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Article: Prevalence, distribution, and morphology of ossification of the ligamentum flavum: A population study of one thousand seven hundred thirty-six magnetic resonance imaging scans

TitlePrevalence, distribution, and morphology of ossification of the ligamentum flavum: A population study of one thousand seven hundred thirty-six magnetic resonance imaging scans
Authors
KeywordsLigamentum flavum
Ossification
Thoracic stenosis
Yellow ligament
Issue Date2010
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2010, v. 35 n. 1, p. 51-56 How to Cite?
AbstractStudy Design. Large scale, cross-sectional imaging study of a general population. Objective. To evaluate the prevalence, morphology, and distribution of ossification of the ligamentum flavum (OLF) in a population, and synthesize the scientific literature on the prevalence of OLF and some factors associated with its occurrence. Summary of Background Data. OLF is a rare disease in which the pathogenesis has not been conclusively established. Little is known about its epidemiology. To date, there is no study that comprehensively assessed the distribution and prevalence of OLF in the whole spine using magnetic resonance imaging (MRI). Methods. A total of 1736 southern Chinese volunteers (1068 women; 668 men) between 8 and 88 years of age (mean, 38 years) were recruited by open invitation. MRI was administered to all the participants. T2-weighted, 5-mm spin-echo MRI sequences of the whole spine were obtained. Presence of OLF was identified as an area of low signal intensity in the T2 sagittal sequence located in the posterior part of the spinal canal, and subsequently confirmed by computed tomography scans showing areas of ossification within the ligamentum flavum. The distribution of OLF was classified into 3 types: the isolated type, continuous type, and noncontinuous type. While the morphology of the lesion was classified into triangular, round, and beak shapes based on the pattern of ossification on T2-weighted sagittal MRIs. Results. OLF was identified in a total of 66 subjects or 3.8% of the population (52 women and 14 men). In 45(68.2%) cases, OLF was present at a single-level (isolated type), whereas in 21 (31.8%) cases OLF was present at multiple levels. The isolated type was found in 45 (68.2%) cases, continuous type in 11 (16.7%), and noncontinuous type in 10 (15.2%). The most common site of involvement is the lower thoracic spine, but they can also occur in the upper thoracic spine. The majority of the segments had a round morphology (n = 75: 81.5%), while 17 (18.5%) segments were triangular in shape. A literature review of the past 26 years showed only 4 reports on the prevalence of OLF, all were in special patient groups. Conclusion. Case reports have described postoperative paraplegia from failure to identify and decompress all stenotic segments of OLF. This study demonstrated that OLF is not uncommon, and that some 15% of the lesions are noncontinuous, and therefore could be missed. The authors recommend that for patients undergoing surgical decompression for 1 level of OLF, the whole spine should be routinely screened for other stenotic segments. Failure to do so could result in paraplegia from the nondecompressed levels. © 2009, Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/125193
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
Funding AgencyGrant Number
Federal funds
Funding Information:

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

References

 

