Ossification of the cervical ligamentum flavum

doi:10.1016/0090-3019(91)90077-M

Surgical Neurology

Volume 35, Issue 3, March 1991, Pages 234-238

https://doi.org/10.1016/0090-3019(91)90077-M Get rights and content

Abstract

A case of a 61-year-old man with ossification of the cervical ligamentum flavum is reported. The ossification was located on the left side of C3-4. The symptoms improved with laminectomy and resection. Ossification of the ligamentum flavum usually occurs in the lower thoracic spine, and is rare in the cervical region. Including the present one, only eight cases have been reported to our knowledge. The clinical features and pathogenesis are discussed.

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Cited by (33)

Coexistence of flavum ligament ossification with diffuse idiopathic skeletal hyperostosis in the cervical spine: Review of literature and technical note starting from a rare case
2022, Neurochirurgie
Citation Excerpt :
High rate (66.7%) of adherence of the lesions to the dura mater has been describe in previous case series [12]. Microscopic magnification reduces risk of post-operative CSF-leak allowing the finding of an optimal plane between ossified ligament and dura mater [2,10–12,25,31–33]. Therefore, gross total decompression leaving a little piece of ossified ligament anchored to dura is also possible [20].
Cervical flavum ligament ossification (C-OLF) is very rare source of myeloradiculopathy. Less than 100 cases have been reported in modern English literature up to 2020. Association between C-OLF and Diffuse Idiopathic Skeletal Hyperostosis (DISH) at cervical level has never been described.
In this article we performed a systematic review about epidemiology, physiopathology, clinical and surgical management of C-OLF. Moreover, we research its possible association with other cervical spine ligament ossification and in particular with anterior longitudinal ligament ossification. We report a case of 73 years-old woman experiencing mild cervical myeloradiculopathy caused by C6-C7 C-OLF compression and coexistence of DISH at cervico-thoracic level. A brief technical note about intraoperative management of C-OLF has also been described.
Our research found 81 previous reported case of C-OLF. The coexistence of Posterior longitudinal ligament ossification has been reported in 21.3% of C-OLF case. Conversely, we reported the first case describing the association between DISH and C-OLF. Posterior surgical decompression is the only useful treatment providing good long-term functional outcome. Instrumentation should be tailored according to pre-operative findings.
C-OLF is a rare source of myeloradiculopathy and it may coexists with DISH probably due to alteration in the cervical mechanical stress and tendency of bone formation in patients harboring coexistent ligament ossifications. According to our result, skip en-bloc microsurgical laminectomy is safe and less invasive method to avoid complication and to provide optimal cervical spinal cord and nerve decompression avoiding CSF-leak.
Thin Cervical Spinal Cord Between Ossifications of the Ligamentum Flavum and the Posterior Longitudinal Ligament: Case Report and Literature Review
2021, World Neurosurgery
Cervical ossification of the ligamentum flavum (OLF) is a rare condition; however, the coexistence of OLF and ossification of the posterior longitudinal ligament (OPLL) is extremely uncommon. These can exist simultaneously and cause thinning of the cervical spinal cord. Sufficient decompression, dural ossification, semispinalis dissection, and postoperative kyphosis were evaluated. We report the successful treatment of coexisting cervical OLF and OPLL.
A 70-year-old man had been experiencing weakness in the left knee and clumsiness in the left hand for 6 months. Hemiparesis was considered; however, magnetic resonance imaging revealed a cervical spinal lesion. Hence a spine surgeon diagnosed the patient with severe stenosis with OLF at the C2–C3 levels and OPLL at the C2–C4 levels. The patient presented with spastic gait and left-hand motor weakness. Computed tomography scan revealed the disappearance of the black line, indicating dural ossification surrounding the OLF. OPLL was observed in 61.5% of the C2 spinal canal. The K-line was (−); however, the alternative K-line between the C1 and C7 level was (+). Posterior laminectomy at the C2–C3 levels and laminoplasty at the C4–C7 levels with muscle preservation resulted in sufficient decompression. The patient's symptoms improved, and cervical alignment was maintained 2 years after surgery.
