Ligamentum flavum: Difference between revisions
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<div class="editorbox"> '''Original Editor ''' - [[User:Rachael Lowe|Rachael Lowe]] | |||
<div class="editorbox"> | |||
'''Original Editor '''- [[User:Rachael Lowe|Rachael Lowe]] | |||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | ||
</div> | |||
== Description == | == Description == | ||
[[Image: | [[Image:Cervical vertebrae lig flavum.png|right|300px]]The ligamenta flavum is a short but thick ligament that connects the laminae of adjacent vertebrae from C2 to S1 and is considered a medial ward continuation of the [[Facet Joints|facet joint]] . It consists of 80% elastin fibres and 20% collagen fibres. This high percentage of elastin fibres gives the ligament it's yellow colour and flexible nature<ref>Nikolai Bogduk. Clinical and Radiological Anatomy of the Lumbar Spine 5th Edition.Churchill Livingstone: Elsevier. Feb 2012.</ref><ref name=":0">Vleeming A ,Mooney V . [https://www.elsevier.com/books/movement-stability-and-lumbopelvic-pain/9780443101786 Movement, Stability & Lumbopelvic Pain 2nd Edition] . Philadelphia.Churchill Livingstone .1st March 2007 | ||
</ref>. | |||
Despite the elastic and flexible nature of the ligament, at neutral position, the ligament has '''pretension,''' preventing it from buckling. '''At lumbar vertebra,''' this pretension is provided by the traction and tension forces applied by muscles on the [[Thoracolumbar Fascia|thoracolumbar fascia]] by the supraspinous, interspinous ligaments to ligamentum flavum, causing pretension in the neutral position (interspinous-supraspinous thoracolumbar ligamentous complex)<ref name=":0" /> | |||
At each intersegmental level the ligamentum flavum is a paired structure | At each intersegmental level, the ligamentum flavum is a paired structure that is represented symmetrically on both sides. | ||
In the neck region the ligaments are thin, but broad and long; they are thicker in the thoracic region, and thickest in the lumbar region. | In the neck region, the ligaments are thin, but broad and long; they are thicker in the thoracic region, and thickest in the lumbar region. | ||
== Attachments == | == Attachments == | ||
The ligament flavum arises from the lower half of the anterior surface of the lamina above and attaches to the posterior surface and upper margin of the lamina below, forming a cup-like grasp on the upper border of the lamina below. | |||
On each side the ligament divides into | On each side the ligament divides into two portions: | ||
* '''The medial portion:''' passes to the back of the next lower lamina and across the gap between the adjacent vertebrae, fusing with the [[interspinous ligament]] | |||
* '''The lateral portion''' ''':''' passes in front of the [[Facet Joints|facet joint]] where it attaches to the anterior aspect of the inferior and superior articular processes and forms the anterior capsule. The most lateral fibres extend beyond the superior articular process to the pedicle below. | |||
== Function == | == Function == | ||
The marked elasticity serves to preserve the upright posture and assist the vertebral column in resuming it's shape after flexion. It resists excessive separation of the adjacent vertebral lamina and prevents buckling of the ligament into the spinal canal during extension, preventing canal compression. The lateral portion of the ligament prevents the anterior capsule of the facet joint being nipped within the joint cavity during movement. | |||
== Pathology == | |||
The | The body goes through several changes as a person ages. Some of these changes occur because of the continued wear that is placed on the body over long periods of time. The neck and back are especially susceptible to these changes since they are responsible for supporting the majority of the body’s weight and movements over time. | ||
< | Ligamentum flavum can lose strength and elasticity, causing it to thicken and buckle towards the spinal column, this is due to the loss of elastic fibres, which at same time increase in the thickness of collagen fibres. These events cause the deposition of Ca<sup>+2</sup> in the ligament. Calcification of the ligament causes hypertrophy and can lead to spinal canal stenosis (narrowing of the spinal canal), which can sometimes cause pain. | ||
= | If the ligamentum flavum buckles to the point that it impinges on a spinal nerve, a patient may experience the following symptoms of spinal stenosis: | ||
*Weakness | |||
*Numbness | |||
*Localised pain | |||
