OSSIFICATION AND HYPERTROPHY OF LIGAMENTUM FLAVUM AT THORACIC SPINE
AbstractBackground: Hypertrophy of the ligamentum flavum is a pathological condition that causes neurological symptom (radiculopathy and / or myelopathy) and usually occurs in the thoracic,2 less frequently in the cervical spine that commonly involves thoracic spine. This study was conducted to analyse the clinical presentation and outcome of surgery of ossified ligamentum flavum at thoracic spine. Methods: This case series was conducted at Department of Neurosurgery, Liaquat University of Medical and Health Sciences Jamshoro, from January 2010 to December 2012. Patients who presented with thoracic myelopathy due to ossified ligamentum flavum were included. All the patients, after detailed history, clinical examination and radiological investigation under went decompressive laminectomy at the appropriate level. Pre-operative, post-operative and neurology at 06 months follow up was recorded. The patients having thoracic myelopathy due to other causes were excluded from the study. SPSS-10 was used to analyse the data. Results: A total of 15 patients were admitted and operated (9 males, 6 females. (M:F ratio of 1.5:1). The majority of patients were in 6th decade. Backache and lower limb weakness was the presenting feature. Overall improvement in preoperative neurological status was seen in 9 (60%) patients. Neurology remained unchanged in 4 (26.6%) patients and worsened in 2 (13.3%) patients. Conclusion: The disease is common in 5th and 6th decade. Preoperative duration of symptoms significantly correlates with recovery.Keywords: Ossified, ligamentum flavum, thoracic myelopathy, laminectomy
Rosenbaum RB, Ciaverella DP. Disorders of Bones, Joints, Ligaments and Meninges. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, editors. Neurology in clinical practice. 4th ed. Philadelphia: Butterworth Heinemann; 2004.p. 2204.
Gil-salu JL, Lopez-escobar M, Gomez-cardenas E, Rodriquez-pena F, Repeto-lopez JA, Lopez-Lopez J, et al. Calcification of thoracic yellow ligament as a cause of myelopathy. Rev Neurol 2002;34:750–3.
Giulioni M, Zucchelli M, Damiani S. Myelopathie thoracique due a une calcification du ligament jaune. Thoracic myelopathy caused by calcified ligamentum flavum. Rev du Rhum 2007;74:909–10.
Kim K, Isu T, Nomura R, Kobayashi S, Teramoto A. Cervical ligamentum flavum ossification – Two case report. Neurol Med Chir (Tokyo) 2008;48:183–7.
Kocer A, Gozke E, Tasali N. Thoracic myelopathy due to enlarged Ossified ligaments (Japanese disease) in a Turkish female patient. J Neurol Sci (Turkish) 2005;22:69-73.
Wang W, Kong L. Ossification of ligamentum. J Neurosurg Spine 2007;6:96.
Aizawa T, Sato T, Sasaki H, Kusakabe T, Morozumi N, Kokubun S. Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. J Neurosur Spine 2006;5:514–9.
Yayama T, Uchida K, Kobayashi S, Kokubo Y, Sato R, Nakajima H, Thoracic ossification of the human ligamentum flavum: histopathological and immunohistochemical findings around the ossified lesion. J Neurosurg Spine 2007;7:184–93.
Li F, Chen Q, Xu K. Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum. J Neurosurg Spine 2006;4:191–7.
Kruse JJ, Awasthi D, Harris M, Waguespack A. Ossification of the ligamentum flavum as a cause of myelopathy in North America: Report of Three Cases. J. Spinal Disord 2000;13:22–5.
Inamasu J, Guiot BH.. A review of factors predictive of surgical outcome for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg Spine 2006;5:133–9.
Gupta RK, Agarwal P, Kumar S, Surana PK, Lal JH, Misra UK. Compressive myelopathy in flurosis: MRI. Neuroradiology 1996;38:338–42.
Yamagami T, Kawano N, Nakano H. Calcification of the ligamentum flavum-case report. Neurol Med Chir 2000;40:234–8.
Sugimura H, Kakitsubata Y, Suzuki Y, Kakitsubita S, Tamura S, Uwada O, et al. MRI of ossification of ligamentum flavum. J Comput Assist Tomogr 1992;16:73–6.
Sushil P, Anant K. Ossified-calcified ligamentum flavum causing dorsal cord compression with computed tomography-magnetic resonance imaging features. Surg Neurol 1994;41:441–2.
Okada K, Oka S, Tohge K, Ono K, Yonenobu K, Hosoya T. Thoracic myelopathy caused by ossification of the ligamentum flavum: Clinicopathologic study and surgical treatment. Spine 1991;16:280–7.
Parekh H, Gurusinghe NT, Perera SS, Prabhu SS. Ossification of the ligamentum flavum in a Caucasion: Case report. Br J Neurosurg 1993;7:687–90.
Fotakopoulos G, Alexiou GA, Mihos E, Voulgaris S. Ossification of Ligamentum Flavum in cervical and Thoracic Spine. Report of three cases. Acta Neurol Belg 2010;110:186–9.
Shiraishi T, Crock HV, Lewis P. Thoracic myelopathy due to isolated ossification of the ligamnetum flavum. J Bone Joint Surg Br 1995;77:131–3.
Jayakumar PN, Devi BI, Bhat DI, Das BS. Thoracic cord compression due to Ossified hypertrophied ligamentum flavum. Neurol India 2002;50:286–9.
Sanghvi AV, Chhabra HS, Mascarenhas AA, Mittal VK, Sangondimath GM. Thoracic myelopathy due to ossification of ligamentum flavum: a retrospective analysis of predictors of surgical outcome and factors affecting preoperative neurological status. Eur Spine J 2011;20:205–15.