title: Analysis of the Relationship between Ligamentum Flavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis.
abstract: METHODS
  Cross-sectional study.
  
  
  OBJECTIVE
  To investigate the relationship between ligamentum flavum (LF) thickening and lumbar segmental instability and disc degeneration and facet joint osteoarthritis.
  
  
  BACKGROUND
  Posterior spinal structures, including LF thickness, play a major role in lumbar spinal canal stenosis pathogenesis. The cause of LF thickening is multifactorial and includes activity level, age, and mechanical stress. LF thickening pathogenesis is unknown.
  
  
  METHODS
  We examined 419 patients who underwent computed tomography (CT) myelography and magnetic resonance imaging after complaints of clinical symptoms. To investigate LF hypertrophy, 57 patients whose lumbar vertebra had normal disc heights at L4-5 were selected to exclude LF buckling as a hypertrophy component. LF thickness, disc space widening angulation in flexion, segmental angulation, presence of a vacuum phenomenon, and lumbar lordosis at T12-S1 were investigated. Disc and facet degeneration were also evaluated. Facet joint orientation was measured via an axial CT scan.
  
  
  RESULTS
  The mean LF thickness in all patients was 4.4±1.0 mm at L4-5. There was a significant correlation between LF thickness and disc degeneration; LF thickness significantly increased with severe disc degeneration and facet joint osteoarthritis. There was a tendency toward increased LF thickness in more sagittalized facet joints than in coronalized facet joints. Logistic regression analysis showed that LF thickening was influenced by segmental angulation and facet joint osteoarthritis. Patient age was associated with LF thickening.
  
  
  CONCLUSIONS
  LF hypertrophy development was associated with segmental instability and severe disc degeneration, severe facet joint osteoarthritis, and a sagittalized facet joint orientation.
authors.affiliation: Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Toyomi
authors.initials: T
authors.lastname: Yoshiiwa
authors.affiliation: Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Notani
authors.affiliation: Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawano
authors.affiliation: Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsumura
keywords: Disc degeneration; Facet orientation; Ligamentum flavum thickness; Lumbar spine