Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife!

Volume 3 | Issue 1 | April-September 2022 | page: 32-35 | Himanshu G. Kulkarni, Gurunath S. Kulkarni, Sidheshwar S. Thosar

DOI: 10.13107/bbj.2022.v03i01.037


Authors: Himanshu G. Kulkarni [1], Gurunath S. Kulkarni [1], Sidheshwar S. Thosar [1]

[1] Department of Orthopaedics, Shraddha Surgical and Accident Hospital, Sangli, Maharashtra, India.

Address of Correspondence

Dr. Sidheshwar S. Thosar,
Department of Orthopaedics, Shraddha Surgical and Accident Hospital, Sangli, Maharashtra, India.
E-mail: dr.sidheshwarthosar@gmail.com


Abstract


Ossification of ligamentum flavum (OLF) is well known but rare entity causing slow progressive thoracic myelopathy. It affects especially lower thoracic spine and is relatively common in the East Asian population particularly in Japan. Posterior decompression in the form of extensive laminectomy with or without instrumented fusion is the treatment of choice. Decompression itself can be very challenging since the flavum is fused with the laminae above and below and it becomes very difficult for the surgeon to insert Kerrison roungers in inter-laminar space. Seven cases of recurrence of OLF at same intervertebral level reported till now but no case of adjacent level OLF in thoracic spine reported yet. We report the case of a 37-year-old male with D6-7-8 ossified ligamentum flavum with coexisting asymptomatic L1-2 disc prolapse and previously operated for D8-9 OLF. Pre-operative counseling of patients should be done regarding possibility of reoperation due to new adjacent segment or same level OLF.
Keywords: Ossified ligamentum flavum, Thoracic myelopathy, Posterior decompression.


References


1. Yamada T, Shindo S, Yoshii T, Ushio S, Kusano K, Miyake N, et al. Surgical outcomes of the thoracic ossification of ligamentum flavum: A retrospective analysis of 61 cases. BMC Musculoskelet Disord 2021;22:7.
2. Ahn DK, Lee S, Moon SH, Boo KH, Chang BK, Lee JI. Ossification of the ligamentum flavum. Asian Spine J 2014;8:89-96.
3. Wang H, Wei F, Long H, Han G, Sribastav SS, Li Z, et al. Surgical outcome of thoracic myelopathy caused by ossification of ligamentum flavum. J Clin Neurosci 2017;45:83-8.
4. Barath AS, Wu OC, Patel M, Kasliwal MK. Repeated recurrence of thoracic spine stenosis following decompression alone for ossification of the ligamentum flavum: Case report. J Neurosurg Spine 2018;30:332-6.
5. Kanno H, Takahashi T, Aizawa T, Hashimoto K, Itoi E, Ozawa H. Recurrence of ossification of ligamentum flavum at the same intervertebral level in the thoracic spine: A report of two cases and review of the literature. Eur Spine J 2018;27:359-67.
6. 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 (Phila Pa 1976) 1991;16:280-7.
7. Geber J, Hammer N. Ossification of the ligamentum f lavum in a nineteenth-century skeletal population sample from Ireland: Using bioarchaeology to reveal a neglected spine pathology. Sci Rep 2018;8:9313.
8. Li B, Qiu G, Guo S, Li W, Li Y, Peng H, et al. Dural ossification associated with ossification of ligamentum flavum in the thoracic spine: A retrospective analysis. BMJ Open 2016;6:e013887.
9. Osman NS, Cheung ZB, Hussain AK, Phan K, Arvind V, Vig KS, et al. Outcomes and complications following laminectomy alone for thoracic myelopathy due to ossified ligamentum flavum: A systematic review and meta-analysis. Spine 2018;43:E842-8.


How to Cite this Article: Kulkarni HG, Kulkarni GS, Thosar SS | Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife! | Back Bone: The Spine Journal | April-September 2022; 3(1): 32-35.

(Abstract Text HTML)      (Download PDF)


.