2014 JOURNAL OF MEDICAL RESEARCHVol.1 No.1Vol.1Jul.–Dec. 2014ERA’S JOURNAL OF MEDICAL RESEARCHJul.–Dec. No.1ERA’S
CoMP RESSIoN NEURoPATHY DUE To
oSSIFICATIoN oF lIGAMENTUM FlAVUM
Khanduri S, Parashari UC, Bhadury S, Singh G. Department of
Radiodiagnosis Era’s Lucknow Medical College. Lucknow.
ABSTRACTAddress for Correspondence
We report a case of 50 years female suffering from compression neuropathy due to ossification of Dr. Sachin Khanduri
ligamentum flavum. This ossification of ligamentum flavum usually presents with neuropathy in Deptt. Lucknow of Radio Medical diagnosisEra’s College,
the setting of thoracic spinal stenosis.Lucknow, UP
h no – 9793059000
Key Words: Ossification of ligamentum flavum, thoracic spine, compression neuropathyPE–Mail – firstname.lastname@example.org
Ossification of ligamentum flavum is a definite clinical entity
and is thought to be a form of ectopic ossification but it’s
cause remains unknown. It develops predominantly in a
lower thoracic spine in middle age and causes compression
neuropathy. Patients with ossification suffer from severe
neurological deficit with gait disturbances, motor weakness in
legs and urinary incontinence. Decompressive laminectomy
with resection of the ossified ligaments does not always
produce a satisfactory result because of recurrent ossification
or progression of the process at other spinal levels. No
therapeutic agent is known to prevent the development of Figure 1: CT scan of thoracic spine showing ossified ligamentum
ossification of ligamentum flavum.flavum (arrow)
CASE REPoRTFigure 2: MRI, sagittal, axial and coronal sections showing ossified
ligamentum flavum causing narrowing of spinal canal with
A female patient aged 50 years presented to orthopedics compression over exiting nerve roots (arrows).
department with chief complaints of bilaterally progressive
numbness in leg and pain. She reported this numbness and DISCUSSIoN
pain for 5 years but sought no treatment. When she started Ossification of ligamentum flavum was reported by Polgar
having difficulty with gait. she reported to hospital for in1929. It has been recognized as an important cause of
treatment. Her past medical history was significant for mild thoracic neuropathy as described by Yamaguchi Tamagake
osteoarthritic changes in knee. She is non–smoker, non–and Fujito Okada et al who described pathology of the same
alcoholic and has no significant family history. Biochemical in detail.
investigations work up was within normal range. Neurologic
examination revealed 4/5 strength in quadriceps, hamstring The normal fibrous structure of ligamentum flavum is lost
muscles bilaterally. Patellar reflex was 3/4 bilateral. Patient and replaced by hypertrophied fibrous tissue, containing
had decreased two point discrimination in her feet, altered numerous fibrocartilagenous cells. Ossification of ligamentum
pain and temperature sense in her lower legs and feet.flavum results from endochondral ossification which extends
along the ventral layer of hypertrophied ligament. As most
Plain radiograph of thoracic and lumbosacral spine showed of the reported ossification of ligamentum flavum’s were
evidence of degenerative changes. On non contrast computed located between T9 and T12, Barnett et al suggested that
tomographic scans of dorso–lumbar spine, calcifications were the hypermobility of lower thoracic spine might promote
seen in posterior part of spinal canal with mild spinal canal degeneration and canal stenosis. Liao’s study showed a high
narrowing at the affected level. On Magnetic Resonance prevalence of coexisting anterior osteophyte and herniated
Imaging, ossification of ligamentum flavum appeared as intervertebral disc at symptomatic ossification of ligamentum
triangular area of low signalEJMR intensity on T1 and T2 weighted flavum segments. So, it was concluded that ossification of
images in posterior margin of spinal canal, producing mild ligamentum flavum might be degenerative response to micro
narrowing of spinal canal with compression over exiting injury.
nerve roots at the affected level.
3031 2014 JOURNAL OF MEDICAL RESEARCHVol.1 No.1Vol.1Jul.–Dec. 2014ERA’S JOURNAL OF MEDICAL RESEARCHJul.–Dec. No.1ERA’S
REFERENCE5. Omojola MF, Cardoso ER, Fox AJ, Drake CG, Durward QJ:
1. J ayakumar PN, Devi BI, Bhat DI, Das BS. Thoracic cord Thoracic neuropathy secondary to ossified ligamentum
compression due to Ossified hypertrophied ligamentum flavum: case report. J Neurosurg 56:448–450, 1982.
flavum. Neurology India 2002; 50:286–9.6. Otani K, Yoshida M, Fujii E, Shibasaki K: Thoracic disc
2. Gil–salu JL, Lopez–escobar M, Gomez–cardenas E, Rodriquez–hernation: surgical treatment in 23 patients. Spine 13;1262–
pena F, Repeto–lopez JA, Lopez–Lopez J et al. Calcification of 1267, 1988.
thoracic yellow ligament as a cause of neuropathy. Rev Neurol 7. Parekh H, Gurusinghe NT, Perera SS, Prabhu SS: Ossification
2002 Apr 16–30; 34(8): 750–3.of the ligamentum flavum in a Caucasion: Case report. Br J
3. Mitra SR, Gurjan SG, Mitra KR: Degenerative disease of the Neurosurg 7:687–690, 1993.
thoracic spine in Central India. Spinal Cord 34:333–337, 1996.8. Shiraishi T, Crock HV, Lewis P: Thoracic neuropathy due to
4. Okada K, Oka S, Tohge K, Ono K, Yonenobu K, Hosoya isolated ossification of the ligamnetum flavum. J Bone Joint
T: Thoracic neuropathy caused by ossification of the Surg 77–B: 131–133, 1995.
ligamentum flavum: Clinicopathologic study and surgical
treatment. Spine 16:280–287, 1991.