobb’s angle, dynamic Cobb’s angle, and dynamic thoracolumbar junction [dTLJ] at the operated level) were measured preoperatively and 1 year postoperatively.Results: Both groups exhibited significant improvements in clinical characteristics postoperatively. LL significantly increased at 1 year postoperatively in both groups. Other sagittal alignment parameters did not change significantly. The dTLJ did not differ significantly between the groups preoperatively; however, the dTLJ of the DL group was larger than that of the LSF group at 1 year postoperatively. There was no significant difference between the groups’ dynamic Cobb’s angles or risk of complications.Conclusion: Decompression surgery for OLF resulted in clinical improvement regardless of whether posterior fixation was performed. Decompression without posterior fixation could allow thoracolumbar motion preservation and might be an effective approach for thoracic OLF with disc degeneration.

Lamina-Lifting Suspension Modification in Bridge Crane Technique in Treatment of Severe Thoracic Ossification of the Ligamentum Flavum (TOLF).

BACKGROUND The aim of this study was to investigate the effectiveness and potential complications of combining a lamina-lifting suspension system with the bridge crane technique in treating thoracic ossification of the ligamentum flavum (TOLF) with thoracic myelopathy. MATERIAL AND METHODS A patient with severe TOLF and myelopathy was treated using a lamina-lifting suspension system combined with bridge crane technique. The brief surgical procedure involved implantation of internal fixation, separation of laminae, installation of cross-bridges, reverse lifting, and fixation of cross-bridges. The modified Japanese Orthopaedic Association (mJOA) scale, Hirabayashi recovery rate, and ASIA grade of the patient were recorded. The canal occupation ratio (COR) and spinal cord status were evaluated by imaging data. RESULTS The surgical intervention significantly enhances the patient's lower limb function, as evidenced by an increase in mJOA score from 5 preoperatively to 11 at terminal follow-up. The Hirabayashi recovery rate after surgery ranges between 25% and 50%. Additionally, ASIA classification improved to grade E. Imaging data showed that the ossification of the thoracic vertebrae had subsided, while the volume of the local spinal canal had recovered and the spinal cord injury had been completely relieved. No adverse effects or complications were observed. CONCLUSIONS The lamina-lifting suspension system preserves the benefits of bridge crane technique while also augmenting the traction of a post laminae-OLF complex (LOC) suspension, rendering it more secure and manageable. Nevertheless, further sample analysis and research are required in the future.

The Impact of Spine Pathology on Posterior Ligamentous Complex Structure and Function.

Spinal ligament is an important component of the spinal column in mitigating biomechanical stress. Particularly the posterior ligamentous complex, which is composed of the ligamentum flavum, interspinous, and supraspinous ligaments. However, research characterizing the biomechanics and role of ligament health in spinal pathology and clinical context are scarce. This article provides a comprehensive review of the implications of spinal pathology on the structure, function, and biomechanical properties of the posterior ligamentous complex. Current research characterizing biomechanical properties of the posterior ligamentous complex is primarily composed of cadaveric studies and finite element modeling, and more recently incorporating patient-specific anatomy into finite element models. The ultimate goal of current research is to understand the relative contributions of these ligamentous structures in healthy and pathological spine, and whether preserving ligaments may play an important role in spinal surgical techniques. At baseline, posterior ligamentous complex structures account for 30-40% of spinal stability, which is highly dependent on the intrinsic biomechanical properties of each ligament. Biomechanics vary widely with pathology and following rigid surgical fixation techniques and are generally maladaptive. Often secondary to morphological changes in the setting of spinal pathology, but morphological changes in ligament may also serve as a primary pathology. Biomechanical maladaptations of the spinal ligament adversely influence overall spinal column integrity and ultimately predispose to increased risk for surgical failure and poor clinical outcomes. Future research is needed, particularly in living subjects, to better characterize adaptations in ligaments that can provide targets for improved treatment of spinal pathology.

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.

