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Mrożek K, Marchewka J, Borowska B, Budnik A. Prevalence and distribution of ossification of the ligamenta flava in a 16th-18th century skeletal population sample from Poland. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 42:1-13. [PMID: 37343491 DOI: 10.1016/j.ijpp.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE This study aimed to determine the prevalence of the ossification of the ligamenta flava (OLF) among skeletal remains from Poland. MATERIALS AND METHODS 124 skeletons aged 25 years and older were analyzed. The presence and size of OLF were observed macroscopically. OLF was recorded at the cranial and caudal attachment sites of each vertebra. The following factors were analyzed: age at death, sex, and presence of other spondyloarthropathies. RESULTS The crude prevalence of OLF in the analyzed series was 68.55 %. OLF was located most frequently in the lower thoracic spine. A statistically significant relationship was observed between the presence of OLF and age at death. OLF coincided with degenerative spondyloarthropathies of the thoracolumbar spine. CONCLUSIONS The results of this study indicate that OLF was not a rare condition in past populations of European ancestry. Analysis of OLF prevalence in skeletal materials can contribute to reconstruction of the conditions and lifestyles of past people. SIGNIFICANCE This study shed new light on the prevalence of OLF and provides information on the variability of OLF in past European populations. The evaluation of the prevalence of OLF represents an important contribution to the field of paleopathology in understanding disease changes in prehistoric and historic human populations. LIMITATIONS The analyzed material came from unknown populations without demographic data. Sex and age at death were assessed using standard anthropological methods. SUGGESTIONS FOR FURTHER RESEARCH It is important to understand the influence of sociocultural factors and physical activity patterns on the development of OLF.
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Affiliation(s)
- Kamil Mrożek
- Nature Education Centre, Jagiellonian University, 5 Gronostajowa St., 30-387 Krakow, Poland; Department of Anthropology, Institute of Zoology and Biomedical Research, Jagiellonian University, 7 Gronostajowa St., 30-387, Krakow, Poland.
| | - Justyna Marchewka
- Department of Human Biology, Institute of Biological Sciences, Cardinal Stefan Wyszynski University in Warsaw, 1/3 Wóycickiego St., Building 24, 01-938 Warsaw, Poland
| | - Beata Borowska
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, 12/16 Banacha St., Building A, 90-237 Lodz, Poland
| | - Alicja Budnik
- Department of Human Biology, Institute of Biological Sciences, Cardinal Stefan Wyszynski University in Warsaw, 1/3 Wóycickiego St., Building 24, 01-938 Warsaw, Poland
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Dou X, Mao T, Ma Y, Jia F, Liu Y, Liu X. Fibrotic and inflammatory characteristics of epidural fat adjacent to the ossification area in patients with ossification of the ligament flavum. JOR Spine 2022; 5:e1229. [PMID: 36601380 PMCID: PMC9799088 DOI: 10.1002/jsp2.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To observe histological and inflammatory characteristics of epidural fat (EF) adjacent to the ossification area in patients with ossification of the thoracic ligament flavum (TOLF) and provide a preliminary research basis for investigating the impact of the EF on OLF. Methods Samples of EF and autologous subcutaneous adipose tissue (SCAT) from TOLF patients (n = 26) and non-TOLF patients (n = 23) were harvested during posterior thoracic spine surgery. Adipocyte size and fibrosis were measured by histology. Vascularization and inflammatory cell infiltration were evaluated by immunohistochemical staining. Adipogenesis-related genes were assessed by real-time quantitative PCR. Conditioned media from cultured EF were evaluated via enzyme-linked immunosorbent assay to detect the secretion of inflammatory cytokines, including interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and leptin. The phosphorylated STAT3 protein level in ligament flavum (LF) was examined using Western blot. Results Adipocytes size in EF was similar between in the TOLF and non-TOLF groups, but significantly smaller than that from autologous SCAT. Adipogenesis-related mRNA expression in EF was lower than that in SCAT. More fibrosis and vascularization were found in TOLF than in non-TOLF. EF in the TOLF group exhibited more macrophages and B lymphocytes infiltrated. The levels of cytokines such as IL-6, TNF-α, and leptin secreted by EF were significantly higher in the TOLF group than non-TOLF. The level of phosphorylated STAT3 in LF was significantly upregulated in the TOLF group. Conclusions Morphologically, EF adjacent to the ossification area is smaller and more uniform than autologous SCAT, exhibiting a characteristic similarity to visceral fat. EF in the TOLF group shows a more fibrotic, vascularized, and inflammatory phenotype, which secretes multiple cytokines. The phosphorylated STAT3 protein was significantly upregulated in the TOLF group. Whether these properties of EF directly affect the process of OLF needs to be further explored.
