Noncalcified Hypertrophic Ligamentum Flavum Causing Severe Cervical Stenosis and Myelopathy: Case Report and Review of the Literature

Coughlin, Daniel J.; Rymarczuk, George N.; Dirks, Michael

doi:10.1016/j.wneu.2016.08.035

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…Primary watertight repair remains ideal, but this is not always practical from the anterior cervical approach. Various other on-lay strategies, including the use of fibrin glue and graft materials, can be employed when primary repair is not attainable [64-67]. An extensive review of the literature by Mazur et al [66] suggested that the use of CSF diversion via lumbar drain or shunt in dural leaks treatment following OPLL surgery has a high success rate, ranging from 83%–100%.…”

Section: Discussionmentioning

confidence: 99%

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

et al. 2019

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Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.

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Section: Discussionmentioning

confidence: 99%

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

et al. 2019

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“…[2,13–15] CSS also describes osteoarthritic changes in the spine, including osteophytes, spondylosis and facet joint disease, in addition to ligament abnormalities such as ossification or hypertrophy of the CLF. [16–19]…”

Section: Discussionmentioning

confidence: 99%

The cervical ligamentum flavum area: A new sensitive morphological parameter for identifying the cervical spinal stenosis

Kim,

Jang,

Choi

et al. 2023

Medicine

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Thickening of the cervical ligamentum flavum (CLF) has been considered as a main cause of cervical spinal stenosis (CSS). A previous study reported that cervical ligamentum flavum thickness (CLFT) is correlated with CSS. However, the whole hypertrophy is different from focal thickness. Therefore, to analyze hypertrophy of the CLF, we created a new morphological parameter, called the cervical ligamentum flavum area (CLFA). We hypothesized that the CLFA is an important morphological parameter in the diagnosis of CSS. CLF samples were acquired from 83 patients with CSS, and from 84 controls who underwent cervical magnetic resonance imaging (C-MRI). T2-weighted axial C-MRI images were acquired. We measured the CLFA and CLFT at the C6-C7 intervertebral level on C-MRI using appropriate image analysis software. The CLFA was measured as the cross-sectional area of the entire CLF at the level of C6-C7 stenosis. The CLFT was measured by drawing a straight line along the ligament side towards the spinal canal at the C6-C7 level. Mean CLFA was 25.24 ± 6.43 mm2 in the control group and 45.34 ± 9.09 mm2 in the CSS group. The average CLFT was 1.48 ± 0.28 mm in the control group and 2.09 ± 0.35 mm in the CSS group. CSS patients had significantly higher CLFA (P < .01) and CLFT (P < .01). For the validity of both CLFA and CLFT as predictors of CSS, a receiver operating characteristic curve analysis revealed an optimal cutoff point for the CLFA was 31.66 mm2, a sensitivity of 92.8%, specificity of 88.4%, and an area under the curve of 0.97 (95% CI, 0.94–0.99). The optimal cut off-point of the CLFT was 1.79 mm, with a sensitivity of 83.5%, specificity of 84.5%, and an area under the curve of 0.92 (95% CI, 0.87–0.96). Both CLFT and CLFA were significantly related to CSS, but CLFA was the more sensitive measurement parameter. Therefore, to evaluate patients with CSS, treating physicians should test for CLFA.

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“…Previous grading system might have overlooked hypertrophy of CLF. Coughlin et al [ 25 ] have reported that calcified hypertrophic CLF is a known entity that causes myelopathy of the cervical spine. They also insisted that noncalcified hypertrophic CLF could cause progressive cervical myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis

Jeong

Lee

et al. 2021

Medicine

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One of major causes of cervical central stenosis (CCS) is thickened change of cervical ligament flavum (CLF). The association of a morphological parameter called cervical ligament flavum thickness (CLFT) with CCS has not been reported yet. Thus, the purpose of this research was to investigate the relationship between CCS and CFJT. Data were obtained from 88 patients with CCS. A total of 87 normal controls also underwent cervical spine magnetic resonance imaging (CSMRI). All subjects underwent axial T2-weighted CSMRI. Using our picture archiving and communications system, thickness of ligament flavum of the cervical spine at C6/7 level was analyzed. The mean CLFT was 1.41 ± 0.24 mm in normal subjects and 2.09 ± 0.39 mm in patients with CCS. The CCS group was found to have significantly ( P < .001) higher rate of CLFT than normal subjects. ROC curves were used to assess the usefulness of CLFT as a predictor of CCS. In the CCS group, the best practical cut off-point of CLFT was 1.71 mm (sensitivity = 90.9%; specificity = 90.8%), with AUC of 0.94 (95% confidence interval: 0.90--0.98). Greater CLFT values were associated with greater possibility of CCS. Thus, treating physician should carefully examine CLFT, as it can help diagnose CCS.

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Noncalcified Hypertrophic Ligamentum Flavum Causing Severe Cervical Stenosis and Myelopathy: Case Report and Review of the Literature

Cited by 6 publications

References 10 publications

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

The cervical ligamentum flavum area: A new sensitive morphological parameter for identifying the cervical spinal stenosis

Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis

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