DC FieldValueLanguage
dc.contributor.authorGuo, JJen_HK
dc.contributor.authorLuk, KDKen_HK
dc.contributor.authorKarppinen, Jen_HK
dc.contributor.authorYang, Hen_HK
dc.contributor.authorCheung, KMCen_HK
dc.date.accessioned2010-10-31T11:16:44Z-
dc.date.available2010-10-31T11:16:44Z-
dc.date.issued2010en_HK
dc.identifier.citationSpine, 2010, v. 35 n. 1, p. 51-56en_HK
dc.identifier.issn0362-2436en_HK
dc.identifier.urihttp://hdl.handle.net/10722/125193-
dc.description.abstractStudy Design. Large scale, cross-sectional imaging study of a general population. Objective. To evaluate the prevalence, morphology, and distribution of ossification of the ligamentum flavum (OLF) in a population, and synthesize the scientific literature on the prevalence of OLF and some factors associated with its occurrence. Summary of Background Data. OLF is a rare disease in which the pathogenesis has not been conclusively established. Little is known about its epidemiology. To date, there is no study that comprehensively assessed the distribution and prevalence of OLF in the whole spine using magnetic resonance imaging (MRI). Methods. A total of 1736 southern Chinese volunteers (1068 women; 668 men) between 8 and 88 years of age (mean, 38 years) were recruited by open invitation. MRI was administered to all the participants. T2-weighted, 5-mm spin-echo MRI sequences of the whole spine were obtained. Presence of OLF was identified as an area of low signal intensity in the T2 sagittal sequence located in the posterior part of the spinal canal, and subsequently confirmed by computed tomography scans showing areas of ossification within the ligamentum flavum. The distribution of OLF was classified into 3 types: the isolated type, continuous type, and noncontinuous type. While the morphology of the lesion was classified into triangular, round, and beak shapes based on the pattern of ossification on T2-weighted sagittal MRIs. Results. OLF was identified in a total of 66 subjects or 3.8% of the population (52 women and 14 men). In 45(68.2%) cases, OLF was present at a single-level (isolated type), whereas in 21 (31.8%) cases OLF was present at multiple levels. The isolated type was found in 45 (68.2%) cases, continuous type in 11 (16.7%), and noncontinuous type in 10 (15.2%). The most common site of involvement is the lower thoracic spine, but they can also occur in the upper thoracic spine. The majority of the segments had a round morphology (n = 75: 81.5%), while 17 (18.5%) segments were triangular in shape. A literature review of the past 26 years showed only 4 reports on the prevalence of OLF, all were in special patient groups. Conclusion. Case reports have described postoperative paraplegia from failure to identify and decompress all stenotic segments of OLF. This study demonstrated that OLF is not uncommon, and that some 15% of the lesions are noncontinuous, and therefore could be missed. The authors recommend that for patients undergoing surgical decompression for 1 level of OLF, the whole spine should be routinely screened for other stenotic segments. Failure to do so could result in paraplegia from the nondecompressed levels. © 2009, Lippincott Williams & Wilkins.en_HK
dc.languageengen_HK
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_HK
dc.relation.ispartofSpineen_HK
dc.rightsThis is a non-final version of an article published in final form in (provide complete journal citation)-
dc.subjectLigamentum flavumen_HK
dc.subjectOssificationen_HK
dc.subjectThoracic stenosisen_HK
dc.subjectYellow ligamenten_HK
dc.subject.meshOssification-
dc.subject.meshLigamentum flavum-
dc.subject.meshYellow ligament-
dc.subject.meshThoracic stenosis-
dc.titlePrevalence, distribution, and morphology of ossification of the ligamentum flavum: A population study of one thousand seven hundred thirty-six magnetic resonance imaging scansen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0362-2436&volume=35&issue=1&spage=51&epage=56&date=2010&atitle=Prevalence,+distribution,+and+morphology+of+ossification+of+the+ligamentum+flavum:+a+population+study+of+one+thousand+seven+hundred+thirty-six+magnetic+resonance+imaging+scansen_HK
dc.identifier.emailLuk, KDK:hcm21000@hku.hken_HK
dc.identifier.emailCheung, KMC:cheungmc@hku.hken_HK
dc.identifier.authorityLuk, KDK=rp00333en_HK
dc.identifier.authorityCheung, KMC=rp00387en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/BRS.0b013e3181b3f779en_HK
dc.identifier.pmid20042956en_HK
dc.identifier.scopuseid_2-s2.0-76149140485en_HK
dc.identifier.hkuros180204en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-76149140485&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume35en_HK
dc.identifier.issue1en_HK
dc.identifier.spage51en_HK
dc.identifier.epage56en_HK
dc.identifier.isiWOS:000274245200009-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridGuo, JJ=35310561000en_HK
dc.identifier.scopusauthoridLuk, KDK=7201921573en_HK
dc.identifier.scopusauthoridKarppinen, J=7004560479en_HK
dc.identifier.scopusauthoridYang, H=8941549700en_HK
dc.identifier.scopusauthoridCheung, KMC=7402406754en_HK

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