*Radiating pain (depending on the location of the spinal stenosis, the pain could radiate into the shoulders, arms, ribs or legs)<ref>https://www.laserspineinstitute.com/back_problems/spinal_anatomy/spine/flavum/</ref> | |||
Hypertrophy of this ligament may cause spinal stenosis because it lies in the posterior portion of the vertebral canal. In patients with spinal stenosis, fibrosis and hypertrophy of ligamentum flavum are associated with increased tissue inhibitor of matrix metalloproteinase-2 (TIMP-2).<ref>Park J B, Lee J K, Park SJ, Riew KD .[https://insights.ovid.com/pubmed?pmid=16322626 Hypertrophy of ligamentum flavum in lumbar spinal stenosis associated with increased proteinase inhibitor concentration].The Journal of Bone and Joint Surgery-American . 2005 Dec:87(12):2750-7. </ref> | |||
Many causes of neck and back pain are directly related to the ligamentum flavum. Though the anatomy of the spine is quite complex, treating conditions that affect it does not have to be.<ref>https://www.laserspineinstitute.com/articles/ligamentum_flavum_articles/anatomy/281/</ref> Unfortunately, there is little to no regeneration power of elastin tissue at ligamentum flavum, loss of elastin tissue cannot be recovered. | |||
Ossification of ligamentum flavum (OLF) is uncommon, but it is important in terms of causing thoracic spinal stenosis, myelopathy, dural ossification. <ref>DANIELS, Alan H., et al. Ossified ligamentum flavum: epidemiology, treatment, and outcomes. ''Journal of the American Academy of Orthopaedic Surgeons'', 2022, 30.12: e842-e851.</ref><ref>YAN, Chen, et al. [https://pubmed.ncbi.nlm.nih.gov/36620130/ Three-dimensional imaging analysis for the diagnosis of dural ossification in thoracic ossification of the ligamentum flavum: a multicenter study.] ''Quantitative Imaging in Medicine and Surgery'', 2023, 13.1: 417.</ref> | |||
== Examination == | == Examination == | ||
Diagnosis of OLF can be best made by the combination of MRI and computed tomography.<ref>J. Hanakita ,H. Suwa , F. Ohta , S. Nishi , H. Sakaida . [https://link.springer.com/article/10.1007/BF00593939 Neuroradiological examination of thoracic radiculo-myelopathy due to ossification of the ligamentum flavum] .Neuroradiology Jan 1990 :32 (1):38-42.</ref> | |||
<div class=" | |||
< | == Resources == | ||
</div> | |||
<div class="row"> | |||
<div class="col-md-6"> {{#ev:youtube|KQHkXyRWEmg|300}} <ref>Dynamic Disc Designs. Ligamentum Flavum - The FIRST Dynamic Ligamentum Flavum Ever To Be Produced. Available from: https://www.youtube.com/watch?v=KQHkXyRWEmg</ref></div> | |||
<div class="col-md-6"> {{#ev:youtube|gd4-FV_lwSE|300}} <ref>Atlantic Spine Center. Normal Lamina and Ligamentum Flavum. | |||
Available from: https://www.youtube.com/watch?v=gd4-FV_lwSE</ref></div> | |||
</div> | |||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Anatomy]] | [[Category:Anatomy]] | ||
[[Category:Cervical Spine - Anatomy]] | |||
[[Category:Lumbar Spine - Anatomy]] | |||
[[Category:Ligaments]] | |||
[[Category:Thoracic Spine - Ligaments]] | |||
[[Category:Musculoskeletal/Orthopaedics]] | |||
[[Category:Thoracic Spine - Anatomy]] | |||
[[Category:Thoracic Spine - Anatomy]] | |||
[[Category:Thoracic Spine]] | |||
[[Category:Lumbar Spine - Ligaments]] | |||
Latest revision as of 12:25, 24 July 2023
Description[edit | edit source]
The ligamenta flavum is a short but thick ligament that connects the laminae of adjacent vertebrae from C2 to S1 and is considered a medial ward continuation of the facet joint . It consists of 80% elastin fibres and 20% collagen fibres. This high percentage of elastin fibres gives the ligament it's yellow colour and flexible nature[1][2].
Despite the elastic and flexible nature of the ligament, at neutral position, the ligament has pretension, preventing it from buckling. At lumbar vertebra, this pretension is provided by the traction and tension forces applied by muscles on the thoracolumbar fascia by the supraspinous, interspinous ligaments to ligamentum flavum, causing pretension in the neutral position (interspinous-supraspinous thoracolumbar ligamentous complex)[2]
At each intersegmental level, the ligamentum flavum is a paired structure that is represented symmetrically on both sides.
In the neck region, the ligaments are thin, but broad and long; they are thicker in the thoracic region, and thickest in the lumbar region.
Attachments[edit | edit source]
The ligament flavum arises from the lower half of the anterior surface of the lamina above and attaches to the posterior surface and upper margin of the lamina below, forming a cup-like grasp on the upper border of the lamina below.