Ligamentum flavum ganglion cyst of the cervical spine: a rare cause of myelopathy. Clinical observation and literature review

Juxtafacet cysts include both synovial cysts directly from the facet capsule and ganglion cysts arising from the ligamentum flavum. Ganglion cysts of the cervical spine are extremely rare benign masses. The inner surface of the capsule of ganglion cysts consists of fibroblasts and has no anatomical connection with the capsule of the facet joint. Magnetic resonance imaging is the method of choice for the diagnosis of ligamentum flavum cysts, with a hyperintense round mass on T2‑weighted images with clear margins and no perifocal edema. On T1‑weighted images, an isointense signal is noted, and with contrast enhancement, the cyst wall more often accumulates a contrast. The method of choice in the surgical treatment of cysts is their total removal with sparing bone resection of the posterior vertebral structures. The outcome of surgical treatment of these formations is good with no risk of recurrence.

M1 macrophage-derived oncostatin M induces osteogenic differentiation of ligamentum flavum cells through the JAK2/STAT3 pathway.

M1 macrophages (Mφs) are involved in osteogenic differentiation of ligamentum flavum (LF) cells and play an important role in heterotopic ossification. However, the mechanism by which M1 Mφs influence osteogenic differentiation of LF cells has not been studied. The effect of conditioned medium including secretions of M1 Mφs (CM-M1) on LF cells was analyzed by GeneChip profiling and ingenuity pathway analysis (IPA). THP-1 cells were polarized into M1 Mφs and CM-M1 was used to induce LF cells. In addition, LF cells were induced by CM-M1 in the presence of cyclooxygenase 2 (COX-2) inhibitors or oncostatin M (OSM)-neutralizing antibodies. Based on the presence of OSM, knockout of OSMR or GP130 receptors, or addition of the Janus kinase 2 (JAK2) inhibitor AZD1480 or signal transducer and activator of transcription 3 (STAT3) inhibitor Stattic were examined for effects on osteogenic differentiation of LF cells. OSM secretion was quantified by ELISA, while qPCR and western blot were used to evaluate expression of osteogenic genes and receptor and signaling pathway-related proteins, respectively. GeneChip and IPA results indicate that the OSM signaling pathway and its downstream signaling molecules JAK2 and STAT3 are significantly activated. ELISA results indicate that OSM is highly expressed in cells treated with CM-M1 and lowly expressed in cells treated with CM-M1 and a COX-2 inhibitor. Besides, CM-M1 induces osteogenic differentiation of LF cells, which is weakened when COX-2 inhibitors or OSM-neutralizing antibody are added to it. Recombinant OSM could induce osteogenic differentiation of LF cells and upregulate expression of OSMR, GP130, phosphorylated (P)-JAK2, and P-STAT3. Upon knockdown of OSMR or GP130, or the addition of AZD1480 or Stattic, P-JAK2 and P-STAT3 expression were decreased and osteogenic differentiation was reduced. M1 Mφ-derived OSM induces osteogenic differentiation of LF cells and the JAK2/STAT3 signaling pathway plays an important role.

The biomechanical effect of different types of ossification of the ligamentum flavum on the spinal cord during cervical dynamic activities

Ossification of the ligamentum flavum (OLF) is thought to be an influential etiology of myelopathy, as thickened ligamentum flavum causes the stenosis of the vertebral canal, which could subsequently compress the spinal cord. Unfortunately, there was little information available on the effects of cervical OLF on spinal cord compression, such as the relationship between the progression of cervical OLF and nervous system symptoms during dynamic cervical spine activities. In this research, a finite element model of C1-C7 including the spinal cord featured by dynamic fluid-structure interaction was reconstructed and utilized to analyze how different types of cervical OLF affect principal strain and stress distribution in spinal cord during spinal activities towards six directions. For patients with cervical OLF, cervical extension induces higher stress within the spinal cord among all directions. From the perspective of biomechanics, extension leads to stress concentration in the lateral corticospinal tracts or the posterior of gray matter. Low energy damage to the spinal cord would be caused by the high and fluctuating stresses during cervical movements to the affected side for patients with unilateral OLF at lower grades.

