PT  - JOURNAL ARTICLE
AU  - Kumar Varma Kalidindi, Kalyan
AU  - Sharma, Jeevan Kumar
AU  - Vishwakarma, Gayatri
AU  - Duggi, Srinath
AU  - Chhabra, Harvinder Singh
TI  - Ligamentum Flavum Buckling vs Hypertrophy in Cervical Myelopathy Using Dynamic Imaging: Are Instability and Loss of Disc Height the Culprits?
AID  - 10.14444/8221
DP  - 2022 Apr 01
TA  - International Journal of Spine Surgery
PG  - 300--308
VI  - 16
IP  - 2
4099  - https://www.ijssurgery.com/content/16/2/300.short
4100  - https://www.ijssurgery.com/content/16/2/300.full
SO  - Int J Spine Surg2022 Apr 01; 16
AB  - Background The literature has not distinguished between LF “hypertrophy” and “buckling” when addressing cervical spondylotic myelopathy. The identification of buckling on dynamic magnetic resonance imaging can determine the levels for decompression more accurately and modify the surgical plan accordingly. No studies have been performed in the cervical spine to analyze the factors affecting LF buckling.Purpose Our objective was to investigate the factors affecting static ligamentum flavum (LF) “hypertrophy” and dynamic LF “buckling.”Study Design Retrospective cohort study.Methods We conducted a retrospective study of hospital records and imaging database from January 2014 to January 2020. The relation of age, disc height, and intervertebral instability to LF hypertrophy and buckling were assessed.Results Measurements were performed from C2-3 to C7-T1 in 169 patients who satisfied the eligibility criteria, making a total of 1014 levels. The samples were divided into 2 groups: 798 levels with buckling <1 mm (group A) and 216 levels with buckling >1 mm (group B). Of those, 161 levels satisfied the criteria for radiological instability (sagittal translation/rotation). No correlation was observed between age/disc height and buckling. Intervertebral instability showed significant association (P = 0.046) with buckling. No correlation was found between age/intervertebral instability and hypertrophy.Conclusion LF buckling but not hypertrophy is related to intervertebral instability in the cervical spine. LF buckling in the cervical spine is not related to age or disc height in the cervical spine.Clinical Relevance Intervertebral instability on dynamic x-ray imaging of the cervical spine can be a predictor of ligamentum flavum buckling and can be utilized for surgical planning.Level of Evidence 3.