University of Texas Health Science Center at San Antonio, Address: 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
University of Texas Health Science Center at San Antonio, Address: 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
Spine J. 2019 Aug;19(8):1346-1353. doi: 10.1016/j.spinee.2019.03.003. Epub 2019 Mar 20.
Obesity, which is currently surging to epidemic levels within the United States, has been linked to hyperostotic conditions like diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL). Excess adipose tissue and insulin-resistance may cause a systemic increase in serum levels of proinflammatory cytokines and these signals can affect bone metabolism. Spinal ligaments and discs may have receptors for these signaling molecules. Anecdotal observations at this institution suggested that there is a clinically important subset of younger patients with obesity and multilevel stenosis in the presence of unusual calcification of the spinal ligaments that is distinct from DISH.
To determine if there is an association between truncal obesity and calcifications of the spine in nonelderly adults.
STUDY DESIGN/SETTING: This is a retrospective analysis of 214 sequential trauma patients between the ages of 29 and 50. Patients' age, sex, truncal obesity, history of hypertension, and diabetes were assessed for association with ligamentous calcification of the spine.
Sequential trauma patients were chosen from our institution's trauma database between 2006 and 2007.
Full spine computed tomography (CT) imaging was examined for bone formation in the region of the anterior longitudinal ligament (ALL) and annulus, posterior longitudinal ligament (PLL) and annulus, and the ligamentum flavum (LF). Visceral and subcutaneous abdominal fat were also evaluated. The authors report no study funding sources or conflicts of interest.
Calcification of the ALL, PLL, and LF were assigned a score at each level and then combined for a total calcification score (TCS) for the entire spine. Obesity was estimated using a truncal body mass index (TBMI) by using a previously validated CT derived truncal total adiposity volume (TAV).
ALL calcification was associated with age, male gender, hypertension, and increased adiposity. PLL calcification was significantly associated with age and hypertension. LF calcification was only associated with increased obesity.
In our analysis of nonelderly patients, LF calcification was independently associated with truncal obesity. This implies obesity plays a greater role in calcification than could be accounted for by simply age-related degeneration or gender.
肥胖在美国呈流行趋势，目前已与弥漫特发性骨肥厚（DISH）和后纵韧带骨化（OPLL）等骨质增生状态相关联。过多的脂肪组织和胰岛素抵抗可能导致血清中促炎细胞因子水平升高，这些信号可能会影响骨骼代谢。脊柱韧带和椎间盘可能存在这些信号分子的受体。本机构的一些观察结果表明，存在一个具有临床重要意义的亚组，即肥胖且多节段狭窄的年轻患者，其脊柱韧带异常钙化，与 DISH 不同。
确定躯干肥胖与非老年成年人脊柱钙化之间是否存在关联。
研究设计/设置：这是对 214 例 29 至 50 岁连续创伤患者的回顾性分析。评估患者年龄、性别、躯干肥胖、高血压和糖尿病病史与脊柱韧带钙化之间的关系。
选择 2006 年至 2007 年期间我院创伤数据库中的连续创伤患者。
对全脊柱 CT 成像进行检查，以评估前纵韧带（ALL）和纤维环、后纵韧带（PLL）和纤维环以及黄韧带（LF）的骨形成情况。还评估了内脏和皮下腹部脂肪。作者报告没有研究资金来源或利益冲突。
在每个节段对 ALL、PLL 和 LF 的钙化进行评分，然后将所有节段的评分组合成总钙化评分（TCS）。使用先前验证的 CT 衍生的躯干总脂肪量（TAV），通过躯干体质量指数（TBMI）估计肥胖。
ALL 钙化与年龄、男性、高血压和肥胖有关。PLL 钙化与年龄和高血压显著相关。LF 钙化仅与肥胖增加有关。
在我们对非老年患者的分析中，LF 钙化与躯干肥胖独立相关。这意味着肥胖在钙化中的作用大于简单的年龄相关性退变或性别因素所能解释的作用。
