scholarly journals Activity of genes of matrix metalloproteinases and their inhibitors in the Ligamentum flavum of patients with stenosing processes in spinal canal and dural sac

2021 ◽  
Vol 6 (6-2) ◽  
pp. 58-72
Author(s):  
L. V. Rodionova ◽  
L. G. Samoilova ◽  
V. A. Sorokovikov
Keyword(s):  
Spinal Canal ◽  
Ligamentum Flavum ◽  
Lumbar Stenosis ◽  
Specific Primers ◽  
Tissue Inhibitors ◽  
Metabolic Characteristics ◽  
Dural Sac ◽  
Expression Of Genes ◽  
Insufficient Response ◽  
Increased Activity

New data have been obtained for assessing the expression of genes of metalloproteinases and their tissue inhibitors (MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, TIMP-1 and TIMP-2) in the Ligamentum flavum in patients with lumbar stenosis of spinal canal and dural sac. The features of the metabolism of the extracellular matrix (ECM) were revealed, the data obtained were compared with those for previously studied candidate genes. The search for relationships with the features of the ECM metabolic characteristics was carried out.The aim. To study the expression of genes of metalloproteinases and their tissue inhibitors in intraoperative biopsies of the Ligamentum flavum of patients with lumbar stenosis of the spinal canal and dural sac.Materials and methods. A group of 33 people (17 women, 16 men) with lumbar stenosis of the spinal canal and dural sac was studied; the average age is 45.73 ± 1.95 years. RNA was isolated from intraoperative biopsies of the Ligamentum flavum, reverse transcription was performed, and PCR using specific primers was performed.Results. In Ligamentum flavum of patients with stenosing processes of the spinal canal and dural sac, an increased activity of MMP-1 and insufficient response of TIMP-1 and TIMP-2 were found; the expression of MMP-1 increased synchronously with Dio2, and both genes decreased their activity with increasing age of the patient. In patients with Ligamentum flavum ossification, the MMR-8 gene was more actively expressed, and the synthesis of the mRNA of the MMR-9 gene decreased compared to the subgroup without ossification.

scholarly journals Change of Lumbar Ligamentum Flavum after Indirect Decompression Using Anterior Lumbar Interbody Fusion

2017 ◽  
Vol 11 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Seiji Ohtori ◽  
Sumihisa Orita ◽  
Kazuyo Yamauchi ◽  
Yawara Eguchi ◽  
Yasuchika Aoki ◽  
...  
Keyword(s):  
Pain Relief ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Ligamentum Flavum ◽  
Case Series ◽  
Anterior Fusion ◽  
Dural Sac ◽  
Canal Diameter ◽  
Indirect Decompression

<sec><title>Study Design</title><p>Retrospective case series.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to examine changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a 10-year follow-up.</p></sec><sec><title>Overview of Literature</title><p>Extreme lateral interbody fusion provides minimally invasive treatment of the lumbar spine; this anterior fusion without direct posterior decompression, so-called indirect decompression, can achieve pain relief. Anterior fusion may restore disc height, stretch the flexure of the ligamentum flavum, and increase the spinal canal diameter. However, changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a long follow-up have not yet been reported.</p></sec><sec><title>Methods</title><p>We evaluated 10 patients with L4 spondylolisthesis who underwent stand-alone anterior interbody fusion using the iliac crest bone. Magnetic resonance imaging was performed 10 years after surgery. The cross-sectional area (CSA) of the dural sac and the ligamentum flavum at L1–2 to L5–S1 was calculated using a Picture Archiving and Communication System.</p></sec><sec><title>Results</title><p>Spinal fusion with correction loss (average, 4.75 mm anterior slip) was achieved in all patients 10 years postsurgery. The average CSAs of the dural sac and the ligamentum flavum at L1–2 to L5–S1 were 150 mm<sup>2</sup> and 78 mm<sup>2</sup>, respectively. The average CSA of the ligamentum flavum at L4–5 (30 mm<sup>2</sup>) (fusion level) was significantly less than that at L1–2 to L3–4 or L5–S1. Although patients had an average anterior slip of 4.75 mm, the average CSA of the dural sac at L4–5 was significantly larger than at the other levels.</p></sec><sec><title>Conclusions</title><p>Spinal stability induced a lumbar ligamentum flavum change and a sustained remodeling of the spinal canal, which may explain the long-term pain relief after indirect decompression fusion surgery.</p></sec>

scholarly journals Characteristics of acetylation reactions in patients with stenosing process of the lumbar spinal canal and dural sac depending on severity of Ligamentum flavum ossification

