Xu Zixuan, Yuan Lei, Zhou Siyu, Guo Xinhu, Jiang Shuai, Wang Longjie, Chen Guanghui, Hu Yuanyu, Qi Junbo, Guo Zhaoqing, Qi Qiang, Li Weishi, Sun Chuiguo
Department of Orthopedics, Peking University Third Hospital, Beijing, China.
Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China.
Orthop Surg. 2025 Jul;17(7):1956-1964. doi: 10.1111/os.70061. Epub 2025 May 26.
There are many causes of thoracic ossification of the ligamentum flavum (TOLF), of which mechanical stress factors have gained increasing attention. This study aimed to explore the potential pathogenesis of TOLF by comparing spinal sagittal alignment parameters between patients with TOLF and an asymptomatic population.
We retrospectively included patients who underwent surgical treatment for thoracic myelopathy caused by OLF at Peking University Third Hospital from 2012 to 2022. Sagittal alignment parameters measured by picture archiving and communication system were compared between the TOLF group and a control group with independent t-test, Wilcoxon rank-sum test, and Chi-Squared test. Patients with caudal insertion of OLF above the T10 level were categorized into Group 1, while those with caudal insertion below the T10 level were categorized into Group 2. Sagittal alignment parameters were then compared among these two groups and the control group.
Compared with the control group, the OLF group exhibited less lumbar lordosis (44.46° ± 11.41° vs. 52.55° ± 9.70°, p < 0.001), greater thoracolumbar curvature, greater PI-LL mismatch, and greater SVA imbalance. In patients with caudal insertion of the OLF above the T10 level, PI, PT, and LL were smaller compared to the control group. Patients with caudal insertion below the T10 level had smaller LL, greater thoracolumbar kyphosis, more severe SVA imbalance, and more severe PI-LL mismatch.
Patients with TOLF have a straighter spine. Mechanical stress plays a more significant role in the development of TOLF in patients with caudal lesions below the T10 level. In patients with TOLF not involving the thoracolumbar segment, factors other than mechanical stress, such as endocrine factors, may play a more crucial role in the development of TOLF.
胸椎黄韧带骨化（TOLF）有多种病因，其中机械应力因素日益受到关注。本研究旨在通过比较TOLF患者与无症状人群的脊柱矢状面排列参数，探讨TOLF的潜在发病机制。
我们回顾性纳入了2012年至2022年在北京大学第三医院因黄韧带骨化导致胸段脊髓病而接受手术治疗的患者。通过图像存档与通信系统测量的矢状面排列参数，在TOLF组和对照组之间进行独立t检验、Wilcoxon秩和检验和卡方检验。黄韧带尾端插入高于T10水平的患者归入第1组，而尾端插入低于T10水平的患者归入第2组。然后比较这两组与对照组之间的矢状面排列参数。
与对照组相比，黄韧带骨化组腰椎前凸较小（44.46°±11.41° vs. 52.55°±9.70°，p<0.001），胸腰段曲度更大，PI-LL失配更大，SVA失衡更严重。黄韧带尾端插入高于T10水平的患者，其PI、PT和LL较对照组小。尾端插入低于T10水平的患者LL较小，胸腰段后凸更大，SVA失衡更严重，PI-LL失配更严重。
TOLF患者的脊柱更直。机械应力在T10水平以下尾端病变患者的TOLF发生中起更重要作用。在不涉及胸腰段的TOLF患者中，除机械应力外的其他因素，如内分泌因素，可能在TOLF的发生中起更关键作用。
