Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife!

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.