2020 ◽  
pp. 45-52
Author(s):  
Л.В. Родионова ◽  
Л.Г. Самойлова ◽  
И.А. Шурыгина ◽  
О.В. Скляренко ◽  
А.П. Животенко ◽  
...  
Keyword(s):  
Gene Expression ◽  
Connective Tissue ◽  
Spinal Canal ◽  
Ligamentum Flavum ◽  
Genetic Characteristics ◽  
Dural Sac ◽  
Nat2 Gene ◽  
Ossification Of Ligamentum Flavum ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

Актуальность. В настоящее время совершенно не изучена экспрессия генов ацетилтрансфераз в структурах, участвующих в формировании патологического очага при развитии дегенеративно-дистрофических процессов в позвоночно-двигательном сегменте. Ведущая роль гипертрофии и оссификации жёлтой связки (Ligamentum flavum) в развитии и прогрессировании стенозирующих процессов позвоночного канала и дурального мешка, а также участие ацетилтрансфераз в метаболизме соединительной ткани определило цель исследования: выявить генетические особенности реакций ацетилирования у больных со стенозами позвоночного канала и дурального мешка на поясничном отделе позвоночника в зависимости от выраженности процессов оссификации Ligamentum flavum. Методы. В исследование включен 31 пациент (15 мужчин, 16 женщин, средний возраст 45,7 ± 2,0 лет) со стенозирующими процессами позвоночного канала и дурального мешка на поясничном уровне. У всех пациентов во время оперативного вмешательства были забраны образцы Ligamentum flavum, в которых затем общепринятыми методами патоморфологии определяли признаки наличия или отсутствия гипертрофии и / или оссификации, а также методом количественной ПЦР (кПЦР) определяли экспрессию генов NAT1 и NAT2. Результаты. В биоптатах Ligamentum flavum обнаружена экспрессия генов NAT1 и NAT2, что свидетельствует о ранее неизвестной роли процессов ацетилирования в метаболизме соединительной ткани. Варианты «медленного» ацетилирования достоверно чаще встречались у пациентов с выявленной оссификацией Ligamentum flavum. Обнаружены различные паттерны экспрессии генов NAT1 и NAT2, что свидетельствует о полиморфности клинических вариантов патологии. Часть выявленных вариантов экспрессии изоферментов ацетилтрансфераз характеризуют склонность к развитию оссификации Ligamentum flavum. Женщины чаще страдают от оссификации Ligamentum flavum по сравнению с мужчинами (χ2 = 39,1, р < 0,01), при этом, повторные оперативные вмешательства, как и избыточная масса тела, не увеличивали риск её оссификации. Активность экспрессии гена NAT2 можно отнести к информативным маркёрам, свидетельствующим о повышенном риске развития процессов эктопической оссификации Ligamentum flavum. Заключение. Выявленные особенности реакций ацетилирования у больных со стенозами позвоночного канала и дурального мешка могут помочь клиницистам прогнозировать развитие гипертрофии и оссификации жёлтой связки при оперативном вмешательстве на позвоночнике, а полученные новые фундаментальные знания лягут в основу разработки способов профилактики развития эпидурального фиброза на дооперационном этапе. Background. Expression of acetyltransferase genes in structures participating in formation of a pathological focus in development of degenerative spine conditions is presently unstudied. Hypertrophy and ossification of Ligamentum flavum play a leading role in the development and progression of stenosing processes in the spinal canal and dural sac whereas acetyltransferases are involved in metabolism of connective tissue. The aim of this study was to identify genetic characteristics of acetylation reactions in patients with stenosis of the lumbar spinal canal and dural sac depending on severity of ossification of Ligamentum flavum. Methods. This study included 31 patients (15 men and 16 women aged 45.7 ± 2.0 years) with stenosing processes of the spinal canal and dural sac at the lumbar level. Samples of Ligamentum flavum were taken from all patients at the time of surgical intervention. Signs of hypertrophy and/or ossification were detected in these samples with standard pathomorphological methods. Real time PCR was used to determine the expression of NAT1 and NAT2 genes. Results. Expression of NAT1 and NAT2 genes was found in biopsy samples of Ligamentum flavum. This indicated a previously unknown role of acetylation processes in connective tissue metabolism. Variants of «slow» acetylation were significantly more common in patients with documented ossification of Ligamentum flavum. Different patterns of NAT1 and NAT2 gene expression were identified, which suggested polymorphism of clinical variants of the disease. Some of the identified variants of acetyltransferase isoenzyme expression characterize a tendency towards development of Ligamentum flavum ossification. Women were more likely to have ossification of Ligamentum flavum than men (χ2 = 39.1, p < 0.01). Repeated surgery and overweight did not increase the risk for ossification of Ligamentum flavum. The activity of NAT2 gene expression can be classified as an informative marker for increased risk of ectopic ossification of Ligamentum flavum. Conclusion. The identified patterns of acetylation reactions in patients with spinal canal and dural sac stenosis may help clinicians to predict the development of hypertrophy and ossification of Ligamentum flavum during spine surgery and to find ways for prevention of epidural fibrosis at the preoperative stage.