An alternative K-line comprised successful treatment for coexisting cervical OLF and OPLL. Surgeons must evaluate the severity of adhesion, damage of the paraspinal muscles, and necessity of posterior corrective surgery along with the patient's comorbidities and possible postoperative complications.
Pathophysiology of Calcification and Ossification of the Ligamentum Flavum in the Cervical Spine
2018, Neurosurgery Clinics of North America
Citation Excerpt :
Almost all patients presented with sensorimotor deficits, whereas muscle atrophy and sphincter dysfunction were rare. The initial symptom is commonly a sensory disturbance of the extremities, as in other cervical degenerative diseases.46 CT is the most useful technique with which to clarify the type of OLF and distinguish OLF from CLF.
Ossification of the Ligaments in the Cervical Spine, Including Ossification of the Anterior Longitudinal Ligament, Ossification of the Posterior Longitudinal Ligament, and Ossification of the Ligamentum Flavum
2018, Neurosurgery Clinics of North America
Citation Excerpt :
They found 34% of cervical OPLL ossification occurred with thoracic OLF. However, the combination of cervical OLF and OPLL is extremely rare.4,50,65–67 OALL is seen in patients with an OLF.68
Lumbar spinal stenosis in a young individual as a result of ligamantum flavum ossification: A case report
2013, International Journal of Surgery Case Reports
Symtomatic lumbar ligamantum flavum calcification is quite rare in the young age group.
The authors report a case of young adult with diagnosis of lumbar spinal stenosis, presenting with leg pain and neurological deficits. Computerized tomography (CT) scan and magnetic resonance (MR) imaging studies revealed ossification of the ligamantum flavum as the causative factor of the disease and the patient recovered completely after the decompressive operation.
It is emphasized that attention should be given to this rare etiological factor of lumbar spinal stenosis.
Complete relief can be achieved with early and adequate surgery.
Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: Report of two cases and literature review
2013, Spine Journal
In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature.
We describe two more cases that exhibited cervical myelopathy resulting from the combination of cervical OLF and OPLL and required surgery. A literature review with a comparative analysis between previous reports and present cases was also performed.
Case report and literature review.
Two patients with combined OLF and OPLL.
Preoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses.
A 76-year-old man (Case 1) presented with disturbance of gait and fine finger movement. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C3–C4 level. Computed tomography showed OPLL at the C2–C6 levels (segmental type) and OLF at the left C3–C4 level. The patient underwent posterior decompression and OLF resection. A 75-year-old man (Case 2) presented with sensory disturbance and muscle weakness in his bilateral upper extremities and disturbance in fine finger movements. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C2–C3 and C3 levels. Computed tomography showed OPLL at the C3–C7 levels (mixed type) and OLF at the left C2–C3 and C3 levels. The patient also underwent posterior decompression and OLF resection.
In both cases, histological examination of the surgical specimens showed osseous tissue and enchondral ossification within the ligamentum flavum, and the diagnosis in each case was OLF. After surgery, both patients' symptoms immediately improved, and no recurrence was observed at 2 years after surgery.
We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor.

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Ossification of the cervical ligamentum flavum

Abstract

Surg Neurol

Roentgenographic analysis of ossification of the spinal ligament; with special reference to the finding of the whole spine

Seikeigeka

Anatomical study of the yellow ligament of spine with special reference to its ossification

J Jpn Orthop Assoc

Cervical myelopathy due to ossification of ligamenta flava

Rinsho Shinkeigaku

Calcium pyrophosphate dihydrate crystal deposition disease in the cervical ligamentum flavum

J Neurosurg

Surgical treatment for the ossification of the lig. flavum

Cent Jpn J Orthop Traumat

3 cases of spinal cord paralysis proved by ligamenta flava ossification

Rinsho Geka