Shai Shemesh1,2, Eliezer Sidon3,4, Efrat Kaisler5, Dimitry Sheinis3,4, Steven Velkes3,4, Nissim Ohana3,4, Dafna Benayahu5. 1. Department of Orthopedic Surgery, Beilinson Campus, Rabin Medical Center, 39 Jabotinsky St., 49100, Petach Tikva, Israel. shemesh.shai@gmail.com. 2. Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel. shemesh.shai@gmail.com. 3. Department of Orthopedic Surgery, Beilinson Campus, Rabin Medical Center, 39 Jabotinsky St., 49100, Petach Tikva, Israel. 4. Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel. 5. Department of Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel.
Abstract
PURPOSE: Lumbar spinal canal stenosis (LSCS) is associated with fibrosis, decreased elastin-to-collagen ratio, and hypertrophy of the ligamentum flavum (LF). Diabetes mellitus (DM) is known to cause metabolic disturbances within the extracellular matrix in multiple tissues. These alterations may play a major role in the severity of clinical symptoms of LSCS affecting diabetic patients. We aimed to examine the hypothesis that DM may contribute to the LF changes seen in patients with LSCS. METHODS: The study cohort included 29 patients: 23 with LSCS (10 with DM vs. 13 without DM) as well as six patients with lumbar disc herniation (LDH). Surgical LF specimens were retrieved for histological assessment. Morphologic quantification of confocal microscopy images using fast Fourier transform analysis allowed us to compare anisotropy and elastin fiber orientation between groups. RESULTS: There was a significant positive correlation between fasting plasma glucose values and degree of elastin degradation (r = 0.36, p = 0.043). The diabetic patients with LSCS showed a significantly greater loss of elastic fibers (2.3 ± 0.9 vs. 1.5 ± 0.55, p = 0.009), although fibrosis was shown to be similar (1.44 ± 0.7 vs. 1.43 ± 0.88, p = 0.98). There was no significant difference in the degree of calcification in the LSCS group between patients with and without diabetes (1.71 vs. 2.05%, p = 0.653). Fiber orientation was found to be less homogenous in the LSCS compared with the LDH group, although not significantly affected by DM. CONCLUSIONS: The present study points to a significant contribution of DM to the loss of elastin fibers that occurs in the LF of patients with LSCS.
PURPOSE: Lumbar spinal canal stenosis (LSCS) is associated with fibrosis, decreased elastin-to-collagen ratio, and hypertrophy of the ligamentum flavum (LF). Diabetes mellitus (DM) is known to cause metabolic disturbances within the extracellular matrix in multiple tissues. These alterations may play a major role in the severity of clinical symptoms of LSCS affecting diabeticpatients. We aimed to examine the hypothesis that DM may contribute to the LF changes seen in patients with LSCS. METHODS: The study cohort included 29 patients: 23 with LSCS (10 with DM vs. 13 without DM) as well as six patients with lumbar disc herniation (LDH). Surgical LF specimens were retrieved for histological assessment. Morphologic quantification of confocal microscopy images using fast Fourier transform analysis allowed us to compare anisotropy and elastin fiber orientation between groups. RESULTS: There was a significant positive correlation between fasting plasma glucose values and degree of elastin degradation (r = 0.36, p = 0.043). The diabeticpatients with LSCS showed a significantly greater loss of elastic fibers (2.3 ± 0.9 vs. 1.5 ± 0.55, p = 0.009), although fibrosis was shown to be similar (1.44 ± 0.7 vs. 1.43 ± 0.88, p = 0.98). There was no significant difference in the degree of calcification in the LSCS group between patients with and without diabetes (1.71 vs. 2.05%, p = 0.653). Fiber orientation was found to be less homogenous in the LSCS compared with the LDH group, although not significantly affected by DM. CONCLUSIONS: The present study points to a significant contribution of DM to the loss of elastin fibers that occurs in the LF of patients with LSCS.
Authors: Olga Adamska; Artur Stolarczyk; Agata Gondek; Bartosz Maciąg; Jakub Świderek; Paweł Czuchaj; Krzysztof Modzelewski Journal: J Clin Med Date: 2022-09-27 Impact factor: 4.964