| Degenerative lumbar spondylolisthesis and lumbar disc herniation are two of the major reasons of low back pain and leg pain, can result in hypertrophy of the ligamentum flavum, thereby escalate stenosis of the spinal canal. Nowadays, there are many imaging studies on the hypertrophy of the ligamentum flavum, but the pathogenesis of molecule and the type of proliferative collagen are rarely reported. Recent researchs indicate that transforming growth factor-pi (TGF-P1) and bone morphogenetic protein (BMP) play a key role in the pathogenesis of the ossification of ligamentum flavum. The process of the ossification of ligamentum flavum shows hyperplasia of collagen type II. TGF-P 1 is a polypeptide with many biologic functions, which promotes the synthesis of extracellular matrix (ECM) and angiogenesis, and inhibits ECM catabolism. The multiple functions of TGF-pl depends on its interaction with TGF-P receptors which includes type I of TGF-P receptor (TGF-pR I) and type II of TGF-p receptor (TGF-PR II) that exist extensively in the cellular membrane. BMP, as hydrophobic acid protein, is involved in the induction of undifferentiated mesenchymal cell into tissue of cartilage and bone, and the ectopic ossification. However, the expression and the effect of TGF-P 1 and BMP of ligamentum flavum in degenerative lumbar spondylolisthesis and lumbar disc herniation are not clear, and the type of proliferative collagen in the hypertrophic ligamentum flavum of degenerative spondylolisthesis is not known yet. The purpose ofthe study was attempted to determine whether the expression of TGF-J31, TGF-0R I, BMP and collagen type II of the ligamentum flavum in the lumbar degenerative spondylolisthesis and lumbar disc herniation was assayed by immunohistochemistry.Materials and Methods37 specimens of lumbar ligamentum flavum were divided into three groups. Group 1: degenerative lumbar spondylolisthesis(DLS), 10 patients (male 5, female 5), age from35 to 69 years (mean 49), mean thickness of ligamentum flavum5.4mm. Group2: lumbar disc herniation (LDH) , 17 patients (male 9, female 8), age from 31 to 65 years (mean 46), mean thickness 4.0mm.Group3: control, 10 patients (male 6, female 4), among them 7 lumbar fracture and 3 dead from traffic accident, age from 20 to 53 years (mean 45), mean thickness 3.2mm. The mean thickness of ligamentum flavum and the mean age of patients between group 1 and group 3 achieved statistical difference (P<0.05) .All samples were taken from the interlaminar portion of ligament flavum including their superficial and deep layers. Tissue samples were immediately fixed in 10% buffered formalin for 24-48 hours and embedded in paraffin. Sections at Sum were stained with hematoxylin and eosin (HE), and Masson trichrome. The expression of TGF-pl, TGF-PR I, BMP and type II collagen of the ligamentum flavum was determined using En Vision two step methods immunohistochemistry. The intensity of cellular and extracellular staining of each samples was evaluated by two observers blinded to the treatment groups using Olympus optical microscope. Results are presented as mean ?SD, And analysis of variance (ANOVA), Kruskl-wallis test were used by SPPSII.O statistical software. Ridit method also was used for Ihe grade information, and the level of statistical significance was chosen as P<0.05.Results HE stainingIn the control group ligamentum flavum was mainly made up of elastic fibers which had fairly uniform diameters and were regularly arranged. There were a few of collagen fibers and dispersed fibroblasts among the elastic fibers. Ligamentum flavum from with lumbar disc herniation showed similar features to those of ligaments of control group. In ligamentum flavum of degenerative lumbar spondylolisthesis group, there were a significant decrease in elastic fiber which were showed smaller diameters, irregularly range of fibers and deformed fibers, and a significant increase in the6collagenous fiber component, when compared...
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