Ossification of the thoracic ligamenta flava in a Caucasian: a rare cause of myelopathy

Arafat, Q W; Jackowski, A.; Chavda, S. V.; West, R.

doi:10.1259/0007-1285-66-792-1193

Cited by 28 publications

(11 citation statements)

References 11 publications

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“…Esta patologia é quase exclusivamente encontrada em publicações japonesas [5][6][7][8][9][10][11][12] . Alguns artigos não japoneses já foram publicados [13][14][15][16][17] . Recentemente, o encontro desta patologia em um paciente, aliado à ausência de publicações nacionais sobre o tema, apesar de uma importante imigração japonesa no pais, nos levou a registrar este caso.…”

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Compressão medular torácica em dois níveis por calcificação de ligamento amarelo: relato de caso

Gondim

Ramos

1998

Arq. Neuro-Psiquiatr.

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RESUMO -Calcificação e/ou ossificação do ligamento amarelo é patologia bem conhecida na literatura japonesa. Causa estenose do canal vertebral torácico e compressão medular. Os autores apresentam o caso de um paciente de origem não japonesa com mielopatia torácica causada por compressão devida a calcificação do ligamento amarelo.PALAVRAS-CHAVES: medula torácica, mielopatia, ligamento amarelo, compressão medular.Thoracic spinal cord compression at two levels due to ligamentum flavum calcification: case report ABSTRACT -Calcification and/or ossification of the ligamenta flava is a well reported clinicopathologic entity causing narrowing of the spinal canal and spinal cord compression. It has been described almost exclusively in Japanese people. The authors present the case of a non Japanese patient with thoracic myelopathy caused by ossification of the ligamentum flavum. [5][6][7][8][9][10][11][12] . Alguns artigos não japoneses já foram publicados [13][14][15][16][17] . Recentemente, o encontro desta patologia em um paciente, aliado à ausência de publicações nacionais sobre o tema, apesar de uma importante imigração japonesa no pais, nos levou a registrar este caso. RELATO DO CASOPaciente do sexo masculino, branco, de 50 anos, sem ascendência japonesa, com quadro de paraparesia espástica de evolução progressiva há 6 meses, acompanhado de dores cérvico-torácicas de predominância noturna, intermitentes e bem localizadas em T2-T3. O exame neurológico mostrava síndrome piramidal bilateral, marcha difícil sem ajuda, com diminuição das sensações proprioceptivas nos membros inferiores, e com nível sensitivo em T4. Não apresentava radiculalgias ou alterações esfincterianas. Os exames complementares laboratoriais foram normais, excluindo causas metabólicas. O estudo radiológico da coluna cérvico-torácica foi inconclusivo, assim como a mielografia torácica, que não mostrou compressão medular. A ressonância nuclear magnética (RNM) mostrou dupla compressão posterior em T2 e T3, com sofrimento medular (Figs 1 e 2). O paciente foi

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Compressão medular torácica em dois níveis por calcificação de ligamento amarelo: relato de caso

Gondim

Ramos

1998

Arq. Neuro-Psiquiatr.

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“…Myelopathy due to other causes occurs less frequently in the thoracic spine, because it is less prone to degeneration as the ribs restrict movement. 3 Thoracic compressive stenotic syndromes are primarily due to the lamina, facet or ligamentum flaval hypertrophy 13,14 and rarely due to an intervertebral disc herniation. 15 Three conditions causing ossification of the spinal ligaments have been described.…”

Section: Discussionmentioning

confidence: 99%

“…A less recognised cause is the ossification of the ligamenta flava (OLF), a condition that is rarely reported in the Western literature. Although thoracic OLF usually occurs in the lower thoracic spine, [1][2][3][4][5][6][7][8][9][10] it has been reported to occur at higher thoracic levels resulting in proximal myelopathy. 11,12 This is particularly important because, regardless of the level and severity of the disease, OLF is easily treatable by decompressive laminectomy if the diagnosis is made early.…”

Section: Introductionmentioning

confidence: 99%

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

2006

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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.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

Ossification Ligamentum Flavum

Ac¹

2011

Imaging of Pain

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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.

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Ossification of the thoracic ligamenta flava in a Caucasian: a rare cause of myelopathy

Abstract: Ossification of the ligamenta flava is rare and has been described almost exclusively in Japanese people. We present a case in which ossification of the thoracic ligamenta flava caused compressive myelopathy in a Caucasian.

Cited by 28 publications

References 11 publications

Compressão medular torácica em dois níveis por calcificação de ligamento amarelo: relato de caso

Compressão medular torácica em dois níveis por calcificação de ligamento amarelo: relato de caso

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

Ossification Ligamentum Flavum

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