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Original research
Prevalence of and factors associated with stenotic thoracic ligamentum flavum hypertrophy
  1. Chan-Sik Kim1,
  2. Hyungtae Kim1,
  3. Sehee Kim2,
  4. Ju Hwan Lee3,4,5,
  5. Koun Jeong1,
  6. Hyun Seung Lee3 and
  7. Yeon-Dong Kim3,4,5
  1. 1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  2. 2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  3. 3Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea
  4. 4Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Republic of Korea
  5. 5Wonkwang Institute of Science, Wonkwang University School of Medicine, Iksan, Republic of Korea
  1. Correspondence to Dr Hyungtae Kim, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; ingwei2475{at}gmail.com; Dr Yeon-Dong Kim, Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea; kydpain{at}hanmail.net

Abstract

Introduction Stenotic thoracic ligamentum flavum hypertrophy can cause leg and/or low back pain similar to that caused by lumbar spinal stenosis. However, the thoracic spine may occasionally be overlooked in patients with leg and/or low back pain. An accurate understanding of the prevalence of stenotic thoracic ligamentum flavum hypertrophy and its associated factors is necessary.

Methods In this prevalence study, we reviewed whole-spine MRI scans of patients who visited the pain clinic complaining of leg and/or low back pain between 2010 and 2019. We analyzed the overall prevalence and prevalence according to the age group, sex, grade of lumbar disc degeneration, and thoracic level. In addition, we identified factors independently associated with stenotic thoracic ligamentum flavum hypertrophy occurrence.

Results Among 1896 patients, the overall prevalence of stenotic thoracic ligamentum flavum hypertrophy was 9.8% (185/1896), with the highest prevalence observed in the ≥80-year-old age group among all age groups (15.9%, 14/88). The region with the highest prevalence was the T10/11 level (3.0%, 57/1896). Multivariable logistic regression analysis revealed that when compared with the <50-year-old age group, all other age groups were significantly associated with stenotic thoracic ligamentum flavum hypertrophy (p<0.01). In addition, grade 5 of lumbar disc degeneration was significantly associated with stenotic thoracic ligamentum flavum hypertrophy (p=0.03).

Conclusions Given the possibility for missed stenotic thoracic ligamentum flavum hypertrophy to potentially result in neurological complications, extending lumbar spine MRI covering the lower thoracic region may be considered for patients over 50 years of age with suspected severe lumbar disc degeneration.

  • Diagnostic Techniques and Procedures
  • Epidemiology
  • Pain Management
  • Back Pain
  • Multimodal Imaging

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/rapm-2023-104692

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • HK and Y-DK contributed equally.

    • Contributors C-SK: data curation; formal analysis; visualization; writing—original draft. HK (guarantor): conceptualization; data curation; formal analysis; investigation; methodology; supervision; writing—review and editing. SK: data curation; formal analysis; writing—review and editing. JHL: data curation; investigation; validation; writing—review and editing. KJ: software; validation; visualization; writing—review and editing. HSL: data curation; investigation; validation; writing—review and editing. Y-DK: conceptualization; data curation; formal analysis; investigation; methodology; supervision; writing—eview and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.