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Diabetes mellitus is associated with increased elastin fiber loss in ligamentum flavum of patients with lumbar spinal canal stenosis: results of a pilot histological study

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Abstract

Purpose

Lumbar spinal canal stenosis (LSCS) is associated with fibrosis, decreased elastin-to-collagen ratio, and hypertrophy of the ligamentum flavum (LF). Diabetes mellitus (DM) is known to cause metabolic disturbances within the extracellular matrix in multiple tissues. These alterations may play a major role in the severity of clinical symptoms of LSCS affecting diabetic patients. We aimed to examine the hypothesis that DM may contribute to the LF changes seen in patients with LSCS.

Methods

The study cohort included 29 patients: 23 with LSCS (10 with DM vs. 13 without DM) as well as six patients with lumbar disc herniation (LDH). Surgical LF specimens were retrieved for histological assessment. Morphologic quantification of confocal microscopy images using fast Fourier transform analysis allowed us to compare anisotropy and elastin fiber orientation between groups.

Results

There was a significant positive correlation between fasting plasma glucose values and degree of elastin degradation (r = 0.36, p = 0.043). The diabetic patients with LSCS showed a significantly greater loss of elastic fibers (2.3 ± 0.9 vs. 1.5 ± 0.55, p = 0.009), although fibrosis was shown to be similar (1.44 ± 0.7 vs. 1.43 ± 0.88, p = 0.98). There was no significant difference in the degree of calcification in the LSCS group between patients with and without diabetes (1.71 vs. 2.05%, p = 0.653). Fiber orientation was found to be less homogenous in the LSCS compared with the LDH group, although not significantly affected by DM.

Conclusions

The present study points to a significant contribution of DM to the loss of elastin fibers that occurs in the LF of patients with LSCS.

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Acknowledgements

The study was supported by a research grant obtained from the research authority at the Rabin Medical Center.

Author information

Author notes

  1. Shemesh Shai, Sidon Eliezer, Ohana Nissim and Benayahu Dafna equally contributed to this study.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Beilinson Campus, Rabin Medical Center, 39 Jabotinsky St., 49100, Petach Tikva, Israel

    Shai Shemesh, Eliezer Sidon, Dimitry Sheinis, Steven Velkes & Nissim Ohana

  2. Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel

    Shai Shemesh, Eliezer Sidon, Dimitry Sheinis, Steven Velkes & Nissim Ohana

  3. Department of Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel

    Efrat Kaisler & Dafna Benayahu

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  1. Shai Shemesh
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All authors have demonstrated (1) substantial contributions to research design, or the acquisition, analysis or interpretation of data; (2) drafting the paper or revising it critically; (3) approval of the submitted and final versions.

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Correspondence to Shai Shemesh.

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Shemesh, S., Sidon, E., Kaisler, E. et al. Diabetes mellitus is associated with increased elastin fiber loss in ligamentum flavum of patients with lumbar spinal canal stenosis: results of a pilot histological study. Eur Spine J 27, 1614–1622 (2018). https://doi.org/10.1007/s00586-017-5315-0

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  • DOI: https://doi.org/10.1007/s00586-017-5315-0

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