Treatment of ossification of ligamentum flavum complicated with lumbar spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the imaging characteristic and operation outcome of ossification of ligamentum flavum with lumbar spinal stenosis.</p><p><b>METHODS</b>January 2013 to January 2016, 9 patients with ossification of ligamentum flavum with lumbar spinal stenosis were treated, included 5 males and 4 females, aged from 51 to 63 years old with an average of 57 years old. All patients complained intermittent claudication and radiating pain at lower limb. The pathologic change regions examined by CT or MRI were as follows:2 cases in L₄,₅ and L₅S₁, 5 in L̀,̀, and 2 in L₅S₁. Four patients underwent simple laminectomy and 5 patients underwent laminectomy and discectomy, interbody fusion and internal fixation with pedicle screw. Clinical effects were evaluated according to JOA score, which items included subjective symptom, daily activity limitation, clinical sign and bladder function.</p><p><b>RESULTS</b>No complications such as infection or nerve injury were found after operation. The follow-up period was from 12 to 60 months with an average of 24 months. The low back pain and radiating pain at lower limb improved significantly and walking distance approached normal at final follow-up;and JOA scores improved obviously.</p><p><b>CONCLUSIONS</b>Ossification of ligamentum flavum has the special characteristic on CT scan, which decide the selection of operation method. The operative aim is effectively spinal decompression and rebuilding lower lumbar stability by minimally invasive surgery.</p>

Unilateral Absent Foramen Complex In Middle Cranial Fossa: An Interesting Case Report

We report a case of 50 years female suffering from compression neuropathy due to ossification of ligamentum flavum. This ossification of ligamentum flavum usually presents with neuropathy in the setting of thoracic spinal stenosis.

Compression Neuropathy Due To Ossification Of Ligamentum Flavum

We report a case of 50 years female suffering from compression neuropathy due to ossification of ligamentum flavum. This ossification of ligamentum flavum usually presents with neuropathy in the setting of thoracic spinal stenosis

Ossification of the Ligamentum Flavum

Ossification of the ligamentum flavum is a rare cause of thoracic myelopathy. It develops in East Asians more frequently than in people from other areas. The exact pathophysiology has not been elucidated yet; however, it largely depends on biomechanical alterations, especially changes in the tensile force. Because the spinal cord is compressed from the posterior side, the first and most common clinical manifestation is usually loss of functional gait and spastic paralysis, which develop as the spinal cord compression progresses. The choice of diagnostic imaging is T2 sagittal magnetic resonance imaging scanning. Whole spine scanning is mandatory to identify multiple areas of compression and any associated distal lumbar diseases. Fine computed tomography imaging is necessary to make a differential diagnosis and set up a precise surgical plan. Conservative treatment does not work in this disorder. Decompression surgery is the only option and prognosis after surgical treatment is better with this disorder than with other causes of thoracic myelopathy. The severity of preoperative symptoms and the time interval before surgical treatment are the most important prognostic factors.

Progressive Relapse of Ligamentum Flavum Ossification Following Decompressive Surgery

Thoracic ossification of the ligamentum flavum (T-OLF) is a relatively rare spinal disorder that generally requires surgical intervention, due to its progressive nature and the poor response to conservative therapy. The prevalence of OLF has been reported at 3.8%-26%, which is similar to that of cervical ossification of the posterior longitudinal ligament (OPLL). The progression of OPLL after cervical laminoplasty for the treatment of OPLL is often shown in long-term follow-up. However, there have been no reports on the progression of OLF following surgery. We report a case of thoracic myelopathy secondary to the progressive relapse of OLF following laminectomy.

Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

OBJECTIVE: Ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy. The aim of this study was to identify factors associated with the surgical outcome on the basis of preoperative clinical and radiological findings. METHODS: Data obtained in 26 patients whot underwent posterior decompression for thoracic myelopathy, caused by thoracic OLF, were analyzed retrospectively. Patient age, duration of symptoms, OLF type, preoperative and postoperative neurological status using the Japanese Orthopedic Association (JOA) scoring system, surgical outcome, and other factors were reviewed. We compared the various factors and postoperative prognosis. All patients had undergone decompressive laminectomy and excision of the OLF. RESULTS: Using the JOA score, the functional improvement was excellent in 8 patients, good in 14, fair in 2, and unchanged in 2. A mean preoperative JOA score of 6.65 improved to 8.17 after an average of 27.3 months. According to our analysis, age, gender, duration of symptoms, the involved spinal level, coexisting spinal disorders, associated trauma, intramedullary signal change, and dural adhesions were not related to the surgical outcome. However, the preoperative JOA score and type of OLF were the most important predictors of the surgical outcome. CONCLUSION: Early diagnosis and sufficient surgical decompression could improve the functional prognosis for thoracic OLF. The postoperative results were found to be significantly associated with the preoperative severity of myelopathy and type of OLF.

Compressive Myelopathy due to Ossification of Ligamentum Flavum in a Patient with Primary Hypoparathyroidism

No abstract available.

Thoracic Myelopathy Due to Ossification of Ligamentum Flavum: Three cases Report / 대한척추외과학회지

Ossification of the ligamentum flavum (OLF) is a definite clinical entity and is thought to be a form of ectopic ossification which develops predominantly in the lower thoracic spine. OLF causes progressive compressive myelopathy, radiculopathy, or combination of both. We experienced 3 cases of OLF with neurological symptoms, which were treated by posterior decompressive laminectomy and removal of the ossified ligamentum flavum with or without fusion with symptomatic improvement.

Spontaneous Spinal Epidural Hematoma Associated with the Ossification of Ligamentum Flavum of the Thoracic Spine

Spontaneous Spinal Epidural Hematoma has been reported to be associated with vascular malformations, tumors, infections, pregnancy, ankylosing spondylitis, rheumatoid arthritis, artherosclerosis, and hypertension. Approximately half of the cases, however, have no apparent cause. The most widely accepted hypothesis of the source of bleeding is that epidural veins are torn by the variations of abdominal or thoracic pressure. The normal hemodynamic fluctuations during usual daily activities are not, however, enough to explain the rare incidence of the spontaneous spinal epidural hematoma, requiring further consideration of the pathogenic factors. The author experienced a case of spontaneous spinal epidural hematoma associated with the ossification of the ligamentum flavum at the lower portion of the hematoma. Venous bleeding from distended epidural veins was observed at the lateral sides of the dural sac after removal of the hematoma. In addition, no vascular malformation was not found in the operative field. Consequently, the auther cautiously suggests that the ossification of the ligamentum flavum may have resulted in the formation of an abnormally dilated vein which ultimately caused bleeding in the patient.

Sacral Radiculopathy Due to Ossification of Ligamentum Flavum and Posterior Longitudinal Ligament: One Case Report / 대한정형외과학회잡지

Ossification of the ligamentum flavum(OLF) is a well recognized cause of acquired spinal canal stenosis resulting in myelopathy, radiculopathy, or a combination of both. OLF is extremely rare in caucasian patients, but is one of the most common causes of compression of the posterior thoracic spinal cord in Japan. In most cases, it has been found in the thoracolumbar regions, and rarely in the cervical region. It is frequently but not alwalys found in association with ossification of the posterior longitudinal ligament(OPLL) and may cause cumulative damage, if comhined with OPLL. We experienced a case of ossification of the ligamentum flavum and posterior longitudinal ligament with sacral radiculopathy, which was treated hy posterior decompressive laminectomy and removal of the ossified ligamentum flavum and posterior longitudinal ligament. The day after operation, the radiating pain and paresthesia dramatically improved.

