{"title":"Visceral Fat and Ossification of the Posterior Longitudinal Ligament: Insights From a Japanese Cohort.","authors":"Tomoya Sato, Tsutomu Endo, Yoshinao Koike, Hideki Sudo, M Alaa Terkawi, Huohuo Xue, Ryo Fujita, Soya Miura, Ryota Suzuki, Yukitoshi Shimamura, Masahiro Kanayama, Ken Kadoya, Katsuhisa Yamada, Daisuke Ukeba, Misaki Ishii, Norimasa Iwasaki","doi":"10.2106/JBJS.OA.25.00195","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Ossification of the posterior longitudinal ligament (OPLL) is relatively common in East Asian populations, with a recently revealed link to obesity. However, evidence linking OPLL with visceral fat obesity, which is prevalent in the Asian population, is insufficient. We aimed to examine the association between visceral fat obesity and the development of OPLL.</p><p><strong>Methods: </strong>In a single-center case-control study, data were collected from 120 Japanese patients diagnosed with OPLL and 91 controls without spinal ligament ossification identified during health screenings. From 2020 to 2023, all participants underwent computed tomography to assess visceral fat content and spinal ligament ossification. OPLL was classified as localized (cervical spine) or diffuse (thoracic/lumbar spine). Multivariable logistic regression was conducted to assess the effect size (odds ratio [OR]) of body mass index on the incidence of OPLL and to compare outcomes between groups with a high and low visceral/subcutaneous fat area (V/S) ratio.</p><p><strong>Results: </strong>The proportion of patients with visceral fat obesity was significantly higher in both the localized and diffuse OPLL groups than in the controls (58.9% vs. 64.1% vs. 25.2%, p < 0.05). Patients with OPLL had a higher rate of comorbid visceral fat obesity than the propensity score-matched controls did (56.8% vs. 18.1%, p < 0.001). The effect of BMI on the development of diffuse OPLL was 2.6-fold greater in the high V/S ratio group (OR, 9.50; 95% confidence interval [CI], 2.11 to 42.71) than in the low V/S ratio group (OR, 3.56; 95% CI, 1.51-8.37).</p><p><strong>Conclusions: </strong>Visceral fat obesity was associated with the development of OPLL, particularly diffuse OPLL. The modifying effect of visceral fat accumulation with overweight status was more strongly associated with diffuse OPLL than was that of subcutaneous fat combined with an overweight status.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 4","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503146/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Open Access","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.OA.25.00195","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/10/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Ossification of the posterior longitudinal ligament (OPLL) is relatively common in East Asian populations, with a recently revealed link to obesity. However, evidence linking OPLL with visceral fat obesity, which is prevalent in the Asian population, is insufficient. We aimed to examine the association between visceral fat obesity and the development of OPLL.
Methods: In a single-center case-control study, data were collected from 120 Japanese patients diagnosed with OPLL and 91 controls without spinal ligament ossification identified during health screenings. From 2020 to 2023, all participants underwent computed tomography to assess visceral fat content and spinal ligament ossification. OPLL was classified as localized (cervical spine) or diffuse (thoracic/lumbar spine). Multivariable logistic regression was conducted to assess the effect size (odds ratio [OR]) of body mass index on the incidence of OPLL and to compare outcomes between groups with a high and low visceral/subcutaneous fat area (V/S) ratio.
Results: The proportion of patients with visceral fat obesity was significantly higher in both the localized and diffuse OPLL groups than in the controls (58.9% vs. 64.1% vs. 25.2%, p < 0.05). Patients with OPLL had a higher rate of comorbid visceral fat obesity than the propensity score-matched controls did (56.8% vs. 18.1%, p < 0.001). The effect of BMI on the development of diffuse OPLL was 2.6-fold greater in the high V/S ratio group (OR, 9.50; 95% confidence interval [CI], 2.11 to 42.71) than in the low V/S ratio group (OR, 3.56; 95% CI, 1.51-8.37).
Conclusions: Visceral fat obesity was associated with the development of OPLL, particularly diffuse OPLL. The modifying effect of visceral fat accumulation with overweight status was more strongly associated with diffuse OPLL than was that of subcutaneous fat combined with an overweight status.
Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景：后纵韧带骨化（OPLL）在东亚人群中相对常见，最近发现与肥胖有关。然而，将OPLL与亚洲人群中普遍存在的内脏脂肪性肥胖联系起来的证据并不充分。我们的目的是研究内脏脂肪肥胖与OPLL发展之间的关系。方法：在一项单中心病例对照研究中，收集了120名诊断为OPLL的日本患者和91名健康筛查中未发现脊髓韧带骨化的对照组的数据。从2020年到2023年，所有参与者都接受了计算机断层扫描，以评估内脏脂肪含量和脊柱韧带骨化。OPLL分为局限性（颈椎）和弥漫性（胸/腰椎）。采用多变量logistic回归来评估体重指数对OPLL发病率的影响大小（比值比[OR]），并比较内脏/皮下脂肪面积（V/S）比高组和低组之间的结果。结果：局限性OPLL组和弥漫性OPLL组内脏脂肪性肥胖患者比例均显著高于对照组（58.9% vs. 64.1% vs. 25.2%, p < 0.05）。与倾向评分匹配的对照组相比，OPLL患者合并内脏脂肪性肥胖的比例更高（56.8% vs. 18.1%, p < 0.001）。BMI对弥漫性OPLL发展的影响在高V/S比组（OR, 9.50； 95%可信区间[CI]， 2.11 ~ 42.71）比低V/S比组（OR, 3.56; 95% CI, 1.51 ~ 8.37）高2.6倍。结论：内脏脂肪性肥胖与OPLL的发展有关，尤其是弥漫性OPLL。超重状态下内脏脂肪积累的调节作用与弥漫性OPLL的相关性比超重状态下皮下脂肪积累的调节作用更强。证据等级：治疗性III级。有关证据水平的完整描述，请参见作者说明。
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