Thoracic myelopathy secondary to ossified ligamentum flavum

Omojola, Matthew F.; Cardoso, Érico R.; Fox, Allan J.; Drake, Charles G.; Durward, Quentin J.

doi:10.3171/jns.1982.56.3.0448

Cited by 77 publications

(21 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Before the early 1990s, when MRI was not commonly used for neurological diagnosis, CT was considered the best diagnostic tool to detect thoracic OLF. 23,26,30,36 OLF can be confirmed to mainly present in the foraminal region on CT, which not only provide an accurate assessment of the contour of the ossification but also show the ossification of dura mater and the size of the spinal canal. Pascal-Moussellard et al 28 reported sagittal reconstructions of CT that are helpful for distinguishing OLF from calcification of the ligamenta flava, which is the only differential diagnosis of OLF.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, when the ligamentum flavum is replaced by a mature bone, its osseous morphology should be V-shaped or a part of V shape on CT images. 12 Although thoracic OLF has been reported in several Asian countries, such as Japan, [11][12][13][14] China 3,4,[15][16][17][18][19] and South Korea, [20][21][22] and also in Caucasian and Caribbean ethnic groups, [23][24][25][26][27][28] extensive studies on thoracic OLF including a large number of patients have not yet been reported in the literature. This is partly due to the relatively low mean prevalence of thoracic OLF, which was reported as 3.8% in China and as 6.2% for Japanese men and 4.8% for Japanese women.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Ren

Zhao

et al. 2015

Spinal Cord

View full text Add to dashboard Cite

Study design: A retrospective comparative study. Objectives: To describe the clinical features and radiological findings, to assess the safety and effectiveness of posterior decompressive laminectomy and resection of the ossification of the ligamentum flavum (OLF), and to determine which presurgical and surgical variables were most closely related to postsurgical prognosis of thoracic myelopathy (TM) caused by OLF in China. Methods: Eighty-five patients with the diagnosis of TM caused by OLF received surgical treatment from July 1998 to May 2012. Clinical data were collected from medical and operative records. Correlations between the surgical outcome and various factors were also analyzed. Results: All cases were followed up for a mean of 49.2 months (range, 24-190 months) postoperatively. The mean Japanese Orthopaedic Association score was 3.8 points preoperatively and 8.2 points at the final follow-up, yielding a mean recovery rate of 63.0%. Postoperative complications included transient neurological deficits (9 cases), persistent neurological deficits (4 cases), dural tears (17 cases), cerebrospinal fluid leakage (9 cases), wound dehiscence (2 cases) and wound infection (3 cases). The OLF level (middle thoracic), preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were important predictors of surgical outcome. Conclusions: Biomechanical and anatomical factors may have a key role in thoracic OLF progression. Posterior decompressive laminectomy and resection of the OLF can be considered an effective, reliable and safe alternative procedure. The OLF level, preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were confirmed and significantly correlated with the surgical outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Ren

Zhao

et al. 2015

Spinal Cord

View full text Add to dashboard Cite

show abstract

“…8 The segments most frequently involved in thoracic stenosis were lower thoracic (T9 ± T12), in which there is great mobility and vulnerability to¯exion, extension, and rotation. 9,10 Both the frequency and severity of ossi®cation of ligamentum¯avum increase as the thoracolumbar junction is approached; this is because the lower thoracic spine undergoes local mechanical stress from tensile force due to frequent motion. 11 Cases in which there was signi®cant stenosis in other segments are summarized in Table 3.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Surgical treatment for thoracic spinal stenosis

Choe

Chung

et al. 2001

Spinal Cord

View full text Add to dashboard Cite

Objectives: To describe the underlying causes, surgical results and prognostic factors in thoracic stenosis causing myelopathy. Methods: The underlying causes and surgical results were analyzed retrospectively in 28 cases of thoracic spinal stenosis which caused myelopathy. Degenerative spondylosis was the most common cause, and three cases were associated with systemic diseases. Decompressive laminectomy was performed in 24 cases, anterior decompression in ®ve cases, and combined decompression in one case. Ossi®cation of ligamentum¯avum was found in 18 cases, facet hypertrophy in 13, ossi®cation of posterior longitudinal ligament in six, and ventral spur in four. Postoperatively 16 patients improved and four patients worsened. Follow-up ranged from 2 months to 5 years and 8 months). Statistical analysis was performed using a w 2 test to investigate the relationship between subjects. Multivariant analysis (general linear model) was used to determine the factors which in¯uence surgical outcome. Results: There were neurological improvements in 16 patients, in whom Nurick grade changed from 3.3 preoperatively to 1.8 postoperatively. Eight patients showed no signi®cant change in functional grade and four patients deteriorated after decompressive laminectomy. The group of which initial symptom duration was less than 2 years showed better results (P=0.006). The group with sucient decompression and no additional proximal stenosis had better treatment outcome (P=0.005, P=0.002). Conclusion: Chronic severe myelopathy caused by thoracic spinal stenosis can be reversible with appropriate decompression. Surgical outcome was dependent on initial symptom duration, sucient decompression and presence of additional proximal stenosis.

show abstract

“…A less recognised cause is the ossification of the ligamenta flava (OLF), a condition that is rarely reported in the Western literature. Although thoracic OLF usually occurs in the lower thoracic spine, [1][2][3][4][5][6][7][8][9][10] it has been reported to occur at higher thoracic levels resulting in proximal myelopathy. 11,12 This is particularly important because, regardless of the level and severity of the disease, OLF is easily treatable by decompressive laminectomy if the diagnosis is made early.…”

Section: Introductionmentioning

confidence: 99%

Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review

2006

View full text Add to dashboard Cite

Study design: Case report and literature review. Objective: To illustrate that ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in a Caucasian patient and that timely surgery can lead to a good outcome. Setting: Nottingham, UK. Methods: Proximal multiple contiguous ossified thoracic ligamenta flava from T3/T4 to T5/T6 causing acute myelopathy was diagnosed in a Caucasian man based on history and examination followed by magnetic resonance imaging and computed tomography scanning. The literature is reviewed for all reported cases of ossified ligamenta flava causing myelopathy in Caucasians. Results: Following prompt diagnosis and T3 to T5 laminectomies, our patient made nearcomplete neurological recovery over a 10-month period. This condition usually affects the lower thoracic spine. Although chronic and subacute myelopathy secondary to this circumstance has been reported in Caucasians, acute myelopathy has not been reported and proximal thoracic involvement has been reported twice. Conclusion: Ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in Caucasians. Prognosis following decompressive surgery is usually good.

show abstract

Thoracic myelopathy secondary to ossified ligamentum flavum

Cited by 77 publications

References 9 publications

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Surgical treatment for thoracic spinal stenosis

Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review

Contact Info

Product

Resources

About