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Affiliation(s)
- Xinyu Dou
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal DiseasesBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| | - Tianli Mao
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal DiseasesBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| | - Yunlong Ma
- Pain Medicine CenterPeking University Third HospitalBeijingChina
| | - Fei Jia
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal DiseasesBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| | - Yu Liu
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal DiseasesBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| | - Xiaoguang Liu
- Department of OrthopedicsPeking University Third HospitalBeijingChina,Beijing Key Laboratory of Spinal DiseasesBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
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Imaging of the Aging Spine. Radiol Clin North Am 2022; 60:629-640. [DOI: 10.1016/j.rcl.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cyclic Tensile Stress to Rat Thoracolumbar Ligamentum Flavum Inducing the Ossification of Ligamentum Flavum: An In Vivo Experimental Study. Spine (Phila Pa 1976) 2021; 46:1129-1138. [PMID: 34384088 DOI: 10.1097/brs.0000000000004087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Western blot, reverse transcription-polymerase chain reaction (RT-PCR), radiological, and histological analyses of the rat ossification of ligamentum flavum (OLF) induced by cyclic tensile stress. OBJECTIVE The aim of this study was to induce the OLF using cyclic tensile stress to rat thoracolumbar ligamentum flavum, and to investigate the possible molecular mechanism of tension-induced OLF. SUMMARY OF BACKGROUND DATA Tensile stress has been considered as an important factor leading to the OLF. So far, however, no OLF induced by tension has been reported. METHODS Forty rats were randomly divided into five equal groups. For control groups, the blank and anesthesia groups were not subjected to tension. For experimental groups, the 4-, 8-, and 12-week groups were subjected to cyclic tensile stress of ligamentum flavum after abdominal anesthesia for 4 weeks, 8 weeks, and 12 weeks, respectively, using an original stress apparatus for rats. The radiological and morphological changes of rat spine, as well as the protein and mRNA expressions of CD44, bone morphogenetic protein-2 (BMP-2), integrin β3, collagen protein type I (COL1), osteopontin (OPN), runt-related transcription factor 2 (RUNX-2), and vascular endothelial growth factor (VEGF), were concerned. RESULTS The micro-CT showed OLF in the 4-, 8-, and 12-week group. The axial maximum occupied area of ossifications was 1.42 mm2, 3.35 mm2, and 7.28 mm2, respectively. In histopathology, chondrocytes proliferated in the experimental model; woven bone arose in the 8- and 12-week groups, and was more noticeable in the 12-week group. According to western blot and RT-PCR, the expressions of seven osteogenesis-related molecules were all increased in three experimental groups. CONCLUSION Cyclic tensile stress to the ligamentum flavum in rats can induce the OLF, and the longer the duration, the more visible the osteogenesis. The upregulation and synergism of osteogenesis-related molecules may contribute to the OLF induced by tensile stress.Level of Evidence: N/A.
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Mesenchyme homeobox 1 mediated-promotion of osteoblastic differentiation is negatively regulated by mir-3064-5p. Differentiation 2021; 120:19-27. [PMID: 34130045 DOI: 10.1016/j.diff.2021.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/16/2021] [Accepted: 05/16/2021] [Indexed: 11/23/2022]
Abstract
Human mesenchymal stem cells (hMSCs) are multipotent cells that can be differentiated into different cell types including osteoblasts. Herein we aimed to assess the regulation of transcription factor mesenchyme homeobox 1 (Meox1) in the osteogenic differentiation of hMSCs and to determine the microRNA which targets on Meox1. Total RNA was extracted from the isolated ligamentum flavum tissue samples and cultured hMSCs, and the expression of Meox1 was assessed by RT-PCR and Western blot assays. Cultured hMSCs were induced towards osteoblastic differentiation, and the osteoblast phenotype was determined by alkaline phosphatase activity and alizarin red staining. The microRNA targeting on the 3'-UTR of Meox1was predicted using bioinformatics tool, and the binding was validated by luciferase and RNA pulldown assays. The osteoblastic differentiation of hMSCs was checked with the knockdown of Meox1 and microRNA inhibitors. Higher expression of Meox1, and lower expression of miR-3064-5p in ossified ligamentum flavum (OLF) tissues were identified. In addition, increased expression along with the osteoblastic differentiation of hMSCs was found. Further research revealed that Meox was a direct target of miR-3064-5p, when the former promoted the differentiation of hMSCs into osteoblasts, the latter significantly suppressed the osteogenesis. The expression of Meox1 increased gradually with the osteoblastic differentiation of hMSCs, during which miR-3064-5p decreased. Meox1 is a direct target of miR-3064-5p, and they both play important roles in the osteogenesis. These findings provide potential target for the development of therapeutic drugs for skeletal system diseases.
