Repeated recurrence of thoracic spine stenosis following decompression alone for ossification of the ligamentum flavum: case report

Barath, Abhijeet S.; Wu, Osmond C.; Patel, Monaliben; Kasliwal, Manish K.

doi:10.3171/2018.8.spine18517

Cited by 6 publications

(8 citation statements)

References 15 publications

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“…Because OLF progresses from the lateral to the medial part of the ligamentum flavum 35) , removal of OLF from the medial to lateral part with preservation of the facet joint may leave the lateral part of OLF. This remained OLF may grow due to micro-motion and tensile stress at the operated segment 2,35) , and the recurrence of OLF has been reported after decompression-only surgery 3,6,14,30,44) . To date, there has been no reported case of recurrence at the surgical site after instrumented fusion.…”

Section: Discussionmentioning

confidence: 99%

Value of Additional Instrumented Fusion in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Hwang

Chung

Kim

et al. 2022

J Korean Neurosurg Soc

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Objective :The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods : A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results : After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the Fgroup than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion : Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.

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Section: Discussionmentioning

confidence: 99%

Value of Additional Instrumented Fusion in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Hwang

Chung

Kim

et al. 2022

J Korean Neurosurg Soc

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“…OLF is shown as the primary cause of thoracic myelopathy (13)(14)(15)(16). The studies have reported that OLF is more common in the fifth and sixth decades of life, its incidence increases with age, and it is seen at a higher rate in East Asian countries, especially in Japanese people (4,14,(17)(18)(19). In many studies, factors such as genetics, dietary habits, mechanical stress, and cytokine production in the ligamentum flavum have been implicated in the etiology of OLF, and no definitive etiological factor has been reported (7).…”

Section: Discussionmentioning

confidence: 99%

“…Since neurological symptoms mostly affect the lower extremities, TSS can be confused with lumbar spinal pathologies and patients may be clinically misdiagnosed (2,10). Generally, patients present to the clinic with symptoms of progressive thoracic myelopathy, back pain, and/or signs of acute severe paraparesis or paraplegia after minor trauma (4)(5)(6)11).…”

Section: Introductionmentioning

confidence: 99%

Thoracic Spinal Stenosis: Surgical Approaches and Outcomes

Gökbel

Seçer²,

Gokbel

2021

Middle Black Sea Journal of Health Science

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Objective: Thoracic spinal stenosis (TSS) develops as a result of decreased spinal canal volume in the thoracic spine. The prevalence of TSS is low as when compared with cervical or lumbar spinal stenosis, and conservative treatment is not effective. The present study aimed to present all surgical methods employed and their outcomes in patients diagnosed with TSS in our clinic.Methods: In this study, the data of 14 patients including three patients with single-level, nine patients with two-level, one patient with three-level, and one patient with multilevel TSS and hypophosphatemic rickets who underwent surgery due to TSS, were retrospectively evaluated using the discharge summary, surgical reports, and preoperative and postoperative radiological images.Results: The age of the patients ranged from 53 to 68 years. Of the patients included in the study, one underwent hemilaminectomy, two underwent total laminectomy, six underwent laminoplasty, and five underwent total laminectomy with fusion and posterior instrumentation. A dramatic improvement was observed in the neurological deficits existing in the preoperative period in patients who were diagnosed in the early period and underwent surgery with adequate decompression before the development of severe neurological deficits and who continued postoperative rehabilitation added to the treatment.Conclusion: Patients with TSS have an insidious clinical course manifested by upper motor neuron symptoms. Although the prevalence of TSS is low, early diagnosis and treatment are important. The results of surgery are satisfactory when adequate decompression is achieved before the clinical condition worsens.

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“…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 that is uncertain due to the low prevalence of disease and inconstant pre-operative status thus is invaluable for further research. Recurrence of OLF leading to thoracic myelopathy has been reported in the literature after laminectomy at the same intervertebral level [4,5] but no case of adjacent level OLF in thoracic spine reported yet. We report a case of a 37-year-old male who was already operated for thoracic myelopathy secondary to OLF at D8-D9 level 4 years ago and now presented with gait abnormality due to OLF at D6 to D8 level with coexisting asymptomatic L1-2 disc prolapse.…”

Section: Introductionmentioning

confidence: 98%

Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife!

Kulkarni¹,

Kulkarni²,

Thosar³

2022

bbj

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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.

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Repeated recurrence of thoracic spine stenosis following decompression alone for ossification of the ligamentum flavum: case report

Cited by 6 publications

References 15 publications

Value of Additional Instrumented Fusion in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Value of Additional Instrumented Fusion in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Thoracic Spinal Stenosis: Surgical Approaches and Outcomes

Ossification of Ligamentum Flavum – Beckoning Surgeon’s Knife!

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