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Wettasinghe MC, Gamage L, Wickramasinghe ND. Hypertrophied posterior longitudinal ligament and ligamentum flavum causing myelopathy: a case report and literature review. Spinal Cord Ser Cases 2023; 9:7. [PMID: 36894528 PMCID: PMC9998656 DOI: 10.1038/s41394-023-00565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION The occurrence of concurrent hypertrophied posterior longitudinal ligament (HPLL) and hypertrophied ligamentum flavum (HLF) in the thoracic spine is a very rare presentation. This case report describes a young female who developed thoracic myelopathy secondary to a combination of both thoracic HPLL and HLF. CASE PRESENTATION A 30-year-old previously well female was referred for an MRI scan of the thoraco-lumbar spine. She was having lower limb weakness and difficulty in walking, which had progressed over 3 months. On examination, she was found to have spastic lower limbs with associated motor weakness. Her biochemical investigations were unremarkable. The MRI scan showed HPLL, which was uniformly hypointense on T2W images and was isointense on T1W images. The hypertrophied segment was extending from T2 level to T7 level. Similarly, the ligamentum flavum was hypertrophied from T1 level to T8 level. The thoracic spinal cord was seen compressed between the hypertrophied ligaments. The compressed cord showed central hyperintense signal pattern in T2W images. CT scan of the thoracic spine did not show any calcifications or ossifications along the ligaments. Patient underwent posterior decompressive surgery and she had an uneventful recovery. DISCUSSION Although few cases of HPLL and HLF were reported in older patients in literature, both these conditions were found in this patient at a younger age. HPLL and HLF are thought to be precursors of ossification of these ligaments and these patients need long-term follow-up.
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Affiliation(s)
| | | | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
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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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