Ossification of the Ligamentum Flavum of the Cervical Spine in an Iranian Woman: Report of a Case With Myelopathy and Review of the Literature (original) (raw)
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Surgical Neurology International
Background: Symptomatic compression of the cervical spinal cord by ossification of the ligamentum flavum (OLF) is rare. It typically involves the elderly and is particularly prominent in the Asian male population. Here, we present a 70-year-old Pakistani female who became quadriparetic due to OLF. Case Description: A 70-year-old female became increasingly quadriparetic over 3 months duration, but exhibited preservation of vibration and proprioception. The cervical magnetic resonance/computed tomography revealed dorsal OLF measuring 7 mm × 25 mm × 14 mm. Two months following a decompressive laminectomy, her symptoms fully resolved. Conclusion: Although rare in older patients, cervical OLF may contribute to significant cervical myelopathy characterized by a progressive quadriparesis that can be readily resolved with a decompressive laminectomy.
Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy
Indian Journal of Orthopaedics, 2009
High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure. Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2-3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3-6 spondylotic changes. A decompressive laminectomy using "posterior floating and enbloc resection" brought significant relief in myelopathy. Histopathology showed mature bony trabeculae, bone marrow and ligament tissue. The coexisting mobile cervical vertebral segment above and congenitally fused or spondylotic rigid segment below the level of LF may have led to abnormal strain patterns within resulting in its unilateral ossification. In dealing with cervical OLF, carefully preserving facets during laminectomy or laminoplasty helps in maintaining normal cervical spinal curvature.
Ossification Of The Ligamentum Flavum Of The Lumbar Spine In Caucasians: Case Series
Journal of Spine & Neurosurgery, 2017
Ossification of the ligamentum flavum or OLF is a disease with heterotopic ossification in this spinal ligament. The key of OLF pathogenesis is the differentiation of fibroblasts into osteoblasts. The majority of cases of ossification of the yellow ligament occur at the lower third of the thoracic or the thoracolumbar spine. However, the literature contains only few reports of patients with OLF of the lumbar spine. The clinical presentation of lumbar OLF is radiculopathy or intermittent neurogenic claudication, although some might remain asymptomatic. Herein, we present 8 Caucasians with symptomatic lumbar OLf. The age and gender as well as the clinical picture, characteristic radiological features, the number of the affected levels will be described. The tips and tricks for achievement of a successful decompressive laminectomy, as the treatment of choice, done at one level in three and at two levels in five cases will be described. Furthermore, the degree of adherence of the lesions to dura and ultimate outcome will be discussed.
Spondylitis and posterior longitudinal ligament ossification in the cervical spine
Arthritis & Rheumatism, 1983
Ossification of the posterior longitudinal ligament of the cervical spine is seen most frequently among Japanese: it is reported in about 3% of the adult Japanese population (1 1. Reports outside Japan have been rather sporadic in nature and have involved only a small number of patients (2,3). The ossification may lead to narrowing of the spinal canal and cause various neurologic signs and symptoms. It also can be asymptomatic, however. The etiology of the condition is not clear. Resnick et a1 (4) have recently reported an association between ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis. We here report a case of ossification of this ligament of the cervical spine in an HLA-B27-positivc patient with ankylosing spondylitis. Case Report. A 36-year-old white man was first seen at Cleveland Metropolitan General Hospital in 1973, complaining of chronic low back pain of 5 years' duration. The back pain had worsened during the preceding year and was associated with pain in both shoulders and both hips. The pain, constant and aching in nature, was not relieved much by aspirin and was exacerbated both by heavy manual work and by lack of activity. The patient denied any pain in the From the Departments of Radiology and Medicine, Case Western Reserve University at Cleveland Metropolitan General Hospital. Cleveland, OH. Supported in part by Irma H. Bender Arthritis Research Fund. Rauf Yagan. MD: Assistant Professor of Radiology; Muhammad A. Khan, MD: Associate Professor of Medicine, Division of Rheumatology; Errol M. Bellon, MD: Professor of Radiology. Address reprint requests to Rauf Yagan, MD. Department of Radiology. Cleveland Metropolitan General Hospital. 3395 Scranton Road, Cleveland, OH 441W.
Myelopathy caused by Ossification of Thoracic Ligamentum Flavum
Indonesian Journal of Rheumatology, 2018
Hypertrophy of the posterior spinal elements leading to compromise of the spinal canal and its neural elements is a well-recognized pathological entity affecting the lumbar or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized rheumatological,metabolic, or orthopedic disorder, or a history of trauma is generally considered to be rare. Spinal ligaments, such as the ligamentum flavum (LF), are prone to degeneration and can lead to back pain and nerve dysfunction. Ossification of ligamentum flavum (OLF) is a pathological condition that cause neurological symptoms and usually occurs in the thoracic spine and less frequently in the cervical spine. However the disease is now being increasingly recognized as acause of thoracic myelopathy. We report a rare case of thoracic myelopathy caused by OLF. A 48-year-old male presented with a chief complaint of weakness of bilateral lower extremities. Neurological examination revealed sensory deficit at Th 11 level b...
