Correlation between Vertebral Slippage in Spondylolisthesis with Ligamentum Flavum Thickening in Dr. Soebandi Hospital, Jember, East Java, Indonesia
Heni Fatmawati, Alvin Candra, Nindya Shinta Rumastika, Al Munawir, Muhamad Hasan, I Nyoman Semita
Abstract
Background: Spondylolisthesis is a vertebral slip condition that compromises the body’s axial alignment and structures such as ligamentum flavum. The ligamentum flavum thickening may play a role in spondylolisthesis. The purpose of this study was to investigate the correlation between the slippage of vertebral body (spondylolisthesis) with ligamentum flavum thickening as a tissue response regarding increased mechanical stress.
Methods: An analytical retrospective radiological observational was used a cross-sectional study from the results of MRI examination in Dr. Soebandi Hospital, Jember, Indonesia, collected from 2018-2021 using the simple random sampling method. Ligamentum flavum thickness and the degree of vertebral slip were measured using T2-weighted MR imaging and the correlation was analyzed using Fisher’s exact test.
Results: Of 102 spondylolisthesis data records, 34 were taken, being female was the most prevalent cases in the age group above 60 years, with the most vertebral segment shift occurring at the L4–L5 level. There was a significant correlation. (p = 0.02; RR = 4.8) between ligamentum flavum thickening and vertebral slip in spondylolisthesis.
Conclusion: The significant correlation between ligamentum flavum thickening and vertebral slip in spondylolisthesis suggest that mechanical stress has caused spondylolisthesis, by inducing chronic inflammation that results in hypertrophy of ligamentum flavum. Lumbar segmental instability due to spondylolisthesis is a factor contributing to the development of ligamentum flavum hypertrophy.
Keywords
Ligamentum flavum thickening, magnetic resonance imaging, spondylolisthesis
Kolte VS, Khambatta S, Ambiye MV. Thickness of the ligamentum flavum: Correlation with age and its asymmetry-an magnetic resonance imaging study. Asian Spine J. 2015;9(2):245–53.
Moon HJ, Park YK, Ryu Y, Kim JH, Kwon TH, Chung HS, et al. The angiogenic capacity from ligamentum flavum subsequent to inflammation: A critical component of the pathomechanism of hypertrophy. Spine (Phila Pa 1976). 2012;37(3):E147–55.
George KM, Hernandez NS, Breton J, Cooper B, Dowd RS, Nail J, et al. Increased thickness of lumbar spine ligamentum flavum in wild-type transthyretin amyloidosis. J Clin Neurosci. 2021;84:33–7.
4. Sun C, Zhang H, Wang X, Liu X. Ligamentum flavum fibrosis and hypertrophy: Molecular pathways, cellular mechanisms, and future directions. FASEB J. 2020;34(8):9854–68.
Jezek J, Sepitka J, Daniel M, Kujal P, Blankova A, Waldauf P, et al. The role of vascularization on changes in ligamentum flavum mechanical properties and development of hypertrophy in patients with lumbar spinal stenosis. Spine J. 2020;20(7):1125–33.
Kundakci YE, Unver Dogan N, Guler I, Uysal II, Fazliogullari Z, Karabulut AK. Evaluation of the facet joints with magnetic resonance images in the patients with disc degeneration and spondylolisthesis. Surg Radiol Anat. 2018;40(9):1063–75.
Berven S, Wadhwa R. Sagittal alignment of the lumbar spine. Neurosurg Clin N Am. 2018;29(3):331–9.
Câmara JR, Keen JR, Asgarzadie F. Functional radiography in examination of spondylolisthesis. AJR Am J Roentgenol. 2015;204(4):W461–9.
Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis: definition, natural history, conservative management, and surgical treatment. Neurosurg Clin N Am. 2019;30(3):299–304.
Hansen BB, Nordberg CL, Hansen P, Bliddal H, Griffith JF, Fournier G, et al. Weight-bearing MRI of the Lumbar Spine: Spinal Stenosis and Spondylolisthesis. Semin Musculoskelet Radiol. 2019;23(6):621–33.
Park JH, Kim KW, Youn Y, Kim H, Chung WS, Song MY, et al. Association of MRI-defined lumbar paraspinal muscle mass and slip percentage in degenerative and isthmic spondylolisthesis: A multicenter, retrospective, observational study. Medicine (Baltimore). 2019;98(49):e18157.
Ramamurthi R, Narain Tandon P. Ramamurthi and Tandon’s textbook of neurosurgery. 3rd ed. New Delhi: Jaypee Brothers Medical Publishers; 2012.
Blom A, Warwick D, Whitehouse MR, editors.. Apley and Solomon’s system of orthopaedics and trauma. 10th Ed. Florida: CRC Press; 2018.
Crawford NR, Baek S, Sawa AGU, Safavi-Abbasi S, Sonntag VKH, Duggal N. Biomechanics of a fixed-center of rotation cervical intervertebral disc prosthesis. Int J Spine Surg. 2012;6:34–42.
Chen J, Liu Z, Zhong G, Qian L, Li Z, Qiao Z, et al. Hypertrophy of ligamentum flavum in lumbar spine stenosis is associated with increased miR-155 level. Dis Markers. 2014;2014:786543.
De Decker S, Da Costa RC, Volk HA, Van Ham LML. Current insights and controversies in the pathogenesis and diagnosis of disc-associated cervical spondylomyelopathy in dogs. Vet Rec. 2012;171(21):531–7.
Hirabayashi S. Ossification of the ligamentum flavum. Spine Surg Relat Res. 2017;1(4):158–63.