Eight Cases of Thoracic Stenosis due to Ossification of Ligamentum Flavum

The authors report eight cases of thoracic stenosis due to ossification of ligamentum flavum. Motor and sensory deficits were found in all cases and urinary incontinence was found in one case. Diagnosis was made from simple x-rays, myelography, computerized tomography, myelography-CT, and magnetic resonance imaging. Treatment consisted of sufficient posterior decompressive laminectomy and medial facetectomy which resulted in satisfactory improvement in 6 cases, fair course in 1 case and poor course in 1 case.

Three Cases of Thoracic Myelopathy due to Ligamentum Flavum Ossification

Ossification of ligamentum flavum is a very rare disease and one of the new disease entities in myelopathy. We report three cases of ossification of ligamentum flavum in thoracic spine causing thoracic myelopathy. Main symptoms of this disease are numbness of both legs and feet, gait disturbance and spastic motor weakness. Simple spine X-ray, metrizamide myelogram, CT and MRI are most useful diagnostic tools. Sufficient decompressive laminectomy and facetectomy are treatment of choice.

Three Cases of Ossification of Ligamentum Flavum Causing Thoracic Myelopathy

The authors report three cases of ossification of ligamentum flavum causing thoracic myelopathy. The symptoms of all cases were numbness in the legs and feet and motor weakness. Preoperative diagnosis were simple spine X-ray, metrizamide CT and magnetic resonance imaging. There was satisfactory improvement in all cases after total laminectomy and medial facetectomy.

Ossification of Spinal Ligaments

This authors reviewed the radiographs of 20,057 patients with spinl radiculomyelopathy from April 1983 August 1990. The incidence and distribtion of the ossification of the spinal ligaments were analized as following. 1) The overall incidence of spinal ligaments ossification was 3.6% among 20,057 patients. 2) The most frequently occurs at lumbar area(67.1%), and then cervical(27.5%) thoracic(0.4%) area as in orders. 3) The OPLL was most common type(2.19%) of these spinal ligaments ossification, and then OALL(0.7%), OLF(0.24%) as in orders. 4) OPLL (1) OPLL was most frequent at lumbar area(58.6%) and then cervical(37.0%), thoracic(0.4%) area as in orders. (2) The cervical OPLL was commonly found at C5 & C6 area and morphologically, the multiple segmented type was most common then continuous type, mixed type and single segmented type in orders. (3) The multiple segmented type was more frequently found at upper cervical area, but the continuous type was more frequent at lower cervical area. 5) OALL (1) OALL was most frequent at lumbar area(86.0%) but thoracic(1.4%) and cervecal area(5.3%) were relatively low in frequency. (2) Of the lumbar OALL, the L4/5 area was most frequent site(37.8%) but the L3/4(25.3%) and L5/S1 area(24.5%) also had relatively high occurance rate. 6) OLF (1) OLF was most frequent at lumbar area(92.7%), but the incidence of OLF was relativerly rare at cervical(2.1%) and thoracic area(5.2%). (2) Of the lumbar OLF, the L4/5 area was most common site(33.1), but L5/S1 area had also high occurance rate(27.2%).

Myelopathy due to Ossification of Ligamentum Flavum

The 4 cases of myelopathy due to ossification of the ligamentum flavum are reported. This disease is often misdiagnosed by the central disc herniation, cauda equina tumor or lower motor neuron disease. The most useful diagnostic procedure is the computerized tomographic myelopgraphy. The sufficient decompressive laminectomy and facetectomy is a treatment of choice.

OSSIFICATION OF THE LIGAMENTUM FLAVUM IN THE THORACIC SPINE: A REPORT OF TWENTY-SIX CASES / 解放军医学杂志

Twenty-six patients with stenosis of the thoracic spinal canal and myelopathy caused by ossification of the ligamentum flavum were treated from 1983 to June 1991. There were 21 patients with spastic paraplegia and 5 with flaccid paraplegia in the series. The findings on radiograms, CT scans, myelograms and MRI were described. Total laminectomy was performed in all of the patients which resulted in an effective rate of 91.6% and exellent and good results in 83.3%. The mechanism of the disease our experience in diagnosis and surgical treatment, causes of misdiagnosis and surgical techniques are discussed.