Symptomatic thoracic ossification of the ligamentum flavum in a patient with ankylosing spondylitis: Report of a case and review
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran.
Abolfazl Rahimizadeh, Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran.
DOI:10.25259/SNI_1067_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Abolfazl Rahimizadeh1, Parviz Habibollahzadeh1, Walter L. Williamson1, Housain Soufiani1, Mahan Amirzadeh1, Shaghayegh Rahimizadeh1. Symptomatic thoracic ossification of the ligamentum flavum in a patient with ankylosing spondylitis: Report of a case and review. 08-Dec-2021;12:596
How to cite this URL: Abolfazl Rahimizadeh1, Parviz Habibollahzadeh1, Walter L. Williamson1, Housain Soufiani1, Mahan Amirzadeh1, Shaghayegh Rahimizadeh1. Symptomatic thoracic ossification of the ligamentum flavum in a patient with ankylosing spondylitis: Report of a case and review. 08-Dec-2021;12:596. Available from: https://surgicalneurologyint.com/surgicalint-articles/11277/
Background: Thoracic spinal cord compression due to both ankylosing spondylitis (AS) and ossification of the ligamentum flavum (OLF) is rare.
Case Description: A 33-year-old male with AS presented with a paraparesis attributed to MR documented T9-T10 OLF/stenosis. He was successfully managed with a decompressive laminectomy; this resulted in marked improvement of his deficit.
Conclusion: Thoracic OLF and AS rarely contribute T9-T10 spinal cord compression that may be readily relieved with a decompressive laminectomy.
Keywords: Ankylosing spondylitis, Myelopathy, Ossification of the ligamentum flavum, Thoracic spine
Rarely, patients will present with a paraparesis attributed to the unique combination of thoracic ankylosing spondylitis (AS) and ossification of the ligamentum flavum (OLF). Here, we present a 33-year-old male with T9-T10 spinal cord compression due to both AS and OLF whose function improved following a decompressive laminectomy.
A 33-year-old male with AS (i.e., initial symptoms 2014 finally diagnosed 2017) presented with a progressive paraparesis of 5 months duration. Total spine radiographs showed AS [
Reconstructed CT scan of thoracic spine, (a) coronal view shows a right sided T9-T10 ossification of the ligamentum flavum (OLF) and (b) sagittal view shows a beak type TOLF, note bamboo spine in thoracic (BASRI score of 4) and interrupted syndesmophytes formation in lumbar spine (BASRI score of 3).
AS, with a prevalence of AS ranging from 0.1 to 0.5%, is a chronic inflammatory disease that involves the primary axial skeleton largely in males during the third decade of life.[
OLF, a well-known entity in East Asian countries but also involving patients from Iran and other countries, may also contribute to thoracic cord compression warranting decompressive laminectomies (i.e., the US).[
Surgery for thoracic cord compression due to AS and OLF
Typically, laminectomy with the meticulous direct dissection/ excision of the OLF utilizing an operating microscope with intraoperative monitoring is the procedure of choice for resecting thoracic OLF with AS.[
The patients presenting with paraparesis attributed to thoracic AS and OLF demonstrating MR/CT dorsolateral cord compression should undergo timely decompressive laminectomies to maximize neurological recovery.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
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