Pathomechanism of Ligamentum Flavum Hypertrophy: A Multidisciplinary Investigation Based on Clinical, Biomechanical, Histologic, and Biologic Assessments

  title={Pathomechanism of Ligamentum Flavum Hypertrophy: A Multidisciplinary Investigation Based on Clinical, Biomechanical, Histologic, and Biologic Assessments},
  author={Koichi Sairyo and Ashok Biyani and Vijay K. Goel and Douglas W. Leaman and Robert E. Booth and Jean Thomas and Daniel J Gehling and L. Vishnubhotla and Rebecca Long and Nabil A Ebraheim},
Study Design. A multidisciplinary study involving clinical, histologic, biomechanical, biologic, and immunohistologic approaches. Objective. To clarify the pathomechanism of hypertrophy of the ligamentum flavum. Summary of Background Data. The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain, and paresis. Canal narrowing, in part, results from hypertrophy of the ligamentum flavum. Although histologic and biologic literature on this… 

Pathomechanism of Loss of Elasticity and Hypertrophy of Lumbar Ligamentum Flavum in Elderly Patients With Lumbar Spinal Canal Stenosis

Investigation of the pathomechanism of loss of elasticity and hypertrophy of the lumbar ligamentum flavum (LF) in the elderly population found decreased elasticity is due to the Loss of elastic fibers and a concomitant increase of collagenous fibers in the dorsal aspect and this could be due to a thickening of the normal elastic layer as well as of the abnormal collagenous layer.

Chondrogenic and Fibrotic Process in the Ligamentum Flavum of Patients With Lumbar Spinal Canal Stenosis

Synthesis of the collagenous fibers and degradation of the elastic and collagenous fiber are both accelerated in the ligamentum flavum of patient with LSCS, which may be the reason for hypertrophy of the tissue.

Lumbar Ligamentum Flavum Hypertrophy Is Due to Accumulation of Inflammation-Related Scar Tissue

It is proposed that the hypertrophy of the ligamentum flavum is caused by accumulation of inflammation-related scar tissue, and it might be possible to prevent the hyperTrophy of ligamentu flavum with antiinflammatory drugs.

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

Although the LFT and LFA were both significantly associated with LCSS, the LFA was a more sensitive measurement parameter, and to evaluate LCSS patients, the treating doctor should more carefully analyze the L FA than LFT.

Clinical outcome of lumbar spinal stenosis based on new classification according to hypertrophied ligamentum flavum.

Analysis of the Relationship between Hypertrophy of the Ligamentum Flavum and Lumbar Segmental Motion with Aging Process

Age-related increases in disc degeneration, combined with continuous lumbar segmental flexion-extension motion, leads to the development of LF hypertrophy.


In elderly patients, LF hypertrophy was correlated with age, LSCS, spinal level, and disc degeneration, and not with disc herniation and gender.

Factors Associated With the Thickness of the Ligamentum Flavum: Is Ligamentum Flavum Thickening Due to Hypertrophy or Buckling?

Thickening of the LF is correlated with disc degeneration, aging, BMI, LSS, spinal level, and disc herniation and is concluded that thickening ofThe LF is due to buckling of the LF into the spinal canal secondary to disc degenerations more than to LF hypertrophy.

Morphological Changes in the Ligamentum Flavum in Degenerative Lumbar Canal Stenosis: A Prospective, Comparative Study

Characteristic morphological changes may be noted on histopathological and electron microscopic examination that mark the degenerative changes in the LF that contribute to the occurrence and pathogenesis of degenerative LCS.



The Pathology of Ligamentum Flavum in Degenerative Lumbar Disease

Various pathologic findings provided important foundations for discussing the pathogenesis of lesions in ligamentum flavum, and calcification was frequently observed in elderly patients and those with cauda equina symptoms, and these patients tended to have severer preoperative symptoms.

Hypertrophied Ligamentum Flavum in Lumbar Spinal Canal Stenosis: Pathogenesis and Morphologic and Immunohistochemical Observation

It is stressed that marked proliferation of Type II collagen from the enthesis to the ligament side was revealed in the capsular portion of the hypertophied ligament.

Histology of the ligamentum flavum in patients with degenerative lumbar spinal stenosis

The results of this study illustrate the important role of histological changes of the ligamentum flavum for the aetiology of lumbar spinal stenosis.

Ligamenta Flava in Lumbar Disc Herniation and Spinal Stenosis: Light and Electron Microscopic Morphology

The ligamenta flava from patients with lumbar stenosis showed areas of fibrosis in which the cells were often represented by actively synthesizing fibroblests and areas of chondroid metaplasia, which are similar to those of the controls of similar ages.

MRI Signal Changes of the Pedicle as an Indicator for Early Diagnosis of Spondylolysis in Children and Adolescents: A Clinical and Biomechanical Study

The correlation between the high stresses in the pedicle and the corresponding HSC suggest that signal changes in MRI could be used as an indicator for early diagnosis of spondylolysis.

Quantitative Analysis of Transforming Growth Factor-Beta 1 in Ligamentum Flavum of Lumbar Spinal Stenosis and Disc Herniation

The current results suggest that higher expression of TGF-&bgr;1 by fibroblasts might be related to the development of hypertrophy of the ligamentum flavum in lumbar spinal stenosis.

Hypertrophied ligamentum flavum. Clinical and surgical significance.

The ligamentum flavum seems to be the major cause of root compression in a limited number of patients and the surgical therapy recommended is a total laminectomy with wide resection of the ligamentu flavum and complete disk removal when indicated.

Athletes with Unilateral Spondylolysis are at Risk of Stress Fracture at the Contralateral Pedicle and Pars Interarticularis: A Clinical and Biomechanical Study

Surgeons should be aware of possibility of contralateral stress fractures in cases in which patients, especially athletes engaged in active sports, show unilateral spondylolysis and persistent low back pain complaints.

Biomechanical rationale of endoscopic decompression for lumbar spondylolysis as an effective minimally invasive procedure - a study based on the finite element analysis.

Endoscopic decompression of the spondylolysis, as a minimally invasive surgery, does not alert mechanical stability by itself, and the results indicate that the Gill's procedure may lead to an increase in intradiscal pressure (IDP) and other biomechanical parameters after the surgery during flexion, whereas the endoscope did not change the segment mechanics after the Surgery.