Clinical and Radiographic Correlation (According to CT) in Patients with Degenerative Lumbar Spinal Stenosis

2017 ◽  
pp. 124-130 ◽  
Author(s):  
S. G. Mlyavykh ◽  
A. Y. Aleynik ◽  
A. E. Bokov ◽  
M. V. Rasteryaeva ◽  
M. A. Kutlaeva
Keyword(s):  
Ct Scan ◽  
Spinal Canal ◽  
Clinical Manifestations ◽  
Intervertebral Discs ◽  
Morphometric Parameters ◽  
Neurogenic Claudication ◽  
Clinical Group ◽  
Lumbar Stenosis ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Lumbar Spinal

Сomputed tomography (CT) is widely used in the diagnosis of  degenerative pathology of the lumbar spine, but the relationship  between clinical manifestations of lumbar stenosis and its anatomical prerequisites has not been sufficiently studied to date.The objective: to determine the significance of the morphometric  parameters of lumbar stenosis according to CT scans and to  establish their relationship with the prevailing symptoms of the disease.Material and methods. Seventy-five consecutive patients with  clinically significant lumbar stenosis who underwent CT scan before  surgery were enrolled in this study. The average values of thirteen  different morphometric parameters were calculated at LIII–SI levels of the intervertebral discs and of the pedicels in the axial and sagittal views. The possibility of classification of clinical observations and the correlation of morphometric parameters with the clinical forms of lumbar stenosis were investigated using discriminant and logistic regression analysis. Results. CT scan with high probability allocates patients with  predominant symptoms of neurogenic claudication or bilateral  radiculopathy. The most significant morphometric predictors of this  clinical group are the depth of the lateral recesses and the cross-sectional area of the spinal canal.Conclusion. CT scan significantly expands the informative value of  magnetic resonance imaging and can be used in planning the  decompressive stage of the surgery intervention in patients with lumbar spinal canal stenosis.

scholarly journals Gravity determines the direction of nerve roots sedimentation in the lumbar spinal canal

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jun Yang ◽  
Zhiyun Feng ◽  
Nian Chen ◽  
Zhenhua Hong ◽  
Yongyu Zheng ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Mr Imaging ◽  
Spinal Canal ◽  
Ventral Side ◽  
Lateral Position ◽  
Dorsal Side ◽  
Mr Images ◽  
Nerve Roots ◽  
Cross Sectional ◽  
Dural Sac

Abstract Objectives To investigate the role of gravity in the sedimentation of lumbar spine nerve roots using magnetic resonance (MR) imaging of various body positions. Methods A total of 56 patients, who suffered from back pain and underwent conventional supine lumbar spine MR imaging, were selected from sanmen hospital database. All the patients were called back to our hospital to perform MR imaging in prone position or lateral position. Furthermore, the sedimentation sign (SedSign) was determined based on the suspension of the nerve roots in the dural sac on cross-sectional MR images, and 31 cases were rated as positive and another 25 cases were negative. Results The mean age of negative SedSign group was significantly younger than that of positive SedSign group (51.7 ± 8.7 vs 68.4 ± 10.5, P < 0.05). The constitutions of clinical diagnosis were significantly different between patients with a positive SedSign and those with a negative SedSign (P < 0.001). Overall, nerve roots of the vast majority of patients (48/56, 85.7%) subsided to the ventral side of the dural sac on the prone MR images, although that of 8 (14.3%) patients remain stay in the dorsal side of dural sac. Nerve roots of only one patient with negative SedSign did not settle to the ventral dural sac, while this phenomenon occurred in 7 patients in positive SedSign group (4% vs 22.6%, P < 0.001). In addition, the nerve roots of all the five patients subsided to the left side of dural sac on lateral position MR images. Conclusions The nerve roots sedimentation followed the direction of gravity. Positive SedSign may be a MR sign of lumbar pathology involved the spinal canal.

The profile of the spinal column in subjects with lumbar developmental spinal stenosis

2021 ◽  
Vol 103-B (4) ◽  
pp. 725-733
Author(s):  
Marcus Kin Long Lai ◽  
Prudence Wing Hang Cheung ◽  
Dino Samartzis ◽  
Jaro Karppinen ◽  
Kenneth M. C. Cheung ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Spinal Stenosis ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Facet Joint ◽  
Spinal Column ◽  
Stepwise Logistic Regression ◽  
Diagnostic Study ◽  
Vertebral Canal ◽  
Dural Sac