Surgical Neurology, 2006
Background: Ossification of ligamentum flavum in the thoracic region causing compressive myelopathy among middle-aged patients is a poorly described entity. Case Description: Five patients of Indian origin with OYL are described. Their clinical presentations, surgical options, and long-term outcome are presented. Radiologic and clinical follow-up of one of the patient is described over a span of 10 years. Conclusions: Decompressive laminectomy and excision of the OYL is the commonly performed surgical procedure. A rapid neurologic improvement follows decompression. The persistent spasticity in certain patients is attributed to irreversible changes within the cord. The disease is thought to be progressive in nature. The prolonged follow-up of these patients suggests that the longterm prognosis is poor. Selective racial involvement and variable clinical presentations, with treatment options, are discussed. D
Ossification of the ligamentum flavum: a unique report of a Hispanic woman
Neurosurgical Focus, 2011
T he ligamentum flava are broad paired spinal ligaments that connect the adjacent laminae of the vertebral column extending from C-2 to S-1. 9,27,52 These ligaments can undergo uni-or bilateral hypertrophy, calcification, or ossification. 30 Ossification of the ligamentum flavum is an acquired degenerative disease that was first described by Polgar 36 in 1920 on lateral radiograms. It occurs through endochondral ossification of hypertrophied fibrous tissue within the ligaments. Ossification of the ligamentum flavum is a relatively rare disease, and there are insufficient controlled epidemiological data in the literature. Ossification of the ligamentum flavum is reported to affect 20% of Asians older than 65 years of age. 10 Although OLF has been reported as endemic to Japan, reports from outside of this endemic area-North Africa, 2,5,13 the Middle East, 3
Ossification of the posterior longitudinal ligament in the cervical spine
O ssificatiOn of the posterior longitudinal ligament is a condition of abnormal calcification of the posterior longitudinal ligament. The most common location is at the cervical spine region. The spinal cord can be compressed by this lesion, which can cause neurological deficits. The treatment of choice for patients with symptomatic OPLL is surgery to relieve spinal cord compression. However, there are many unresolved controversies concerning OPLL: the exact pathogenesis and natural history of OPLL are still unclear, there is no standard treatment for patients with asymptomatic OPLL, and there is disagreement about the best surgical approach for OPLL surgery. In this study, we review the current literature including the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL. Methods The PubMed databases were searched for publications from January 2000 through August 2010 using the MeSH terms "OPLL" and "ossification of posterior longitudinal ligament." The search was limited to articles in the English language. Related reference sections of recent articles were reviewed and pertinent articles identified. Full-texts manuscripts of all articles were obtained and reviewed. Radiographic images from the senior author's institution are also included. Results Incidence The incidence of OPLL was reported by Tsuyama et al. 126 The incidence is 2.4% in Asian populations and 0.16% in non-Asian populations, with the highest rates in Japan. OPLL is twice as common in men as in women, and symptomatic OPLL usually presents in the 5th to 6th decade of life. Most studies of OPLL are reported from Asian countries, but anecdotal reports of OPLL cases in European countries also exist in the literature. Maiuri et al. 72 reported on 8 Italian patients with cervical spine stenosis due to OPLL.
Symptomatic Ossification of the Ligamentum Flavum: A Clinical Series From the French Antilles
Spine, 2005
Study Design. A series of 14 patients from the French Antilles treated for ossification of the ligamentum flavum (OLF). Objectives. To describe the clinical and radiologic aspects, as well as disease course in a group of Caribbean patients. Also describe the use of sagittal computerized tomography (CT) reconstructions to distinguish OLF from calcification of the ligamenta flava. Summary of Background Data. OLF is a rare disease described almost exclusively in Japanese patients. Only rarely are patients of African descent affected. No series of OLF in African American or African Caribbean subjects has previously been published. Methods. A retrospective study of 14 consecutive patients, including 7 men and 7 women (mean age, 66.8 years), was conducted from 1996 to 2003. Diagnosis in each case was established using CT. Magnetic resonance imaging was also performed in every case. For the 11 patients treated surgically, pathology studies were performed. Results. Walking difficulties were the most common presenting complaint. A picture of spastic paraparesis associated with sphincter dysfunction was the most common finding on initial examination. In each case, CT provided sufficient information to establish a diagnosis of OLF, while magnetic resonance imaging was helpful for showing spinal cord involvement. In most of the patients, OLF was located in the lower thoracic spine. Surgical decompression through a posterior approach resulted in regression of symptoms in all 11 patients treated surgically. Conclusions. This study is the first reported series of OLF in a group of Caribbean patients. The disease appears to be underreported in the African Caribbean population. OLF can lead to debilitating thoracic myelopathy. Surgery is frequently indicated and achieves favorable results.
BMC musculoskeletal disorders, 2016
Supra/interspinous ligaments connect adjacent spinous processes and act as a stabilizer of the spine. As with other spinal ligaments, it can become ossified. However, few report have discussed ossification supra/interspinous ligaments (OSIL), so its epidemiology remains unknown. We therefore aimed to investigate the prevalence and distribution of OSIL in symptomatic patients with cervical ossification of the posterior longitudinal ligament (OPLL). The participants of our study were symptomatic patients with cervical OPLL who were diagnosed by standard radiographs of the cervical spine. The whole spine CT data as well as clinical parameters such as age and sex were obtained from 20 institutions belong to the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament (JOSL). The prevalence and distribution of OSIL and the association between OSIL and clinical parameters were reviewed. The sum of the levels involved by OPLL (OP-index) and OSIL (OSI-index) as wel...