The Role of Vertebral Morphometry in the Pathogenesis of Degenerative Lumbar Spinal Stenosis

The aim of the current study was to establish whether the vertebral morphometry (e.g., vertebral body width and spinal canal diameters) is associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study from L1 to L5 for two sample populations was used. The first included 165 participants with symptomatic DLSS (sex ratio 80 M/85F), and the second had 180 individuals from the general population (sex ratio: 90 M/90F). Vertebral body length (VL) and width (VW) were significantly greater in the stenosis males and females compared to their counterparts in the control. The mean VL in the stenosis males was 31.3 mm at L1, 32.6 mm at L2, 34 mm at L3, 34.1 mm at L4, and 34.5 at L5 compared to 29.9 mm, 31.3 mm, 32.6 mm, 32.8 mm, and 32.9, respectively, in the control group ( P ≤ 0.003 ). Additionally, the bony anterior-posterior (AP) canal diameters and cross-sectional area (CSA) were significantly smaller in the stenosis group compared to the control. The mean AP canal values in the stenosis males were 17.8 mm at L1, 16.6 mm at L2, 15.4 mm at L3, 15.6 mm at L4, and 16.1 at L5 compared to 18.7, 17.8, 16.9, 17.6, and 18.8, respectively, in the control group. Vertebral length (OR-1.273 to 1.473; P ≤ 0.002 ), AP canal diameter (OR-0.474 to 0.664; P ≤ 0.007 ), and laminar inclination (OR-0.901 to 0.856; P ≤ 0.025 ) were significantly associated with DLSS. Our study revealed that vertebral morphometry has a role in DLSS development.

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Pedicle Morphometry Variations in Individuals with Degenerative Lumbar Spinal Stenosis

BioMed Research International ◽

10.1155/2020/7125914 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Janan Abbas ◽

Natan Peled ◽

Israel Hershkovitz ◽

Kamal Hamoud

Keyword(s):

General Population ◽

Sex Ratio ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Vertebrae ◽

Control Group ◽

Degenerative Lumbar Spinal Stenosis ◽

Males And Females ◽

Lumbar Spinal ◽

Age Range

The aim of this study was to compare pedicle dimensions in degenerative lumbar spinal stenosis (DLSS) with those in the general population. A retrospective computerized tomography (CT) study for lumbar vertebrae (L1 to L5) from two sample populations was used. The first included 165 participants with symptomatic DLSS (age range: 40-88 years, sex ratio: 80 M/85 F), and the second had 180 individuals from the general population (age range: 40-99 years, sex ratio: 90 M/90 F). Both males and females in the stenosis group manifested significantly greater pedicle width than the control group at all lumbar levels (P<0.05). In addition, pedicle heights for stenosis females were remarkably smaller on L4 and L5 levels compared to their counterparts in the control group (P<0.001). Males have larger pedicles than females for all lumbar levels (P<0.001). Age and BMI did not demonstrate significant association with pedicle dimensions. Our outcomes indicate that individuals with DLSS have larger pedicle widths than the control group. More so, pedicle dimensions are gender-dependent but independent of age and BMI.

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Is Lumbosacral Transitional Vertebra Associated with Degenerative Lumbar Spinal Stenosis?

BioMed Research International ◽

10.1155/2019/3871819 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Janan Abbas ◽

Natan Peled ◽

Israel Hershkovitz ◽

Kamal Hamoud

Keyword(s):

