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ORIGINAL ARTICLEJ of Evidence Based Med & Hlthcare, pISSN-2349-2562, eISSN-2349-2570/ Vol. 1/Issue 16/Dec22, 2014 Page 2059A STUDY ON FUSED VERTEBRAL BODIES ALONG WITH OSSIFIED VERTEBRAL LIGAMENTSVidya K. S1, Meenakshi P2HOW TO CITE THIS ARTICLE: Vidya K. S, Meenakshi P.”A Study on Fused Vertebral Bodies along with Ossified Vertebral Ligaments”. Journal of Evidence based Medicine and Healthcare; Volume 1, Issue 16, December22,2014; Page: 2059-2066.ABSTRACT: Congenital or acquired anomalies are common in the vertebral column and site for many orthopaedic disorders which may be pathological or developmental deformity leading to instability, kyphosis, low back pain, scoliosis, Ankylosing spondylitis, forestier’s disease, myelopathy. In present study, done on 50 dried sets of vertebral column bones, of unknown age and sex in the Department of Anatomy, BMCRI, Bangalore. We noted 10 had fused bodies of vertebraes at different levels along with ossification of ligaments of vertebrae’samong which 6 were at thoraco-lumbar level, 3 at cervical level and1 thoracic level giving it an appearance of bamboo/poker spine. The knowledge of this variation is important because of the probability of clinical manifestations associated with the abnormal vertebrae.KEYWORDS: Ossification of anterior longitudinal ligament(OALL), Posterior longitudinal ligament(OPLL), Interspinous ligament(OISL), Supraspinous ligament(OSSL), Ankylosing spondylitis(AS)INTRODUCTION:The human vertebral column plays an important role in maintaining upright posture, stability, weighttransmission and adapted to protect the spinal cord.The ligaments which hold the vertebrae are Anterior longitudinal ligament, Posterior longitudinal ligament, Supraspinous ligament and interspinous ligament. The adjacent vertebrae are held together by intervertebral disc. The Anterior longitudinal ligament is strong, broad fibrous band, covers and connects anterior aspects of bodies of vertebral and intervertebral disc, extends from anterior arch of atlas to pelvic surface of sacrum. It helps to maintainthe stability and prevent the hyperextension of vertebral column. The Posterior longitudinal ligament interconnects the vertebral bodies and intervertebral disc posteriorly with in the vertebral canal, which limits the flexion of vertebral column and resists the gravitational pull. The Supraspinous ligament is a strong fibrous cord, which connects apices of spinous processes from C7 to sacrum. The Interspinous ligament is thin membranous, interconnects the spinous process.1At the points of attachment to the tips of the spinous processes fibrocartilage is developed in the ligaments leading to ossification or calcification of the ligaments.2Any pathological condition of vertebral column may be developmental or acquired and associated with neurological signswhich leads to low back pain, discomfort and stiffness.MATERIAL AND METHODS:During routine osteology classes conducted for first year undergraduate medical students in Department of Anatomy, BMCRI, 50 dried bone sets of vertebral column(Each set contain 7-cervical, 12-thoracic, 5-lumbarand 1-sacrum) irrespective of
ORIGINAL ARTICLEJ of Evidence Based Med & Hlthcare, pISSN-2349-2562, eISSN-2349-2570/ Vol. 1/Issue 16/Dec22, 2014 Page 2060age and sex were collected and observed for fusion of vertebral bodies along with ossified vertebral ligaments and subjected for radiological investigations.OBSERVATION AND RESULTS:Out of50 dried sets of vertebral column, 10 had fusion of vertebral bodies at different level like 6 at thoraco-lumbar level, 3 at cervical level and 1 thoracic level along with ossified anterior longitudinal ligament(OALL), posterior longitudinal ligament(OPLL), supraspinous ligament(OSSL), interspinous ligament(OISL).Fusion of vertebral bodies.Cervical Level: Fusion of vertebral bodies seen between C2-C8-Partially fused-C2-C5, obliteration of intervertebral space-C6-C7; calcified interveterbral disc –C4-C6.Thoracic Level: Fusion seen between T3-T6-obliteration of intervertebral space between T4-T5; calcified interverbral disc –T3-T4.Thoraco-lumbar Level: Fusion seen between T3-L5 –giving appearance of bamboo spine.DISCUSSION:Ankylosing spondylitis (AS) -progressive inflammatory, stiffening of the joints-axial skeleton especially the joints of the sacroiliac and lumbar vertebrae, causes ossification of all ligaments, may involve thoracic and cervical vertebrae. Joints involvement leads to permanent damage like stiff spine limiting all spinal movements with compression of spinal roots. Bamboo spine is seen in x-ray as a result of fusion of vertebral bodies.3A strong association has been found that there is ageneticpredisposition with AS-patients have HLA –B27 positive in their laboratory findings. HLA complex gene is located on chromosome 6.2Ossification of ALL in cervical region (C2-C6) may compress the larynx or trachea and lead toimmobility or mucosal thickening of larynx, dysphagia(Epstein).4Rresnick et al5and Rresnick, Shauland Robins6coined the term diffuse idiopathicskeletal hyperostosis for forestier’s disease andossification of the spinal ligaments has beenconsidered as a part of this entity. Theydefined diffuse idiopathic skeletal hyperostosisas showing calcification or ossification alongthe anterior to anterolateral aspect of four contiguousvertebral bodies.7OPLL is common in the Asian population and accordingly, genetic factors are considered to be an important factor for the incidence. There have been many studies on collagen genes, including on the human collagen A2 gene (COL11A2).Koga et al8reported that the gene is located at chromosome 6p nearby human leukocyte antigen region, and seriously involves in development of OPLL. Maeda et al,9also reported sex-specific association of COL11A2 haplotype in male OPLL patients. In addition, retinoicX receptor β and collagen 11A2 were also reported to be closely related with OPLL. Bone morphogenic protein (BMP) induces the formation of ectopic bones and cartilage, and is considered to play an important role in the pathogenesis of OPLL. More specifically, BMP-2 stimulates differentiation of ligament cells of OPLL patients, and induces ossification by increasing alkaline phosphatase activity and stimulating DNA and procollagen Type I carboxyl-terminal peptide synthesis. Transforming growth factor (TGF)-β was also considered to be an important factor for OPLL formation, but Kawaguchi et al9reported that TGF-β1 polymorphism is not related to onset of