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Significance of body mass index on thoracic ossification of the ligamentum flavum in Chinese population

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Abstract

Purpose

To investigate the risk factors for thoracic ossification of the ligamentum flavum (TOLF), especially the relationship between BMI and TOLF.

Methods

A total of 856 individuals consisting of 326 controls without ossification of spinal ligaments and 530 TOLF inpatients who underwent thoracic spine decompression surgery at our hospital between January 2013 and September 2020 were included. All subjects were classified into 4 grades: Grade 0) control; Grade 1) single-segment TOLF; Grade 2) multi-segment TOLF; and Grade 3) TOLF combined thoracic ossification of the posterior longitudinal ligament (T-OPLL). Logistic regression analysis was performed to identify the risk factors for TOLF. The TOLF index was calculated to assess the severity of TOLF, and its relationship with BMI was investigated by correlation analysis.

Results

Overall, TOLF patients are most numerous in the 50–59 age group. Age and gender were considered as independent risk factors for Grades 1 and 2. BMI was identified as an independent risk factor for TOLF. Furthermore, BMI was significantly higher in Grade 1 (26.1 VS 24.5 kg/m2, P = 0.0001), Grade 2 (28.2 VS 24.5 kg/m2, P < 0.0001), and Grade 3 (29.1 VS 24.5 kg/m2, P < 0.0001) than Grade 0. Notably, in TOLF patients without combined T-OPLL, BMI was positively correlated with TOLF index, while BMI was negatively correlated with age in younger individuals.

Conclusion

BMI is a crucial risk factor for TOLF. It highlights the necessity of close follow-up of asymptomatic TOLF patients with high BMI to detect and treat their TOLF progression promptly.

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References

  1. Chen ZQ, Sun CG (2015) Clinical guideline for treatment of symptomatic thoracic spinal stenosis. Orthop Surg 7:208–212. https://doi.org/10.1111/os.12190

    Article  Google Scholar 

  2. Xu N, Yu M, Liu X, Sun C, Chen Z, Liu Z (2017) A systematic review of complications in thoracic spine surgery for ossification of the posterior longitudinal ligament. European Spine J : Off Publ European Spine Soc, European Spinal Deformity Soc, European Sec Cerv Spine Res Soc 26:1803–1809. https://doi.org/10.1007/s00586-015-4097-5

    Article  Google Scholar 

  3. Aizawa T, Sato T, Tanaka Y, Ozawa H, Hoshikawa T, Ishii Y, Morozumi N, Ishibashi K, Kasama F, Hyodo H, Murakami E, Nishihira T, Kokubun S (2006) Thoracic myelopathy in Japan: epidemiological retrospective study in Miyagi prefecture during 15 years. Tohoku J Exp Med 210:199–208. https://doi.org/10.1620/tjem.210.199

    Article  Google Scholar 

  4. Guo JJ, Luk KD, Karppinen J, Yang H, Cheung KM (2010) Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine 35:51–56. https://doi.org/10.1097/BRS.0b013e3181b3f779

    Article  CAS  Google Scholar 

  5. Kudo S, Ono M, Russell WJ (1983) Ossification of thoracic ligamenta flava. AJR Am J Roentgenol 141:117–121. https://doi.org/10.2214/ajr.141.1.117

    Article  CAS  Google Scholar 

  6. Lang N, Yuan HS, Wang HL, Liao J, Li M, Guo FX, Shi S, Chen ZQ (2013) Epidemiological survey of ossification of the ligamentum flavum in thoracic spine: CT imaging observation of 993 cases. European Spine J: Off Publ European Spine Soc, European Spinal Deformity Soc European Sect Cerv Spine Res Soc 22:857–862. https://doi.org/10.1007/s00586-012-2492-8

    Article  Google Scholar 

  7. Qu X, Hou X, Chen Z, Chen G, Fan T, Yang X (2021) Association analysis and functional study of COL6A1 single nucleotide polymorphisms in thoracic ossification of the ligamentum flavum in the Chinese Han population. European Spine J: Off Publ European Spine Soc, European Spinal Deformity Soc European Sect Cerv Spine Res Soc. https://doi.org/10.1007/s00586-021-06932-y