On each side the ligament divides into two portions:
- The medial portion: passes to the back of the next lower lamina and across the gap between the adjacent vertebrae, fusing with the interspinous ligament
- The lateral portion : passes in front of the facet joint where it attaches to the anterior aspect of the inferior and superior articular processes and forms the anterior capsule. The most lateral fibres extend beyond the superior articular process to the pedicle below.
Function[edit | edit source]
The marked elasticity serves to preserve the upright posture and assist the vertebral column in resuming it's shape after flexion. It resists excessive separation of the adjacent vertebral lamina and prevents buckling of the ligament into the spinal canal during extension, preventing canal compression. The lateral portion of the ligament prevents the anterior capsule of the facet joint being nipped within the joint cavity during movement.
Pathology[edit | edit source]
The body goes through several changes as a person ages. Some of these changes occur because of the continued wear that is placed on the body over long periods of time. The neck and back are especially susceptible to these changes since they are responsible for supporting the majority of the body’s weight and movements over time.
Ligamentum flavum can lose strength and elasticity, causing it to thicken and buckle towards the spinal column, this is due to the loss of elastic fibres, which at same time increase in the thickness of collagen fibres. These events cause the deposition of Ca+2 in the ligament. Calcification of the ligament causes hypertrophy and can lead to spinal canal stenosis (narrowing of the spinal canal), which can sometimes cause pain.
If the ligamentum flavum buckles to the point that it impinges on a spinal nerve, a patient may experience the following symptoms of spinal stenosis:
- Weakness
- Numbness
- Localised pain
- Radiating pain (depending on the location of the spinal stenosis, the pain could radiate into the shoulders, arms, ribs or legs)[3]
Hypertrophy of this ligament may cause spinal stenosis because it lies in the posterior portion of the vertebral canal. In patients with spinal stenosis, fibrosis and hypertrophy of ligamentum flavum are associated with increased tissue inhibitor of matrix metalloproteinase-2 (TIMP-2).[4]
Many causes of neck and back pain are directly related to the ligamentum flavum. Though the anatomy of the spine is quite complex, treating conditions that affect it does not have to be.[5] Unfortunately, there is little to no regeneration power of elastin tissue at ligamentum flavum, loss of elastin tissue cannot be recovered.
Ossification of ligamentum flavum (OLF) is uncommon, but it is important in terms of causing thoracic spinal stenosis, myelopathy, dural ossification. [6][7]
Examination[edit | edit source]
Diagnosis of OLF can be best made by the combination of MRI and computed tomography.[8]
Resources[edit | edit source]
References[edit | edit source]
- ↑ Nikolai Bogduk. Clinical and Radiological Anatomy of the Lumbar Spine 5th Edition.Churchill Livingstone: Elsevier. Feb 2012.
- ↑ 2.0 2.1 Vleeming A ,Mooney V . Movement, Stability & Lumbopelvic Pain 2nd Edition . Philadelphia.Churchill Livingstone .1st March 2007
- ↑ https://www.laserspineinstitute.com/back_problems/spinal_anatomy/spine/flavum/
- ↑ Park J B, Lee J K, Park SJ, Riew KD .Hypertrophy of ligamentum flavum in lumbar spinal stenosis associated with increased proteinase inhibitor concentration.The Journal of Bone and Joint Surgery-American . 2005 Dec:87(12):2750-7.
- ↑ https://www.laserspineinstitute.com/articles/ligamentum_flavum_articles/anatomy/281/
- ↑ DANIELS, Alan H., et al. Ossified ligamentum flavum: epidemiology, treatment, and outcomes. Journal of the American Academy of Orthopaedic Surgeons, 2022, 30.12: e842-e851.
- ↑ YAN, Chen, et al. Three-dimensional imaging analysis for the diagnosis of dural ossification in thoracic ossification of the ligamentum flavum: a multicenter study. Quantitative Imaging in Medicine and Surgery, 2023, 13.1: 417.
- ↑ J. Hanakita ,H. Suwa , F. Ohta , S. Nishi , H. Sakaida . Neuroradiological examination of thoracic radiculo-myelopathy due to ossification of the ligamentum flavum .Neuroradiology Jan 1990 :32 (1):38-42.
- ↑ Dynamic Disc Designs. Ligamentum Flavum - The FIRST Dynamic Ligamentum Flavum Ever To Be Produced. Available from: https://www.youtube.com/watch?v=KQHkXyRWEmg
- ↑ Atlantic Spine Center. Normal Lamina and Ligamentum Flavum. Available from: https://www.youtube.com/watch?v=gd4-FV_lwSE
