Study design: A descriptive computed tomography (CT) study of the ligamentum flavum (LF) thickness in individuals with normal and stenotic lumbar spines.
Objective: To establish standards for normal and pathologic range of LF thickness and its asymmetry as indicated in CT images and to examine its association with vertebral body size, age, and gender.
Summary of background data: LF lines a considerable part of the posterior and lateral walls of the spinal canal and is a major role contributor to spinal canal stenosis. Due to methodologic deficiencies (e.g., small sample size, lack of control for vertebral body size, gender, and age), the normal range of LF thickness is still controversial. Furthermore, data on important aspect of LF thickness such as left-right differences are missing.
Methods: Two groups of individuals were studied. The first group included 65 individuals with lumbar spinal stenosis (LSS) (mean age: 66 +/- 9.7 years) and the second, 150 individuals (mean age: 52 +/- 19 years) without LSS-related symptoms. LF thickness was measured on CT images (Philips Brilliance 64), obtained from axial plane scan at the intervertebral disc level. Measurements were performed at the levels of L3-L4, L4-L5, and L5-S1. Analysis of variance and t test were carried out to evaluate the association between LF thickness and demographic factors.
Results: Absolute and relative LF thickness were significantly greater in the LSS group at the levels of L3-L4 and L4-L5 on both sides, compared to control group (P < 0.05). LF thickness was independent of gender (absolute and relative thickness). Even though LF thickness at all levels significantly increases with age, significant changes after the age of 60 occurred only at L3-L4. Significant asymmetry in LF thickness was found at L3-L4 (2.9 +/- 0.90 mm on the right vs. 2.76 +/- 0.90 mm on the left) and L5-S1 (3.42 +/- 1.1 mm on the right vs. 3.22 +/- 1.22 mm on the left) (P < 0.05).
Conclusion: LF thickness is an age-dependent and gender-independent phenomenon. LF is significantly thicker on the right side. The borderline between normal and pathologic LF thickness should not be set at 4 mm.