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Zhang B, Chen G, Chen X, Sun C, Chen Z. Cervical Ossification of Ligamentum Flavum: Elaborating an Underappreciated but Occasional Contributor to Myeloradiculopathy in Aging Population Based on Synthesis of Individual Participant Data. Clin Interv Aging 2021; 16:897-908. [PMID: 34079239 PMCID: PMC8163622 DOI: 10.2147/cia.s313357] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Cervical ossification of ligamentum flavum (COLF) is a rare clinical entity which can occasionally contribute to severe myeloradiculopathy. Many orthopedists are unfamiliar with or underestimate this pathology. Therefore, a comprehensive research is obligatory to reappraise the epidemiological, radiological, clinical and histopathological characteristics of COLF-myeloradiculopathy based on synthesis of individual patient data. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, EMBASE, Scopus and Web of Science databases were searched for studies discussing COLF-myeloradiculopathy from the inception to December 2020. Results A total of 94 cases from 54 studies were identified. The annual publications demonstrated a steady increase, and most reports were from Japan and China. The mean age was 58.76±13.39 years and nearly 60% of cases occurred in the 55–64 and 65–74 years age group. The male-female ratio was 1.4:1. Most cases belonged to East Asian population (60.64%). COLF predominately appeared in the lower cervical and cervicothoracic spine (76.60%) and mainly affected C4-5 (23.29%) and C5-6 (21.23%). Single-segment type ossification accounted for 62.76 and 45.45% of ossification lesions distributed bilaterally. The majority of COLF (81.1%) were spontaneous, and motor disturbance (76.4%), spinal ataxia (62.5%) and sensory disturbance (58.9%) were the most common manifestations. Histopathologically, it’s a metaplastic process of endochondral ossification with the formation of mature lamellar bone which was distinguished from calcification of ligamentum flavum. About 21.28% of concurrent COLF and COPLL cases were identified as a separated group, with unique characteristics. Conclusion COLF is an underappreciated but potentially growing pathogeny of myeloradiculopathy in aging population, though its distinct epidemiological, radiological, clinical and histopathological features are not fully supported by current evidence. However, our findings will provide several referential data for future researches to shed light on COLF.
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Affiliation(s)
- Baoliang Zhang
- Peking University Third Hospital, Department of Orthopaedics, Beijing, 100191, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, People's Republic of China
| | - Guanghui Chen
- Peking University Third Hospital, Department of Orthopaedics, Beijing, 100191, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, People's Republic of China
| | - Xi Chen
- Peking University Third Hospital, Department of Orthopaedics, Beijing, 100191, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, People's Republic of China
| | - Chuiguo Sun
- Peking University Third Hospital, Department of Orthopaedics, Beijing, 100191, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, People's Republic of China
| | - Zhongqiang Chen
- Peking University Third Hospital, Department of Orthopaedics, Beijing, 100191, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, People's Republic of China
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Yamada T, Shindo S, Yoshii T, Ushio S, Kusano K, Miyake N, Arai Y, Otani K, Okawa A, Nakai O. Surgical outcomes of the thoracic ossification of ligamentum flavum: a retrospective analysis of 61 cases. BMC Musculoskelet Disord 2021; 22:7. [PMID: 33397347 PMCID: PMC7784257 DOI: 10.1186/s12891-020-03905-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/22/2020] [Indexed: 12/05/2022] Open
Abstract
Background Thoracic ossification of ligamentum flavum (T-OLF), as one of the causes of thoracic myelopathy, is often combined with other spinal disorders. Concurrent lumbar spinal canal stenosis (LCS) is often obscured by symptoms due to T-OLF, leading to difficulty in identifying the origin of these neurological findings. It is common to be misdiagnosed or delayed diagnosis due to the complicated nature. We evaluated the prevalence, distribution, and clinical characteristics of OLF, especially in patients with LCS. Methods The authors performed a retrospective analysis of the outcomes of 61 patients who underwent thoracic surgeries performed for symptomatic T-OLF. In all the patients, whole spine lesions were evaluated preoperatively. We examined the factors related to poor outcomes (the recovery rate of the Japanese Orthopedic Association score for thoracic myelopathy is less than 40%) following OLF surgeries. We compared the clinical outcomes according to whether there was concurrent LCS, and determined the optimal surgical approach. Results The occurrence of T-OLF increased with age. Forty-six cases (75.4%) were considered to be tandem T-OLF and LCS (LCS group). An advanced age, and concurrent LCS were associated with a poor outcome after the surgery. The LCS group significantly included a greater number of elderly, and more light-weighted patients with Modic change in thoracic spine and a greater sagittal vertical axis, resulting in the lower neurological recovery. Additional lumbar surgery (13cases) effectively improved both the T-JOA and L-JOA scores (from 6.5 ± 2.0 points to 8.0 ± 1.8 points, p = 0.0406, and from 14.5 ± 4.7 points to 20.7 ± 2.6 points, p = 0.001, respectively) in OLF patients with LCS. Conclusions T-OLF was highly associated with other spinal disorders. Poor outcomes in T-OLF surgery could be associated with age and concurrent LCS, and an additional surgery for another lumbar lesion significantly improved neurological findings in T-OLF patients.