    Article  Google Scholar 

  8. Qu X, Chen Z, Fan D, Xiang S, Sun C, Zeng Y, Li W, Guo Z, Qi Q, Zhong W, Jiang Y (2017) Two novel BMP-2 variants identified in patients with thoracic ossification of the ligamentum flavum. European J Human Genetics : EJHG 25:565–571. https://doi.org/10.1038/ejhg.2017.2

    Article  CAS  Google Scholar 

  9. Liu Y, Zhao Y, Chen Y, Shi G, Yuan W (2010) RUNX2 polymorphisms associated with OPLL and OLF in the Han population. Clin Orthop Relat Res 468:3333–3341. https://doi.org/10.1007/s11999-010-1511-5

    Article  Google Scholar 

  10. Kong Q, Ma X, Li F, Guo Z, Qi Q, Li W, Yuan H, Wang Z, Chen Z (2007) COL6A1 polymorphisms associated with ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament. Spine 32:2834–2838. https://doi.org/10.1097/BRS.0b013e31815b761c

    Article  Google Scholar 

  11. Liang H, Liu G, Lu S, Chen S, Jiang D, Shi H, Fei Q (2019) Epidemiology of ossification of the spinal ligaments and associated factors in the Chinese population: a cross-sectional study of 2000 consecutive individuals. BMC Musculoskelet Disord 20:253. https://doi.org/10.1186/s12891-019-2569-1

    Article  Google Scholar 

  12. Hou X, Sun C, Liu X, Liu Z, Qi Q, Guo Z, Li W, Zeng Y, Chen Z (2016) Clinical features of thoracic spinal stenosis-associated myelopathy: a retrospective analysis of 427 Cases. Clinic Spine Surg 29:86–89. https://doi.org/10.1097/bsd.0000000000000081

    Article  Google Scholar 

  13. Fan D, Chen Z, Chen Y, Shang Y (2007) Mechanistic roles of leptin in osteogenic stimulation in thoracic ligament flavum cells. J Biol Chem 282:29958–29966. https://doi.org/10.1074/jbc.M611779200

    Article  CAS  Google Scholar 

  14. Shi YC, Baldock PA (2012) Central and peripheral mechanisms of the NPY system in the regulation of bone and adipose tissue. Bone 50:430–436. https://doi.org/10.1016/j.bone.2011.10.001

    Article  CAS  Google Scholar 

  15. Endo T, Koike Y, Hisada Y, Fujita R, Suzuki R, Tanaka M, Tsujimoto T, Shimamura Y, Hasegawa Y, Kanayama M, Yamada K, Iwata A, Sudo H, Ishii M, Iwasaki N, Takahata M (2021) Aggravation of ossified ligamentum flavum lesion is associated with the degree of obesity. Global Spine J. https://doi.org/10.1177/21925682211031514

    Article  Google Scholar 

  16. Kawaguchi Y, Nakano M, Yasuda T, Seki S, Hori T, Kimura T (2013) Ossification of the posterior longitudinal ligament in not only the cervical spine, but also other spinal regions: analysis using multidetector computed tomography of the whole spine. Spine 38:E1477-1482. https://doi.org/10.1097/BRS.0b013e3182a54f00

    Article  Google Scholar 

  17. Ahn DK, Lee S, Moon SH, Boo KH, Chang BK, Lee JI (2014) Ossification of the ligamentum flavum. Asian spine journal 8:89–96. https://doi.org/10.4184/asj.2014.8.1.89

    Article  Google Scholar 

  18. Chen G, Fan T, Yang X, Sun C, Fan D, Chen Z (2020) The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review. European Spine J: Off Publ European Spine Soc European Spinal Deformity Soc, European Sect Cerv Spine Res Soc 29:2164–2172. https://doi.org/10.1007/s00586-020-06520-6

    Article  Google Scholar 

  19. Hou X, Chen Z, Sun C, Zhang G, Wu S, Liu Z (2018) A systematic review of complications in thoracic spine surgery for ossification of ligamentum flavum. Spinal Cord 56:301–307. https://doi.org/10.1038/s41393-017-0040-4