Sex Ratio ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Control Group ◽

Lumbar Region ◽

Degenerative Lumbar Spinal Stenosis ◽

Transitional Vertebra ◽

Lumbosacral Transitional Vertebra ◽

Lumbar Spinal ◽

Age Range

The aim of this study was to shed light on the association between lumbosacral transitional vertebra (LSTV) and degenerative lumbar spinal stenosis (DLSS). A cross-sectional retrospective study was performed on 165 individuals that were diagnosed with clinical picture of DLSS (age range: 40-88 years; sex ratio: 80M/85F) and 180 individuals without DLSS related symptoms (age range: 40-99 years; sex ratio: 90M/90F). All participants had undergone high-resolution CT scan for the lumbar region in the same position. We also used the volume rendering method to obtain three-dimensional CT images of the lumbosacral area. Both males and females in the stenosis group manifest greater prevalence of LSTV than their counterparts in the control group (P<0.001). Furthermore, the presence of LSTV increases the likelihood of degenerative spinal stenosis (odds ratio= 3.741, P<0.001). In the control group, LSTV was more common in males, and sacral slope angle of males was significantly greater in LSTV group compared to non-LSTV. This study indicates that LSTV was significantly associated with symptomatic DLSS.

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Spinal canal diameter in degenerative lumbar spinal stenosis

Journal of Anatomical Society of India ◽

10.1016/j.jasi.2018.07.005 ◽

2018 ◽

Vol 67 ◽

pp. S25-S28 ◽

Cited By ~ 1

Author(s):

R. Sethi ◽

V. Singh

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Degenerative Lumbar Spinal Stenosis ◽

Canal Diameter ◽

Lumbar Spinal

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Facet Tropism and Orientation: Risk Factors for Degenerative Lumbar Spinal Stenosis

BioMed Research International ◽

10.1155/2020/2453503 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Janan Abbas ◽

Natan Peled ◽

Israel Hershkovitz ◽

Kamal Hamoud

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Control Group ◽

Degenerative Lumbar Spinal Stenosis ◽

Lower Lumbar Spine ◽

Lumbar Spinal ◽

Lower Lumbar ◽

Facet Tropism

The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study including 274 individuals was divided into two groups: control (82 males and 81 females) and stenosis (59 males and 52 females). All participants have undergone high-resolution CT scan of the lumbar spine in the same position. FT and FO were measured at L1-2 to L5-S1. Significant sagittal FO was noted in the stenosis males (L2-3 to L4-5) and females (L2-3 to L5-S1) compared to the controls. The prevalence of FT was remarkably greater in the stenosis males (L4-5, L5-S1) and females (L3-4, L5-S1) compared to their counterparts in the control group. Our results also showed that FT (L3-4 to L5-S1) increases approximately 2.9 times the likelihood for DLSS development. This study indicates that FO and FT in the lower lumbar spine are significantly associated with DLSS.

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Clinical usefulness of assessing lumbar somatosensory evoked potentials in lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2009.3.spine08513 ◽

2009 ◽

Vol 11 (1) ◽

pp. 71-78 ◽

Cited By ~ 7

Author(s):

Xinyu Liu ◽

Shunsuke Konno ◽

Masabumi Miyamoto ◽

Yoshikazu Gembun ◽

Gen Horiguchi ◽

...

Keyword(s):

Evoked Potentials ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Somatosensory Evoked Potentials ◽

