The Role of Ligamentum Flavum Calcification at Lumbar Spine Causing Cauda Equina Syndrome and Lumbar Radiculopathy: Case Report

Abstract

The focal calcification or ossification of ligamentum flavum is a rare cause of thoracic myelopathy and most often occurs among individuals of Japanese descent. It is rare in other ethnic groups and in individuals below the age of 50 year. It is most often described at the lower thoracic level, being uncommon in the lumbar region and rare in the cervical region. Here, we present the case of a 40-year-old Indian female patient who sought medical attention with a six month history of paraesthesia of the lower limbs and progressive difficulty in walking. The clinical profile, together with computed tomography and magnetic resonance imaging of the spine, led to a diagnosis of compressive lumbar myelopathy due to ossification of the ligamentum flavum of lumbar spine. The patient underwent laminectomy and dissection of some of the affected ligamentum flavum. After three months of clinical follow-up, the patient had progressed favorably, having no sensory complaints and again becoming ambulatory. CASE REPORT: A previously healthy 40-year-old female patient sought medical attention at our hospital. The patient presented with a 2-month history of ascending paraesthesia of the left leg, with progressive worsening and right leg involvement, accompanied by reduced (right and left) leg muscle strength. She reported lower back discomfort. She also found difficulty in sitting and walking showing signs of neurological claudication. Neurological examination revealed paraparesis. A computed tomography (CT) scan of the lumbar spine revealed the following: calcification of ligament flavum at L2-L3 to L4-L5 levels worst at L3-L4 and lateral recess stenosis at L3-L4 and L4-L5.