Role of Epiligament in Ligamentum Flavum Hypertrophy in Patients  with Lumbar Spinal Canal Stenosis:a Pilot Study

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  • Sato Nori
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Higashino Kosaku
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Sakai Toshinori
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Terai Tomoya
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Goel Vijay K.
    ECORE, Department of Bioengineering and Orthopedic Surgery, University of Toledo
  • Biyani Ashok
    ECORE, Department of Bioengineering and Orthopedic Surgery, University of Toledo
  • Ebraheim Nabil
    ECORE, Department of Bioengineering and Orthopedic Surgery, University of Toledo
  • Takata Yoichiro
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Hayashi Fumio
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Yamashita Kazuta
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Morimoto Masatoshi
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Manabe Hiroaki
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Sairyo Koichi
    Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School

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<p>Ligamentum flavum (LF) hypertrophy is one of the main factors of lumbar spinal canal stenosis (LSCS). The primary object of this study is to clarify the existence of epiligament in the LF and its role in hypertrophy, and to develop an LF hypertrophy animal model. A cadaveric spine from a 30‐year‐old man was used to investigate the existence of epiligament in LF. Five LF samples from LSCS patients were obtained to evaluate hypertrophied LF. To create a rat model, we destabilized the lumbar spine. Each LF was sagittally cut for histological evaluation. The epiligament was clearly evident in normal LF specimens, which stained pink on Elastica van Gieson and green on Masson Trichrome. One layer was observed on the dural side and another on the dorsal side of the LF. LSCS patients had an enlarged dorsal epiligament, at around 30 times that of the regular thin epiligament on the dural side. The destabilized rat model showed an enlarged dorsal epiligament, with a mean thickness 8‐fold that of the control. LF hypertrophy may be due to enlargement of the dorsal epiligament. Mechanical loading of the LF is an important factor for inducing hypertrophy in the rat model. J. Med. Invest. 65:85‐89, February, 2018</p>

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