Role of Panchakarma in the Management of Spinal Canal Stenosis - A Case Study

Spinal canal stenosis is a painful, degenerative condition, and is localized to facets, joints, and ligamentum flavum of the vertebra which is often referred to for surgical correction. The main cause of stenosis is herniated vertebral disc. If there is no compression, the spinal canal can be referred to as narrow, but not stenotic. Certain studies have defined lumbar spinal stenosis as the narrowing of the osteo-ligamentous vertebral canal or the intervertebral foramina, which causes compression of the thecal sac or the caudal nerve roots. The narrowing may impact the entire canal or just a portion of it, but it occurs at a single vertebral level. In this condition, it may, drastically affect the quality of life due to severe pain in doing daily routine activities. In contemporary science, there is no treatment except surgical intervention which is having a high chance of complication and the chances of recurrence. Surgery is necessary when there are clinically significant motor deficiencies or symptoms of cauda equina syndrome. Based on the manifestation of clinical signs and symptoms it can be correlated with Gridhrasi, according to Ayurveda. Gridhrasi can be treated successfully by the intervention of Panchakarma procedures along with Shamana Chikitsa. Here is a case study of a patient suffering from low back pain radiating to bilateral lower limbs, stiffness, numbness, burning sensation in the bilateral sole region, and unable to walk without support, who was previously diagnosed as a case of Spinal Canal Stenosis. He was treated with a Panchakarma procedure, Shamana Chikitsa along with Physiotherapy Exercises. The patient showed marked improvement and could do daily routine activities properly.

The correlation between clinical symptom and morphological parameters on magnetic resonance imaging in patients with spondylolisthesis levels L4/L5 and L5/S1.

Spondylolisthesis is one of the common causes of spinal pain. There is currently a lack of studies on the correlation between magnetic resonance imaging (MRI) and clinical symptoms of patients with spondylolisthesis. This study is aimed to find the correlation between clinical symptoms of L4/L5, L5/S1 lumbar spondylolisthesis, and imaging parameters on MRI. A retrospective study on 100 patients who were diagnosed with lumbar spondylolisthesis at the L4/L5, L5/S1 levels from August 2022 to February 2023. Parameters on MRI are measured the cross-sectional area of the dural sac (DSA), the cross-sectional area of the spinal canal (SCA), the ligamentum flavum cross-sectional area (LFA), and ligamentum flavum thickness (LFT), anterior-posterior diameter (APD), sliding distance (SD) at the spondylolisthesis level. Clinical symptoms were investigated according to the Visual Analogue Scale (VAS) for grading of pain and the subjective disability was assessed by the Oswestry Disability Index (ODI). There was no statistically significant difference between SD, APD, SCA, DSA, LFA, and LFT between the mild and moderate pain VAS and severe pain VAS groups. No correlation was found between VAS and SD, APD, SCA, DSA, LFA, and LFT. There is a negative correlation between ODI and APD, SCA, and DSA. The statistically significant difference in APD, SCA, and DSA indexes in the two groups with mild/moderate disability (ODI ≤40%) and the group with severe disability (ODI >40%). A higher DSA and SCA, APD are associated with lower ODI. Decreased APD, SCA, and DSA are all suggestive of decreased spinal function. However, the MRI findings did not correlate with the patient's clinical pain level.

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

Single-level ossified ligamentum flavum causing a holocord syrinx: illustrative case.

Syringomyelia is a neurological disorder that is caused by abnormal cerebrospinal fluid flow or circulation. It is an incidental finding in most cases, predominantly presenting with sensory symptoms of insensitivity to pain and temperature. Spinal ossified ligamentum flavum (OLF) leading to syringomyelia is one of the rare causes. The authors report an unusual case of syringomyelia due to a thoracic OLF. A 54-year-old female presented with backache, difficulty walking, spasticity in the bilateral lower limbs, tingling sensation in the bilateral lower limbs, and paraparesis for 5 years. Her radiological investigations were suggestive of an OLF causing a syrinx. She underwent laminectomy, and her syrinx resolved on subsequent follow-up. A syrinx due to a single-level OLF is rare, and this uncommon cause should be kept in mind while formulating treatment plans.