Cervical Ligamentum Flavum Ossification -Two Case Reports-

Abstract

A 58-year-old woman (Case 1) presented with disturbance of fine movement and gait. Magnetic resonance (MR) imaging and computed tomography (CT) demonstrated bilateral ossified ligamentum flava at the C3-4 and C4-5 levels and severe cervical canal stenosis. She underwent posterior decompression and despite strong adhesion to the dura mater, the ossified ligamentum flavum was removed without inducing liquorrhea. Her neurological symptoms improved postoperatively. A 63-year-old man (Case 2) was admitted with disturbance of fine movement and gait that had developed gradually. MR imaging and postmyelography CT demonstrated cervical canal stenosis via the ossified posterior longitudinal ligament at the C4-6 levels and ossified ligamentum flavum on the right at the C4-5 levels. He underwent right posterior decompression of C4-5. After right hemilaminectomy of C4-5, the ligamentum flavum was exposed. Neither the ligamentum flavum nor the ossification had adhered to the dura mater, so complete removal was successful and he recovered completely from his neurological symptoms. Diffuse-type ossified ligamentum flavum had adhesion to the dura mater, as in our Case 1, whereas focal-type ossified ligamentum flavum did not, as in our Case 2. This information is useful for treatment planning.

The Symptomatic Calcification and Ossification of the Ligamentum Flavum in the Spine: Our Experience and Review of the Literature

“…CLF: All cases of CLF were elderly females aged ≥70 years, which is in line with previous studies, in which most cases were Asian females aged ≥70 years [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The lesion was predominantly located in the middle or lower cervical spine, consistent with previous reports [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

“…CLF: All cases of CLF were elderly females aged ≥70 years, which is in line with previous studies, in which most cases were Asian females aged ≥70 years [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The lesion was predominantly located in the middle or lower cervical spine, consistent with previous reports [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. In the present study, the prevalence of CLF requiring surgery in spondylotic changes was 15 (0.83%) out of the 1800 cases who presented to MIMH and OMUH between April 2010 and March 2022 for spinal surgery due to neurological symptoms and spondylotic changes.…”

“…Notably, there are no previous reports of CLF [ 4 ]. The neurological symptoms and signs included gradually progressive myelopathy ( Table 1 and Table 2 ) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. These symptoms and signs developed gradually due to the compression of the spinal cord by the calcified mass ( Table 1 and Table 2 ).…”

“…MR T1- and T2-weighted images depicted these mass lesions as low intensity or isointense, with compression of the spinal cord. The presence of low-intensity and isointense regions suggested a combination of calcified regions and ligamentum tissue ( Table 3 , Figure 1 and Figure 2 ) [ 3 , 4 , 6 , 7 , 9 , 10 , 12 , 14 , 15 , 17 ].…”

“…Calcification of the ligamentum flavum (CLF) is a disease that spinal surgeons often encounter. Some studies have categorized CLF as distinct from the ossification of the ligamentum flavum (OLF) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. The clinical, radiological, and histopathological features and surgical management of CLF are well-known [ 1 , 2 , 4 , 7 , 11 , 12 , 13 , 14 , 15 , 16 ].…”