Cervical Myelopathy Secondary to Combined Ossification of Ligamentum Flavum and Posterior Longitudinal Ligament

Abstract

In the cervical spine, the combined ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. Patients are usually treated with cervical laminectomy or laminoplasty with OLF resection. In most of the cases, OLF is adhered to the dura and there is a risk of dural tear or cerebrospinal fluid (CSF) leakage during its resection. In this case report, authors present results of laminectomy with debulking instead of complete excision of OLF for spinal cord decompression in a cervical myelopathy case where OLF was adhered to the dura. A 69-year-old man presented with insidious-onset weakness in bilateral lower limbs and unsteady gait since 1 month. He had a history of neck pain with left upper limb radiation for 2 years. Magnetic resonance imaging (MRI) showed C5 to C6 severe central canal stenosis with underlying myelomalacia. Computed tomography (CT) showed OPLL and OLF contributing to severe central canal stenosis at C5 to C6 level. Patient underwent C4 to C6 laminectomy, debulking of OLF, posterior instrumentation, and fusion with autogenous bone graft from C3 to C6. Histological specimen showed osseous tissue within the ligamentum flavum. After surgery, patient's symptoms improved, and no recurrence was observed at 4 years after surgery. The symptoms of myelopathy were successfully treated with debulking instead of complete excision of OLF, thus reducing the risk of dural tear or CSF leakage.

Endoscopic Bilateral Decompression for Cervical Stenosis Caused by Calcification of Ligamentum Flavum Through Unilateral Approach

“…4 Although conservative treatment can be found in the literature, 3 surgical decompression is recommended for patients with severe or progressive neurological deficits. 5,6 For cervical CLF, osteoplastic open-door laminoplasty was used for decompression of multisegmental compressive lesions and microscopic laminotomy for single-level lesions. 5 However, adverse reactions after open surgery, such as axial pain, 7 promote the use of minimally invasive procedures.…”

“…Myeloradiculopathy symptoms caused by CLF, such as numbness, dysesthesia, weakness of extremities, or pain, are similar to cervical spondylosis or ossification of the posterior longitudinal ligament 4. Although conservative treatment can be found in the literature,3 surgical decompression is recommended for patients with severe or progressive neurological deficits 5,6…”