Albishi Waleed, Alhuqbani Mohammed N, Aldosar Omar A, Aldosari Zyad A, Alhomaidhi Sara, Alaseem Abdulrahman, Awwad Waleed
Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
J Orthop. 2025 May 30;68:171-174. doi: 10.1016/j.jor.2025.05.056. eCollection 2025 Oct.
Lumbar spinal stenosis (LSS) is a prevalent degenerative condition, with ligamentum flavum hypertrophy (LFH) contributing significantly to neural compression. Despite its clinical importance, few studies have evaluated longitudinal trends in LFH. This study investigates the temporal progression and demographic associations of LFH over the past decade.
This retrospective cohort study included adult patients undergoing surgery for LSS at a tertiary academic center during two periods: 2013-2017 and 2018-2023. Exclusion criteria included prior spinal surgery, trauma, malignancy, or inadequate imaging. Two radiologists reviewed axial MRI images to measure ligamentum flavum thickness (≥4 mm indicated hypertrophy). Demographic data and coexisting spinal conditions were also recorded.
A total of 202 patients were analyzed-98 from the initial and 104 from the later period. LFH prevalence rose from 24.5 % to 44.7 % over time. Patients aged ≥60 demonstrated significantly higher LFH rates in both periods (p = 0.004). Although female predominance persisted, it declined from 71.4 % to 55 %. LFH was most commonly associated with disc bulging, particularly at the same spinal level. Multilevel LFH increased from 25 % to 44.1 %, though L4-L5 remained the most affected segment.
The incidence of LFH has increased substantially over the past decade, particularly among older adults. Given its role in LSS pathogenesis, greater attention to LFH in imaging and surgical planning is warranted. Further research is needed to clarify its etiology and guide effective management strategies.
腰椎管狭窄症（LSS）是一种常见的退行性疾病，黄韧带肥厚（LFH）是导致神经受压的重要因素。尽管其具有临床重要性，但很少有研究评估LFH的纵向变化趋势。本研究调查了过去十年中LFH的时间进展情况以及与人口统计学的关联。
这项回顾性队列研究纳入了在三级学术中心接受LSS手术的成年患者，分为两个时间段：2013 - 2017年和2018 - 2023年。排除标准包括既往脊柱手术史、创伤、恶性肿瘤或影像学资料不充分。两名放射科医生对轴向MRI图像进行评估，测量黄韧带厚度（≥4毫米表明肥厚）。同时记录人口统计学数据和并存的脊柱疾病。
共分析了202例患者，其中初期98例，后期104例。随着时间推移，LFH患病率从24.5%上升至44.7%。两个时间段内，年龄≥60岁的患者LFH发生率显著更高（p = 0.004）。尽管女性仍占主导，但比例从71.4%降至55%。LFH最常与椎间盘突出相关，尤其是在同一脊柱节段。多节段LFH从25%增至44.1%，不过L4 - L5仍是受影响最严重的节段。
在过去十年中，LFH的发生率大幅上升，尤其是在老年人中。鉴于其在LSS发病机制中的作用，在影像学检查和手术规划中应更加关注LFH。需要进一步研究以阐明其病因并指导有效的管理策略。
