Thickness of the ligamentum flavum: correlation with age, sex, side, spinal level and degenerative disc disease
DOI:
https://doi.org/10.18203/2320-6012.ijrms20250253Keywords:
Age, Degenerative disc disease, Ligamentum flavum thickness, Sex, Side, Spinal levelAbstract
Background: Few researchers have studied thickness at different spinal levels and compared with age, sex, side, spinal level and relationship with degenerative disc disease. However, there is no literature pertaining to the study of LF thickness correlation with all these five parameters in single study. Here, we determined the correlation of dorsal and lumbar spine LF thickness with age, sex, side asymmetry, at different spinal levels and relation with degenerative disc disease (DDD) using magnetic resonance imaging (MRI).
Methods: LF thickness was measured retrospectively at all dorsal and lumbar spinal levels (T1 to S1 level) on both sides in MRI scans of 200 individuals attending Shree Narayana Hospital, Raipur, Chhattisgarh from 1st July 2023 to 30th June 2024. On axial T2-weighted MRI at the mid-disc level, LF thickness was measured perpendicular to the lamina border, either at half the length of LF or at maximum thickness, whichever was greater.
Results: All results were collected in tabular form. All individuals were divided into three age groups- 21to 40 years,41 to 60 years, 61 to 80 years. LF thickness increase significantly with increasing age, but there was no side or sex dominance. LF thickening has a predominant tendency to occur specifically at the T10-T11 and L4-L5 levels and was significantly more in those having associated degenerative disc disease.
Conclusions: LF thickness does not appear to have any side or sex dominance but increase significantly with increasing age. Also, LF thickness have significant correlation with spinal levels. LF thickness was significantly higher in those having associated degenerative disc disease.
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References
Sinnatamby CS, Last RJ. Last’s anatomy regional and applied. 12th edn. Edinburgh: Churchill Livingstone/Elsevier; 2011
2. Safak AA, Is M, Sevinc O, et al. The thickness of the ligamentum flavum in relation to age and gender. Clin Anat. 2010;23:79-83. DOI: https://doi.org/10.1002/ca.20883
Liu LM, Song YM, Gong Q. Treatment of lumbar stenosis and root pain resulting from simple hypertrophy of lumbar ligamentum flavum. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2003;17:50-1.
Okuda T, Fujimoto Y, Tanaka N, Ishida O, Baba I, Ochi M. Morphological changes of the ligamentum flavum as a cause of nerve root compression. Eur Spine J. 2005;14:277-86. DOI: https://doi.org/10.1007/s00586-004-0782-5
Alvarez JA, Hardy RH Jr. Lumbar spine stenosis: a common cause of back and leg pain. Am Fam Phys. 1998;57:1825-40.
Brown HA. Enlargement of the ligamentum flavum. J Bone Joint Surg Am. 1938;20:325-38.
Spurling R, Mayfield FH, Rogers JB. Hypertrophy of the ligamenta flava as a cause of low back pain. JAMA. 1937;109:928-33. DOI: https://doi.org/10.1001/jama.1937.02780380012004
Horwitz T. Lesions of the intervertebral disk and ligamentum flavum of the lumbar vertebrae. Surgery. 1939;6:410-25.
Ramani PS, Perry RH, Tomlinson BE. Role of ligamentum flavum in the symptomatology of prolapsed lumbar intervertebral discs. J Neurol Neurosurg Psychiatr. 1975;38:550-7. DOI: https://doi.org/10.1136/jnnp.38.6.550
Sairyo K, Biyani A, Goel V, Leaman D, Booth Jr R, Thomas J, et al. Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments. Spine. 2005;30(23):2649-56. DOI: https://doi.org/10.1097/01.brs.0000188117.77657.ee
Sakamaki T, Sairyo K, Sakai T, Tamura T, Okada Y, Mikami H. Measurements of ligamentum flavum thickening at lumbar spine using MRI. Arch Orthop Trauma Surg. 2009;129:1415-9. DOI: https://doi.org/10.1007/s00402-009-0849-1
Abbas J, Hamoud K, Masharawi YM, May H, Hay O, Medlej B, et al. Ligamentum flavum thickness in normal and stenotic lumbar spines. Spine. 2010;35(12):1225-30. DOI: https://doi.org/10.1097/BRS.0b013e3181bfca15
Altinkaya N, Yildirim T, Demir S, Alkan O, Sarica FB. Factors associated with the thickness of the ligamentum flavum: is ligamentum flavum thickening due to hypertrophy or buckling? Spine. 2011;36:E1093-7. DOI: https://doi.org/10.1097/BRS.0b013e318203e2b5
Twomey L, Taylor J. Age changes in the lumbar spinal and intervertebral canals. Paraplegia. 1988;26:238-49. DOI: https://doi.org/10.1038/sc.1988.37
Fukuyama S, Nakamura T, Ikeda T, Takagi K. The effect of mechanical stress on hypertrophy of the lumbar ligamentum flavum. J Spinal Disord. 1995;8:126-30. DOI: https://doi.org/10.1097/00002517-199504000-00006
Abdel-Meguid EM. An anatomical study of the human lumbar ligamentum flavum. Neurosciences. 2008;13:11-6.
Chokshi FH, Quencer RM, Smoker WR. The “thickened” ligamentum flavum: is it buckling or enlargement? AJNR Am J Neuroradiol. 2010;31:1813-6. DOI: https://doi.org/10.3174/ajnr.A2241
Park JB, Chang H, Lee JK. Quantitative analysis of transforming growth factor-beta 1 in ligamentum flavum of lumbar spinal stenosis and disc herniation. Spine. 2001;26:E492-5. DOI: https://doi.org/10.1097/00007632-200111010-00007
Grenier N, Kressel HY, Schiebler ML, Grossman RI, Dalinka MK. Normal and degenerative posterior spinal structures: MR imaging. Radiology. 1987;165:517-25. DOI: https://doi.org/10.1148/radiology.165.2.3659376