The Main Immune Markers of Ligamentum Flavum Hypertrophy: A Narrative Literature Review

LF hypertrophy contributes to the narrowing and compression of neural structures, impairing limb function. It is a leading cause of spinal stenosis, particularly in the lumbar region. About 20% of those over 60 show lumbar stenosis on imaging, but over 80% have no symptoms. Surgery is the main treatment option and is only recommended for symptomatic cases. The exact cause of LF hypertrophy remains unclear, though chronic inflammation, fibrosis and oxidative stress are implicated. Research consistently shows that increased cytokines and growth factors drive extracellular matrix remodeling, immune cell infiltration, and fibroblast and osteoblast activation. The aim of this article is to briefly review the role of the main immune markers that are involved in the pathogenesis of LF hypertrophy. This narrative review is based on a PubMed literature search and includes 23 original articles published between 2019 and 2026.