    Article  Google Scholar 

  20. An B, Li XC, Zhou CP, Wang BS, Gao HR, Ma HJ, He Y, Zhou HG, Yang HJ, Qian JX (2019) Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum. European Spine J: Off Publ European Spine Soc European Spinal Deformity Soc European Sect Cervical Spine Res Soc 28:492–501. https://doi.org/10.1007/s00586-018-05866-2

    Article  Google Scholar 

  21. Moon BJ, Kuh SU, Kim S, Kim KS, Cho YE, Chin DK (2015) Prevalence, distribution, and significance of incidental thoracic ossification of the ligamentum flavum in korean patients with back or leg pain : MR-based cross sectional study. J Korean Neurosurg Soc 58:112–118. https://doi.org/10.3340/jkns.2015.58.2.112

    Article  CAS  Google Scholar 

  22. Kim SI, Ha KY, Lee JW, Kim YH (2018) Prevalence and related clinical factors of thoracic ossification of the ligamentum flavum-a computed tomography-based cross-sectional study. Spine J 18:551–557. https://doi.org/10.1016/j.spinee.2017.08.240

    Article  Google Scholar 

  23. He S, Hussain N, Li S, Hou T (2005) Clinical and prognostic analysis of ossified ligamentum flavum in a Chinese population. J Neurosurg Spine 3:348–354. https://doi.org/10.3171/spi.2005.3.5.0348

    Article  Google Scholar 

  24. Aizawa T, Sato T, Sasaki H, Kusakabe T, Morozumi N, Kokubun S (2006) Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. J Neurosurg Spine 5:514–519. https://doi.org/10.3171/spi.2006.5.6.514

    Article  Google Scholar 

  25. Shiokawa K, Hanakita J, Suwa H, Saiki M, Oda M, Kajiwara M (2001) Clinical analysis and prognostic study of ossified ligamentum flavum of the thoracic spine. J Neurosurg 94:221–226. https://doi.org/10.3171/spi.2001.94.2.0221

    Article  CAS  Google Scholar 

  26. Fujimori T, Watabe T, Iwamoto Y, Hamada S, Iwasaki M, Oda T (2016) Prevalence, concomitance, and distribution of ossification of the spinal ligaments: results of whole spine CT scans in 1500 Japanese patients. Spine 41:1668–1676. https://doi.org/10.1097/brs.0000000000001643

    Article  Google Scholar 

  27. Endo T, Takahata M, Koike Y, Fujita R, Suzuki R, Hisada Y, Hasegawa Y, Suzuki H, Yamada K, Iwata A, Sudo H, Yoneoka D, Iwasaki N (2022) Association between obesity and ossification of spinal ligaments in 622 asymptomatic subjects: a cross-sectional study. J Bone Miner Metab 40:337–347. https://doi.org/10.1007/s00774-021-01292-5

    Article  Google Scholar 

  28. Endo T, Takahata M, Koike Y, Iwasaki N (2020) Clinical characteristics of patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament. J Bone Miner Metab 38:63–69. https://doi.org/10.1007/s00774-019-01026-8

    Article  Google Scholar 

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Funding

Funding was provided by National Natural Science Foundation of China (82172480).

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Author notes

  1. Jialiang Lin and Fei Xu have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China

    Jialiang Lin, Fei Xu, Shuai Jiang, Longjie Wang, Zhuoran Sun, Zhongqiang Chen, Zhaoqing Guo, Qiang Qi, Yan Zeng, Chuiguo Sun & Weishi Li

  2. Beijing Key Laboratory of Spinal Disease Research, Beijing, China

    Jialiang Lin, Fei Xu, Shuai Jiang, Longjie Wang, Zhuoran Sun, Zhongqiang Chen, Zhaoqing Guo, Qiang Qi, Yan Zeng, Chuiguo Sun & Weishi Li

  3. Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China

    Jialiang Lin, Fei Xu, Shuai Jiang, Longjie Wang, Zhuoran Sun, Zhongqiang Chen, Zhaoqing Guo, Qiang Qi, Yan Zeng, Chuiguo Sun & Weishi Li

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  1. Jialiang Lin
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Lin, J., Xu, F., Jiang, S. et al. Significance of body mass index on thoracic ossification of the ligamentum flavum in Chinese population. Eur Spine J 31, 3308–3315 (2022). https://doi.org/10.1007/s00586-022-07362-0

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