Roche P H, Figarella-Branger D, Malca S, Bouvier C, Soumare O, Pellet W
Service de Neurochirurgie, Hôpital Sainte-Marguerite, Marseille.
Neurochirurgie. 1999 May;45(2):91-7.
Symptomatic lumbar canal stenosis without bony stenosis has previously been described. We describe the pathological modifications of ligamentum flavum among such operated patients. Ten patients were prospectively included in this study. Their mean age was 74, ranges: from 52-90. Clinical manifestation was a radicular claudication (sciatic or crural). Neuroradiology confirmed in all cases the ligamentum flavum thickness as the main cause of the symptomatology. This feature was also confirmed operatively and complete resection of the ligamentum flavum was performed. Resolution of the radicular pain was obtained in all cases at last follow-up. Pathological examination of the ligamentum flavum displayed characteristic features of degenerative modifications and elastic fibers fragmentation caused by numerous amorphous deposits. The deposits were studied using red Congo staining, polarized light and immunostaining methods. Such technique showed evidence of amyloid origin of the deposits. Immunodetection was positive for the P component in the amyloid deposits and for beta-2-microglobulin in one case (chronic renal failure and hemodialysis). The deposits did not express antitransthyretin antibodies. In parallel, control ligamentum flavum were obtained from 10 operated patients affected by bony lumbar stenosis. Moderate degenerative features were observed but small amounts of amyloid deposits were found in only 3 of those cases, without thickening of the ligamentous structure. This study correlates the presence of thickened ligamentum flavum caused by amyloid deposition, with symptomatic non-osseous lumbar canal stenosis. Association with degenerative modifications of the spine in the studied cases is suggestive of a microtraumatic origin.
此前已有关于无骨质狭窄的症状性腰椎管狭窄的描述。我们描述了此类手术患者中黄韧带的病理改变。本研究前瞻性纳入了10例患者。他们的平均年龄为74岁，范围在52 - 90岁之间。临床表现为神经根性间歇性跛行（坐骨神经或股神经相关）。神经放射学在所有病例中均证实黄韧带增厚是症状的主要原因。这一特征在手术中也得到了证实，并对黄韧带进行了完整切除。在最后一次随访时，所有病例的神经根性疼痛均得到缓解。黄韧带的病理检查显示出退行性改变的特征以及由大量无定形沉积物导致的弹性纤维断裂。使用刚果红染色、偏振光和免疫染色方法对沉积物进行了研究。这种技术显示沉积物有淀粉样蛋白起源的证据。淀粉样沉积物中的P成分免疫检测呈阳性，1例（慢性肾衰竭和血液透析）中β2 -微球蛋白免疫检测呈阳性。沉积物未表达抗转甲状腺素蛋白抗体。同时，从10例患有骨质性腰椎管狭窄的手术患者中获取对照黄韧带。观察到有中度退行性特征，但仅在其中3例中发现少量淀粉样沉积物，且韧带结构未增厚。本研究将由淀粉样蛋白沉积导致的黄韧带增厚与症状性非骨性腰椎管狭窄联系起来。在所研究的病例中，与脊柱退行性改变的关联提示了微创伤起源。
