Ossification of the ligamentum flavum as cause of thoracic cord compression: Case report of a Latin American man and review of the literature

Abstract

Background:Ossification of the ligamentum flavum is a widely described pathology in eastern Asia. Cases have been reported in northern Africa, the Middle-East, India, the Caribbean, Europe, and North America, but no cases from Latin America have been published in the literature. It affects mostly elderly men, with a possible association with obesity and type 2 diabetes.Case Description:A 38-year-old previously healthy Latin American male presented to the emergency room department with severe functional disability and a 3/5 paraparesis. Blood reports showed no abnormalities. Computed tomography and magnetic resonance imaging showed a ligamentum flavum ossification with myelopathy. The patient underwent a T3-T9 laminotomy. At hospital discharge, the patient remained with a 3/5 paraparesis, mild hypoesthesia in both lower limbs and bladder incontinence. Rectal sphincter was continent. At 6 months, he was able to walk with a cane, with no sphincter or sensory alterations.Conclusions:Ligamentum flavum ossification is rare. To our understanding, this is the first case reported in the Latin American population.

Four Cases of Thoracic Ossification of the Ligamentum Flavum with Acute Progressive Myelopathy

“…In addition to pyramidal tract disorders, problems in the posterior funiculus have often been reported to occur due to compression of the posterior side of the spinal cord [2]. In this paper 2 of the 4 patients had difficulty walking even though their muscle strength was preserved with an MMT in the lower legs >4.…”

“…In our 4 patients, however, there were no episodes of trauma, and the exact mechanism of paraplesia is still unclear. Saito et al and Igata et al describe the following possible mechanism [2,5].…”

Dorsal Compressive Myelopathy Due to Ossified Yellow Ligament - A Comparative Study

“…It is thought that the hyperkyphosis of this region of the spine is associated with mechanical stress, which makes ligaments in this region more prone to ossification. 8 About twenty-one cases are studied. The men who are suffering from Dorsal Compressive Myelopathy due to Ossified Yellow Ligament are generally in the age group of 31-70 years.…”

Progress on Clinical Characteristics and Identification of Location of Thoracic Ossification of the Ligamentum Flavum

“…In Japan, surgery for TOLF treatment accounts for about 0.09% of all spinal surgeries and only 0.006% of all residents of Japan require surgery for TOLF 4 . However, in recent years, TOLF has been increasingly reported in other countries [18][19][20][21][22][23] , particularly China [24][25][26][27][28] . Epidemiological investigations in China have found that TOLF is quite common in adults.…”