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Affiliation(s)
- Tsuyoshi Yamada
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan- minami, Chiyoda-ku, 102-0074, Tokyo, Japan. .,Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan.
| | - Shigeo Shindo
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan- minami, Chiyoda-ku, 102-0074, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Shuta Ushio
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan- minami, Chiyoda-ku, 102-0074, Tokyo, Japan
| | - Kazuo Kusano
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan- minami, Chiyoda-ku, 102-0074, Tokyo, Japan
| | - Norihiko Miyake
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan- minami, Chiyoda-ku, 102-0074, Tokyo, Japan
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, 332-8558, Kawaguchi-city, Saitama, Japan
| | - Kazuyuki Otani
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan- minami, Chiyoda-ku, 102-0074, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Osamu Nakai
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudan- minami, Chiyoda-ku, 102-0074, Tokyo, Japan.,Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
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Iftekhar N, Rasool A, Khan I. Cervical cord compression due to ossification of the ligamentum flavum – A case report and literature review. Surg Neurol Int 2020; 11:37. [PMID: 32257563 PMCID: PMC7110401 DOI: 10.25259/sni_605_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Symptomatic compression of the cervical spinal cord by ossification of the ligamentum flavum (OLF) is rare. It typically involves the elderly and is particularly prominent in the Asian male population. Here, we present a 70-year-old Pakistani female who became quadriparetic due to OLF. Case Description: A 70-year-old female became increasingly quadriparetic over 3 months duration, but exhibited preservation of vibration and proprioception. The cervical magnetic resonance/computed tomography revealed dorsal OLF measuring 7 mm × 25 mm × 14 mm. Two months following a decompressive laminectomy, her symptoms fully resolved. Conclusion: Although rare in older patients, cervical OLF may contribute to significant cervical myelopathy characterized by a progressive quadriparesis that can be readily resolved with a decompressive laminectomy.
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Affiliation(s)
- Noama Iftekhar
- Stritch School of Medicine, Loyola University of Chicago, Maywood, Illinois, United States,
| | - Abdullah Rasool
- Secondary School, Lahore Grammar School, Lahore, Punjab, Pakistan,
| | - Irfan Khan
- Department of Neurosurgery, Nawaz Sharif Medical College, University of Gujrat, Gujrat, Punjab, Pakistan
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Contiguous Multilevel Thoracic Ossification of Ligamentum Flavum in a Young Adult Spine. Case Rep Orthop 2019; 2019:1640485. [PMID: 31360567 PMCID: PMC6652055 DOI: 10.1155/2019/1640485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/29/2019] [Indexed: 11/19/2022] Open
Abstract
The ossification of the ligamentum flavum (OLF) was characterized by the replacement of the ligamentum flavum by ectopic new bone formation. Although OLF is well known as one of the causes of thoracic myelopathy through the compression of the spinal cord from the posterolateral side, contiguous multilevel OLF is quite a rare cause of myelopathy. Severe ossifications were reported that only present in individuals aged over 25 years. External triggers of OLF might likely be increased as a consequence of biomechanical stress to the effect of posttraumatic ossification. The authors described one rare case of an enormous contiguous multilevel OLF in a 20-year-old female's thoracic spine after mild back trauma, to the extent that it was misdiagnosed as an old epidural hematoma initially. This female with obesity presented with a 6-month history of progressively worsening dorsal cord disorders. Resection or floating of the enormous OLF could be successfully achieved using O-arm-based navigation, and sensory loss, numbness, and gait disturbance were improved after operation.
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