Calcification of the ligamentum flavum of the cervical spine

Iwasaki, Yoshinobu; Akino, Minoru; Abe, Hiroshi; Tsuru, Mitsuo; Tashiro, Kunio; Miyasaka, Kazuo; Kaneda, Kiyoshi; Isu, Toyohiko; Itō, Tarō

doi:10.3171/jns.1983.59.3.0531

Cited by 44 publications

(34 citation statements)

References 8 publications

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“…CPPD crystal deposition is occasionally observed in the cervical [11,12] or lumbar spine [13,14], but rarely in the thoracic spine [15,16]. Generally, CPPD crystal deposition in the LF has been observed in normal asymptomatic elderly individuals as one of the physiological aging processes [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…In our series, photomicrography of the resected LF showed degenerated elastic fibers and CPPD crystal deposition, findings that are consistent with previous reports. Iwasaki et al [12] reported four cases of calcification of the cervical LF, all in women over 60 years of age. They concluded that this calcification might have been induced by the degeneration or abnormal nutritional state of the LF.…”

Section: Discussionmentioning

confidence: 99%

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Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Odate¹,

Shikata²,

Fujibayashi

et al. 2012

Eur Spine J

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Purpose We describe cases presenting with progressive thoracic myelopathy after lumbopelvic fusion attributed to proximal junctional vertebral compression fracture (PJF) followed by spinal calcium pyrophosphate dehydrate (CPPD) crystal deposition. Methods The study included six patients, ranging from 62 to 75 years. All patients had been treated previously with lumbopelvic fusion. The mean period from the detection of PJF to the onset of myelopathy was 4.8 months. Notably, five patients demonstrated upper-instrumented vertebra (UIV) collapse. Results After revision surgery involving decompressive laminectomy and extension of the spinal fusion, all patients experienced significant improvement. Photomicrographs of the resected ligamentum flavum showed CPPD crystals and multinucleated giant cells. Conclusions The combination of mechanical stress plus PJF and CPPD crystal deposition followed by a foreign body reaction to the deposited crystals caused myelopathy. Patients with radiographic evidence of PJF, especially UIV collapse, after lumbopelvic fusion should be followed carefully for the emergence of myelopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Odate¹,

Shikata²,

Fujibayashi

et al. 2012

Eur Spine J

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“…In contrast, calcification originates from the center of the ligament. In our case, CT myelography clearly demonstrated that the degenerative change originated from the rim of the ligament 10) (Fig. 3).…”

Section: Discussionmentioning

confidence: 85%

Cervical Myelopathy Caused by Hypoplasia of the Atlas and Ossification of the Transverse Ligament. Case Report.

Tsuruta

Yanaka

Okazaki

et al. 2003

Neurol. Med. Chir.(Tokyo)

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A 79-year-old Japanese female presented with symptomatic cervical myelopathy caused by a hypoplastic posterior arch of the atlas and ossification of the transverse ligament. Neuroradiological examination demonstrated a hypoplastic posterior arch of the atlas and ossification of the transverse ligament. The cervical spinal cord was compressed at the level of the atlas by both the hypoplastic posterior arch of the atlas and the ossification of the transverse ligament. The patient underwent C-1 laminectomy, which arrested the progressive myelopathy and resulted in a good recovery. Atlas hypoplasia with ossification of the transverse ligament may be associated with Asian ethnicity.

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“…Our report of two West Indian patients, as well as a previous one involving a black American [3] suggests the disease may be overlooked in people of African ancestry. The prominent neurological picture is a chronic cervical myelopathy affecting old women with symptoms and signs of impairment of the posterior spinal tracts [1,6]. CT examination is the key procedure in making a diagnosis of CLF.…”

Section: Discussionmentioning

confidence: 99%

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mentioning

confidence: 99%

Myelopathy due to calcification of the cervical ligamenta flava: a report of two cases in West Indian patients

Pascal‐Moussellard

Cabre

Smadja

et al. 1999

European Spine Journal

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IntroductionCalcification of the ligamenta flava (CLF) of the cervical spine causing myeloradiculopathy is a rare disorder occasionally reported in Japanese people [6]. CLF seems to be exceptional in non-Asian populations. We encountered for the first time two such cases in black patients living in the French West Indies. We present here the clinical and radiological findings and outcome in these patients. Case reportsCase 1A 72-year-old black woman first noticed numbness in her hands 3 months before admission. During the next weeks, she had difficulty walking and working with her hands. She had no history of spinal injury or rheumatic disease. On admission, the gait was clearly ataxic and neurological exam showed a proximal weakness in the lower limbs. There was no impairment of touch sensation, but position sense, in particular, was absent in all limbs. Deep tendon reflexes were brisk, a bilateral Hoffman sign was found and plantar responses were extensor. She complained of neither radiating pain nor urinary symptoms. General examination was otherwise normal. Routine blood tests were unremarkable. Myelography revealed a partial block at the level C4-C5 and a subsequent CT scan showed voluminous oval masses involving both ligamenta flava at the same level (Fig. 1). The patient was then treated with posterior decompressive C4 and C5 laminectomies. At surgery, the above masses appeared as white granular deposits within degenerated ligamenta flava and were easily dissected from the dura matter. Microscopic examination of the removed material revealed hydroxyapatite crystals (HAP) at the centre of the nodules, surrounded by calcium pyrophosphate dihydrate crystals (CPPD). After surgery, there was dramatic improvement. The gait returned to nearly normal and disturbances of the deep sensation Abstract Two cases of cervical myelopathy due to calcification of the ligamenta flava (CLF) are described for the first time in black patients from the French West Indies. A pre-operative CT scan differentiated the diagnosis from one of ossification of the ligamenta flava. Microanalysis on the operatively excised specimen in one patient revealed a mixture of calcium pyrophosphate dihydrate crystals and hydroxypatite crystals. Poor outcome in one patient contrasting with excellent recovery in the other one, who had undergone posterior decompressive laminectomy, emphasizes the importance of surgery in the management of CLF.

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Calcification of the ligamentum flavum of the cervical spine

Cited by 44 publications

References 8 publications

Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Progressive thoracic myelopathy caused by spinal calcium pyrophosphate crystal deposition because of proximal junctional vertebral compression fracture after lumbopelvic fusion

Cervical Myelopathy Caused by Hypoplasia of the Atlas and Ossification of the Transverse Ligament. Case Report.

Myelopathy due to calcification of the cervical ligamenta flava: a report of two cases in West Indian patients

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