- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
DOI:10.4103/sni.sni_308_18Copyright: © 2018 Surgical Neurology International This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to cite this article: Abolfazl Rahimizadeh, Naser Asgari, Housain Soufiani, Shaghayegh Rahimizadeh. Ossification of the cervical ligamentum flavum and case report with myelopathy. 24-Dec-2018;9:263
How to cite this URL: Abolfazl Rahimizadeh, Naser Asgari, Housain Soufiani, Shaghayegh Rahimizadeh. Ossification of the cervical ligamentum flavum and case report with myelopathy. 24-Dec-2018;9:263. Available from: http://surgicalneurologyint.com/surgicalint-articles/9144/
Background:Ossification of the ligamentum flavum (OLF) occurs mostly in adult males, typically in the thoracolumbar spine where it may contribute to neurological deficits. Here we reviewed 68 cases of cervical OLF resulting in progressive quadriparesis.
Methods:The literature on cervical OLF was reviewed between 1962 and 2018 along with the case of an 81-year-old male with progressive quadriparesis attributed to cervical OLF.
Results:Most patients with cervical OLF are Asian, with Caucasians constituting the second most frequently impacted population.
Conclusions:Cervical OLF is typically reported in the Asian, followed by the Caucasian population, and is most often found in the thoracolumbar spine. Here we presented an 81-year-old male with cervical OLF contributing to quadriparesis.
Keywords: Cervical myelopathy, cervical spine, ossification of ligamentum flavum, ossification of posterior longitudinal ligament, ossification of yellow ligament, review article
Ossification of the ligamentum flavum (OLF) typically occurs in adults involving the thoracolumbar spine. It is less frequently encountered in the cervical region (<1%).[
An 81-year-old bed-ridden male presented a spastic quadriparesis. The T1-weighted sagittal magnetic resonance image (MRI) showed a large heterogeneous mass resulting in dorsolateral cord compression at C4-C5, and a smaller lesion at the C5-C6 levels, consistent with OLF [
Cervical MRI: (a) T1-weighted sagittal image showing a heterointense epidural mass at the posterior aspect of the spinal cord at the C4-C5 level, a smaller one is visualized below this level. (b) T2-weighted sagittal image demonstrating a hypointense mass with an isointensity at the center of the mass. (c) It also reveals a significant reduction in the cervical canal diameter
The patient underwent a C4-C6 laminectomy for resection of large dorsolateral OLF masses (C45, C56) [
About 80% of the ligamentum flavum is composed of elastic fibers, and 20% with collagen.[
There are 69 previously reported cases of cervical OLF
Patients with cervical OLF often present late in the clinical course with cord compression/spondylosis resulting in chronic myeloradiculopathy and an evolving quadriparesis.[
Lateral cervical plain radiographs may demonstrate OLF located between the bases of two spinal processes.[
A decompressive laminectomy with excision of OLF may be warranted in symptomatic patients. The OLF dissection from the dura should be accomplished under the operating microscope to lyse adhesions. Li et al. described decompressive en-block laminectomy for removal of OLF.[
Typically following a cervical laminectomy with resection of OLF, patients should significantly recover from their preoperative myeloradicular syndrome.
Cervical OLF rarely causes cervical myeloradiculopathy. Following both MR and CT studies to adequately document the location/extent of disease, laminectomy alone often suffices to decompress the cord.
Declaration of patient consent
Written informed consent was obtained from the patient for publication and corresponding images.
The steps of this article from design to writing were made by Abolfazl Rahimizadeh, Naser Asgari, Housain Soufiani, and Shaghayegh Rahimizadeh, retrospectively.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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