Clinical Usefulness ◽

Control Group ◽

Vas Score ◽

Vas Scores ◽

The Mean ◽

Lumbar Spinal

Object The aim of this retrospective study was to evaluate the clinical usefulness of assessing lumbar somatosensory evoked potentials (SSEPs) in central lumbar spinal stenosis (LSS). Methods The latencies of lumbar SSEPs were recorded in 40 patients with central LSS, including 16 men and 24 women. The mean age of the patients was 67.3 ± 7.4 years. The diagnosis was LSS in 23 cases and LSS associated with degenerative spondylolisthesis in 17 cases. The average duration of symptoms was 43.8 ± 51.2 months. Twenty-two cases had bilateral and 18 cases had unilateral leg symptoms. Thirty-seven cases were associated with neurogenic intermittent claudication and the mean walking distance of patients with this condition was 246.8 ± 232.7 m. The mean Japanese Orthopedic Association scale score, as well as the visual analog scale (VAS) scores of low-back pain, leg pain, and numbness, were 16.5 ± 3.5, 6.0 ± 2.5, 6.9 ± 2.1, and 7.8 ± 2.2, respectively. The minimal cross-sectional area of the dural sac on MR imaging was 0.44 ± 0.21 cm2. Thirty-nine cases of cervical spondylotic myelopathy without lumbar and peripheral neuropathy were chosen as the control group. Results The latencies of lumbar SSEPs in patients with LSS and in the control group were 23.0 ± 2.0 ms and 21.6 ± 1.9 ms, respectively. There was a statistically significant difference between the LSS and control groups (p < 0.05). The latency of lumbar SSEPs was significant correlated with the VAS score of leg numbness (p < 0.05). The latency of lumbar SSEPs in LSS was clearly delayed when the VAS score of leg numbness was ≥ 8 (p < 0.05). Conclusions Lumbar SSEPs are able to detect neurological deficit in the lumbar area effectively, and they can reflect part of the subjective severity of sensory disturbance (numbness) in LSS. Both lumbar SSEPs and VAS scores of leg numbness may be useful for clinical evaluation in patients with LSS.

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The Role of the Ligamentum Flavum Area as a Morphological Parameter of Lumbar Central Spinal Stenosis

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e424 ◽

2017 ◽

Vol 3 (20;3) ◽

pp. E419-E424

Author(s):

Jeong Hun Suh

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Ligamentum Flavum ◽

Facet Joint ◽

Control Group ◽

Morphological Parameter ◽

Roc Curve Analysis ◽

Cross Sectional ◽

Degenerative Lumbar Spinal Stenosis ◽

Lumbar Spinal

Background: Hypertrophy of the ligamentum flavum (LF) has been considered as a major cause of lumbar central spinal stenosis (LCSS). Previous studies have found that ligamentum flavum thickness (LFT) is correlated with aging, disc degeneration, and lumbar spinal stenosis. However, hypertrophy is different from thickness. Thus, to evaluate hypertrophy of the whole LF, we devised a new morphological parameter, called the ligamentum flavum area (LFA). Objectives: We hypothesized that the LFA is a key morphologic parameter in the diagnosis of LCSS. Study Design: Retrospective observational study. Setting: The single center study in Seoul, Republic of Korea. Methods: LF samples were collected from 166 patients with LCSS, and from 167 controls who underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. T1- weighted axial MR imageswere acquired at the facet joint level from individual patients. We measured the LFA and LFT at the L4-L5 intervertebral level on MRI using a picture archiving and communications system. The LFA was measured as the cross-sectional area of the whole LF at the L4-L5 stenotic level. The LFT was measured by drawing a line along the side of the ligament facing the spinal canal and along the laminar side of the ligament curve and then measuring the thickest point at the L4-L5 level. Results: The average LFA was 96.56 ± 30.74 mm2 in the control group and 132.69 ± 32.68 mm2 in the LCSS group. The average LFT was 3.61 ± 0.72 mm in the control group and 4.24 ± 0.97 mm in the LCSS group. LCSS patients had significantly higher LFA (P < 0.001) and LFT (P < 0.001). Regarding the validity of both LFA and LFT as predictors of LCSS, Receiver Operator Characteristics (ROC) curve analysis showed that the best cut-off point for the LFA was 105.90 mm2 , with 80.1% sensitivity, 76.0% specificity, and area under the curve (AUC) of 0.83 (95% CI, 0.78 – 0.87). The best cut off-point of the LFT was 3.74 mm, with 70.5% sensitivity, 66.5% specificity, and AUC of 0.72 (95% CI, 0.66 – 0.77). Limitations: The principal methodological limitation was the retrospective observational nature. Anatomically, degenerative lumbar spinal stenosis can involve the central canal, foramina, and lateral recess. However, we focused on LCSS only. Conclusions: Although the LFT and LFA were both significantly associated with LCSS, the LFA was a more sensitive measurement parameter. Thus, to evaluate LCSS patients, the treating doctor should more carefully analyze the LFA than LFT. Institutional Review Board (IRB) approval number: S2015-1328-0001 Key words: Ligamentum flavum, ligamentum flavum area, ligamentum flavum thickness, lumbar central spinal stenosis, hypertrophy of the ligamentum flavum, morphological parameter, crosssectional area, optimal cut-off point