Aims The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort. Methods This was a radiological analysis of 2,387 participants who underwent L1-S1 MRI. Means and ranges were calculated for age, sex, BMI, and MRI measurements. Anteroposterior (AP) vertebral canal diameters were used to differentiate those with DSS from controls. Other imaging parameters included vertebral body dimensions, spinal canal dimensions, disc degeneration scores, and facet joint orientation. Mann-Whitney U and chi-squared tests were conducted to search for measurement differences between those with DSS and controls. In order to identify possible associations between DSS and MRI parameters, those who were statistically significant in the univariate binary logistic regression were included in a multivariate stepwise logistic regression after adjusting for demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported where appropriate. Results Axial AP vertebral canal diameter (p < 0.001), interpedicular distance (p < 0.001), AP dural sac diameter (p < 0.001), lamina angle (p < 0.001), and sagittal mid-vertebral body height (p < 0.001) were significantly different between those identified as having DSS and controls. Narrower interpedicular distance (OR 0.745 (95% CI 0.618 to 0.900); p = 0.002) and AP dural sac diameter (OR 0.506 (95% CI 0.400 to 0.641); p < 0.001) were associated with DSS. Lamina angle (OR 1.127 (95% CI 1.045 to 1.214); p = 0.002) and right facet joint angulation (OR 0.022 (95% CI 0.002 to 0.247); p = 0.002) were also associated with DSS. No association was observed between disc parameters and DSS. Conclusion From this large-scale cohort, the canal size is found to be independent of body stature. Other than spinal canal dimensions, abnormal orientations of lamina angle and facet joint angulation may also be a result of developmental variations, leading to increased likelihood of DSS. Other skeletal parameters are spared. There was no relationship between DSS and soft tissue changes of the spinal column, which suggests that DSS is a unique result of bony maldevelopment. These findings require validation in other ethnicities and populations. Level of Evidence: I (diagnostic study) Cite this article: Bone Joint J 2021;103-B(4):725–733.

scholarly journals Molecular Genetic Studies of Intraoperative Ligamentum Flavum Bioptates of Patients with Spinal Canal Stenosis

2021 ◽  
Vol 5 (6) ◽  
pp. 144-150
Author(s):  
L. V. Rodionova ◽  
L. G. Samoilova ◽  
S. L. Bogorodskaya ◽  
V. G. Gorokhova ◽  
V. A. Sorokovikov
Keyword(s):  
Spinal Canal ◽  
Ligamentum Flavum ◽  
Molecular Genetic ◽  
Spinal Canal Stenosis ◽  
Genetic Studies ◽  
Canal Stenosis

scholarly journals Axial loading during MRI reveals insufficient effect of percutaneous interspinous implants (Aperius™ PerCLID™) on spinal canal area

2019 ◽  
Vol 29 (1) ◽  
pp. 122-128 ◽  
Author(s):  
Hrafnhildur Hjaltadottir ◽  
Hanna Hebelka ◽  
Caroline Molinder ◽  
Helena Brisby ◽  
Adad Baranto
Keyword(s):  
Spinal Canal ◽  
Axial Loading ◽  
Adjacent Level ◽  
Cross Sectional ◽  
Beneficial Effects ◽  
Dural Sac ◽  
Interspinous Implants ◽  
Significant Difference ◽  
Interspinous Process Device ◽  
Lumbar Spinal

Abstract Purpose To evaluate the effect on the spinal canal at the treated and adjacent level(s), in patients treated for lumbar spinal stenosis (LSS) with percutaneous interspinous process device (IPD) Aperius™ or open decompressive surgery (ODS), using axial loading of the spine during MRI (alMRI). Materials Nineteen LSS patients (mean age 67 years, range 49–78) treated with IPDs in 29 spine levels and 13 LSS patients (mean age 63 years, range 46–76) operated with ODS in 22 spine levels were examined with alMRI pre- and 3 months postoperatively. Radiological effects were evaluated by measuring the dural sac cross-sectional area (DSCSA) and by morphological grading of nerve root affection. Results For the IPD group, no DSCSA increase was observed at the operated level (p = 0.42); however, a decrease was observed in adjacent levels (p = 0.05). No effect was seen regarding morphological grading (operated level: p = 0.71/adjacent level: p = 0.94). For the ODS group, beneficial effects were seen for the operated level, both regarding DSCSA (p < 0.001) and for morphological grading (p < 0.0001). No changes were seen for adjacent levels (DSCSA; p = 0.47/morphological grading: p = 0.95). Postoperatively, a significant difference between the groups existed at the operated level regarding both evaluated parameters (p < 0.003). Conclusions With the spine imaged in an axial loaded position, no significant radiological effects of an IPD could be detected postoperatively at the treated level, while increased DSCSA was displayed for the ODS group. In addition, reduced DSCSA in adjacent levels was detected for the IPD group. Thus, the beneficial effects of IPD implants on the spinal canal must be questioned. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

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