Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review

Abstract

Study design: Case report and literature review. Objective: To illustrate that ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in a Caucasian patient and that timely surgery can lead to a good outcome. Setting: Nottingham, UK. Methods: Proximal multiple contiguous ossified thoracic ligamenta flava from T3/T4 to T5/T6 causing acute myelopathy was diagnosed in a Caucasian man based on history and examination followed by magnetic resonance imaging and computed tomography scanning. The literature is reviewed for all reported cases of ossified ligamenta flava causing myelopathy in Caucasians. Results: Following prompt diagnosis and T3 to T5 laminectomies, our patient made nearcomplete neurological recovery over a 10-month period. This condition usually affects the lower thoracic spine. Although chronic and subacute myelopathy secondary to this circumstance has been reported in Caucasians, acute myelopathy has not been reported and proximal thoracic involvement has been reported twice. Conclusion: Ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in Caucasians. Prognosis following decompressive surgery is usually good.

Phenotypic Characterization of Ligamentum Flavum Cells from Patients with Ossification of Ligamentum Flavum

“…However, over the past decade, the number of OLF case reports has been increasing also in non-Asian patients 1,3,5,21. Now, OLF is recognized as an important disease occurring not only in Asians, but also in peoples in Europe and the United States.…”

“…Enlarged ossified tissue can compress the spinal cord and its roots, resulting in various degrees of neurological symptoms, ranging from discomfort to severe myelopathy 2. The lower thoracic spine is the most frequently affected area, and OLF has been increasingly recognized as an important cause of thoracic myeloradiculopathy 2-5. Treatment of symptomatic OLF has most often been reported as posterior decompressive laminectomy with removal of ossified ligaments, but surgical decompression does not always produce a satisfactory result due to recurrent ossification at another or the same spinal level 6.…”

Chest Discomfort Secondary to Ossification of the Ligamentum Flavum of the Thoracic Spine: A Case Report

“…However, once symptomatic OLF is diagnosed, it is usually progressive and refractory to conservative management, and surgical decompression is indicated. In general, it is diagnosed using MRI, myelography, computed tomography, and plain radiographs [1,6,11,12]. TOLF was first reported by Polgar in 1920 based on lateral radiographs [5].…”

“…Among the above-mentioned issues, thoracic ossification of the ligamentum flavum (thoracic OLF or TOLF), a main cause of thoracic myelopathy, is a rare disease entity [4,5]. Although TOLF usually occurs in the lower thoracic spine, it has been reported at higher thoracic levels [6]. Herein, the authors will report on an extremely rare presentation of OLF in the thoracic spine in a patient who experienced chest discomfort.…”

Ossification Ligamentum Flavum

“…In the past, OLF was considered to be a disease of mostly the Japanese, and the incidence is 20% among elderly Japanese (over 65 years of age) regardless of the symptoms [2]. However, this disease has been reported in other East Asian countries like Korea and China [3,4] and even outside of Asia [5][6][7].…”