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Spinous Process Inclination in Degenerative Lumbar Spinal Stenosis Individuals

BioMed Research International ◽

10.1155/2020/8875217 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Janan Abbas ◽

Natan Peled ◽

Israel Hershkovitz ◽

Kamal Hamoud

Keyword(s):

Spinal Stenosis ◽

Computerized Tomography ◽

Lumbar Spinal Stenosis ◽

Spinous Process ◽

Control Group ◽

Midsagittal Plane ◽

Degenerative Lumbar Spinal Stenosis ◽

Spinous Processes ◽

Lumbar Spinal

The aim of this study is to determine the sagittal inclination of lumbar spinous processes (SPs) in individuals with degenerative lumbar spinal stenosis (DLSS). It is a retrospective computerized tomography (CT) study including 345 individuals divided into two groups: control (90 males, 90 females) and stenosis (80 males and 85 females. The SP inclination was measured in the midsagittal plane from L1 to L5 levels. Stenosis males (L3-L5) and females (L1, L4) manifested significantly greater SP inclination compared to their counterparts in the control group. Males had significantly horizontal SP orientation compared to females (L1, L2). We also found that SP inclination became steeper as we descend caudally. This study indicates that SP inclinations are significantly associated with DLSS.

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The identification of novel gene mutations for degenerative lumbar spinal stenosis using whole-exome sequencing in a Chinese cohort

BMC Medical Genomics ◽

10.1186/s12920-021-00981-4 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Xin Jiang ◽

Dong Chen

Keyword(s):

Exome Sequencing ◽

Whole Exome Sequencing ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Gene Mutations ◽

Specific Gene ◽

Single Nucleotide ◽

Degenerative Lumbar Spinal Stenosis ◽

Whole Exome ◽

Lumbar Spinal

Abstract Background Degenerative lumbar spinal stenosis (DLSS) is a common lumbar disease that requires surgery. Previous studies have indicated that genetic mutations are implicated in DLSS. However, studies on specific gene mutations are scarce. Whole-exome sequencing (WES) is a valuable research tool that identifies disease-causing genes and could become an effective strategy to investigate DLSS pathogenesis. Methods From January 2016 to December 2017, we recruited 50 unrelated patients with symptoms consistent with DLSS and 25 unrelated healthy controls. We conducted WES and exome data analysis to identify susceptible genes. Allele mutations firstly identified potential DLSS variants in controls to the patients’ group. We conducted a site-based association analysis to identify pathogenic variants using PolyPhen2, SIFT, Mutation Taster, Combined Annotation Dependent Depletion, and Phenolyzer algorithms. Potential variants were further confirmed using manual curation and validated using Sanger sequencing. Results In this cohort, the major classification variant was missense_mutation, the major variant type was single nucleotide polymorphism (SNP), and the major single nucleotide variation was C > T. Multiple SNPs in 34 genes were identified when filtered allele mutations in controls to retain only patient mutations. Pathway enrichment analyses revealed that mutated genes were mainly enriched for immune response-related signaling pathways. Using the Novegene database, site-based associations revealed several novel variants, including HLA-DRB1, PARK2, ACTR8, AOAH, BCORL1, MKRN2, NRG4, NUP205 genes, etc., were DLSS related. Conclusions Our study revealed that deleterious mutations in several genes might contribute to DLSS etiology. By screening and confirming susceptibility genes using WES, we provided more information on disease pathogenesis. Further WES studies incorporating larger DLSS patient cohorts are required to comprehend the genetic landscape of DLSS pathophysiology fully.

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