Light and Electron Microscopy of Hydroxyapatite Depositions in the Ligamentum Flavum

Hijioka, Akihiko; Suzuki, Katsumi; Nakamura, Toshitaka; Yokoyama, Mitsuru; Kanazawa, Yosuke

doi:10.1097/00007632-199412000-00005

Cited by 19 publications

(10 citation statements)

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“…As for the mechanism and localization of calcification, degeneration of the facet joint may give rise to calcification in the anteromedial and the posterior regions of the articular capsule or HAP crystal deposition may be brought about by induction of neocapillarization in the cure process of the very small trauma in the dorsal side of the ligamentum flavum. 47,48 In ultrastructural study, it was reported that calcification was observed in the matrix vesicles originating from necrotic cells. 49 -51 Many reports suggested that hypertrophied ligamentum flavum associated with calcification.…”

Section: Discussionmentioning

confidence: 99%

“…This histology can also be seen not only in granulation but also in hemorrhage, and it is considered that blood capillaries within granulation tissue around the facet joint may be broken down by repetitive stress, 21,22 resulting in formation of granulomatous cyst as reactive lesions of giant cells. Some reported that cumulative minor trauma initially may induce the neocapillarization and localization within the ligament in the dorsal side of the ligamentum flavum 48 and that there were more capillaries in the median portion compared with the marginal portion within the ligament on the intralamina. 15 However, in our cases, capillaries extended diffusively without any localization.…”

Section: Discussionmentioning

confidence: 99%

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The Pathology of Ligamentum Flavum in Degenerative Lumbar Disease

Okuda

Baba²,

Fujimoto³

et al. 2004

Spine

107

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Various pathologic findings provided important foundations for discussing the pathogenesis of lesions in ligamentum flavum. Calcification was frequently observed in elderly patients and those with cauda equina symptoms, and these patients tended to have severer preoperative symptoms. Chondroid cells were frequently observed in patients with spondylolisthesis, and patients with ossification had a greater % slip, suggesting involvement of mechanical load in ossification of ligaments. The pathologic findings were significantly related to the clinical features, and these findings will be profitable for understanding the pathogenesis of degenerative lumbar disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Pathology of Ligamentum Flavum in Degenerative Lumbar Disease

Okuda

Baba²,

Fujimoto³

et al. 2004

Spine

107

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“…It has been suggested that repetitive microtrauma to the LF is the initial inciting event, which may lead to neovascularization, and calcium crystal deposition may occur because of the increased permeability of the newly formed vessels. 20 Others have suggested that hypertrophy of the LF is a predisposing factor for CLF. 4 Degeneration of the LF caused by localized nutritional deficiency is yet another possible contributing factor that has been advanced as being of possible etiologic significance.…”

Section: Discussionmentioning

confidence: 99%

Acute Quadriparesis Caused by Calcification of the Entire Cervical Ligamentum Flavum in a White Female—Report of An Unusual Case And A Brief Review of the Literature

Khan

Smith

Donaldson

2005

Spine

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“…Our findings in case 1 reinforce this hypothesis. However, recent reports favour a wider spectrum of histopathological features, such as HAP in the dural side of the ligamenta flava [4] or acute inflammation accompanying the crystalline deposits [5]. It is commonly accepted that mineralized deposits precipitate around the degenerated elastic fibers of the ligamentum flavum [9] due to a conjunction of various factors including aging process, decrease in oestrogen in older women, mechanical stress of the mid-cervical spine [13] and chondrocytic metaplasia [12].…”

Section: Discussionmentioning

confidence: 99%

Myelopathy due to calcification of the cervical ligamenta flava: a report of two cases in West Indian patients

Pascal‐Moussellard

Cabre

Smadja

et al. 1999

European Spine Journal

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IntroductionCalcification of the ligamenta flava (CLF) of the cervical spine causing myeloradiculopathy is a rare disorder occasionally reported in Japanese people [6]. CLF seems to be exceptional in non-Asian populations. We encountered for the first time two such cases in black patients living in the French West Indies. We present here the clinical and radiological findings and outcome in these patients. Case reportsCase 1A 72-year-old black woman first noticed numbness in her hands 3 months before admission. During the next weeks, she had difficulty walking and working with her hands. She had no history of spinal injury or rheumatic disease. On admission, the gait was clearly ataxic and neurological exam showed a proximal weakness in the lower limbs. There was no impairment of touch sensation, but position sense, in particular, was absent in all limbs. Deep tendon reflexes were brisk, a bilateral Hoffman sign was found and plantar responses were extensor. She complained of neither radiating pain nor urinary symptoms. General examination was otherwise normal. Routine blood tests were unremarkable. Myelography revealed a partial block at the level C4-C5 and a subsequent CT scan showed voluminous oval masses involving both ligamenta flava at the same level (Fig. 1). The patient was then treated with posterior decompressive C4 and C5 laminectomies. At surgery, the above masses appeared as white granular deposits within degenerated ligamenta flava and were easily dissected from the dura matter. Microscopic examination of the removed material revealed hydroxyapatite crystals (HAP) at the centre of the nodules, surrounded by calcium pyrophosphate dihydrate crystals (CPPD). After surgery, there was dramatic improvement. The gait returned to nearly normal and disturbances of the deep sensation Abstract Two cases of cervical myelopathy due to calcification of the ligamenta flava (CLF) are described for the first time in black patients from the French West Indies. A pre-operative CT scan differentiated the diagnosis from one of ossification of the ligamenta flava. Microanalysis on the operatively excised specimen in one patient revealed a mixture of calcium pyrophosphate dihydrate crystals and hydroxypatite crystals. Poor outcome in one patient contrasting with excellent recovery in the other one, who had undergone posterior decompressive laminectomy, emphasizes the importance of surgery in the management of CLF.

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Light and Electron Microscopy of Hydroxyapatite Depositions in the Ligamentum Flavum

Cited by 19 publications

References 0 publications

The Pathology of Ligamentum Flavum in Degenerative Lumbar Disease

The Pathology of Ligamentum Flavum in Degenerative Lumbar Disease

Acute Quadriparesis Caused by Calcification of the Entire Cervical Ligamentum Flavum in a White Female—Report of An Unusual Case And A Brief Review of the Literature

Myelopathy due to calcification of the cervical ligamenta flava: a report of two cases in West Indian patients

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