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

Abstract

Thoracic ossification of the ligamentum flavum (TOLF) is the most common cause for thoracic spinal stenosis. TOLF is usually complicated by thoracic disc herniation, ossification of the posterior longitudinal ligament and degenerative spinal diseases such as cervical spondylosis and lumbar spinal stenosis, and the ossification also usually has a discontinuous or continuous multi-segment distribution. The resultant superposition of several symptoms makes the clinical manifestations complex. Currently, the diagnosis of TOLF depends mainly on the patient's symptoms, physical examination and thoracic CT and MRI examinations. Identification of the location of TOLF depends more on the doctor's subjective judgement. Diagnostic problems are related to the specific region and level of surgical decompression: if the extent of decompression is insufficient, the treatment is inadequate, resulting in residual symptoms. Obversely, unnecessary trauma and a various complications will occur if the decompression is too extensive. Hence, the clinical features and process of diagnosis, especially the means of identifying the location, still require further improvement. It is necessary to establish a simple and accurate means of identifying the segment of TOLF that is responsible for the neurologic deficit: a number of spinal surgeons have been working hard on this. This article will provided an overview of the clinical features of TOLF and the related problems of clinical identification of the location of the segment causing the neurological deficit. The relationship between the imaging manifestations and clinical characteristics still need to be explored with the aim of establishing a simple and precise method for determining precisely whether TOLF is related to spinal cord injury or not, thus reducing surgical trauma and achieving an optimal prognosis.

Notch signaling pathways in human thoracic ossification of the ligamentum flavum

“…Ligaments with a typical size of approximately 0.5–1 cm were aseptically harvested from patients during surgery and rinsed with phosphate‐buffered saline (PBS). The surrounding tissue was removed carefully under a dissecting microscope to avoid possible contamination by osteogenic cells.…”

“…Thoracic ossification of the ligamentum flavum (OLF), which is the primary cause of thoracic spinal canal stenosis and myelopathy in our previous retrospective review, is reported almost exclusively in East Asian countries such as China, Japan, and Korea . Our previous epidemiological survey revealed a standardized prevalence rate of 63.9% in Chinese people .…”

Evaluation of Prognostic Factor and Pain Intensity Following Thoracolumbar Disc Surgeries

“…Out of the 49 patients studied, 37 (75%) were fusion and 12 (25%) were not fusion, and the severity of pain in the non-fusion group was 16.7% and in the fusion group 16.2%, and the mild pain In the non-fusion group 83.3% and in the fusion group 83.8%, it was interesting to note that there was no difference between the two groups regarding the amount of pain in the lower limb. Finally, the lower limb pain in our study was 16.3%, which was more than Qi Q, Chen Qi (10.5%) [5,[19][20][21][22][23][24][25][26][27].…”

Thoracic myelopathy secondary to multi-level ossification of the ligamentum flavum in an Asian patient

“…[10] Ossification can affect several levels and occur in a contiguous or non-contiguous fashion. [11] OLF frequently co-exists with OPLL, ossification of the dura and cervical/lumbar spondylosis. [11,12] This may contribute to a delay in diagnosis and complicate management.…”