The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Conservative Treatment of Thoracic Radiculopathy due to Ossification of the Yellow Ligament in a Young Patient -A case report-

황색인대 골화증으로 인해 발생한 흉추부 신경근병증 환자의 보존적 치료 -증례보고-

  • Lim, Byung Gun (Department of Anesthesiology and Pain Medicine, Guro Hospital, College of Medicine, Korea University) ;
  • Kim, Nam Yeop (Department of Anesthesiology and Pain Medicine, Guro Hospital, College of Medicine, Korea University) ;
  • Lee, Mi Kyoung (Department of Anesthesiology and Pain Medicine, Guro Hospital, College of Medicine, Korea University) ;
  • Jung, Sun Sop (Department of Anesthesiology and Pain Medicine, Guro Hospital, College of Medicine, Korea University) ;
  • Lee, Dong Kyu (Department of Anesthesiology and Pain Medicine, Guro Hospital, College of Medicine, Korea University) ;
  • Choi, Sang Sik (Department of Anesthesiology and Pain Medicine, Guro Hospital, College of Medicine, Korea University)
  • 임병건 (고려대학교 의과대학 구로병원 마취통증의학교실) ;
  • 김남엽 (고려대학교 의과대학 구로병원 마취통증의학교실) ;
  • 이미경 (고려대학교 의과대학 구로병원 마취통증의학교실) ;
  • 정선섭 (고려대학교 의과대학 구로병원 마취통증의학교실) ;
  • 이동규 (고려대학교 의과대학 구로병원 마취통증의학교실) ;
  • 최상식 (고려대학교 의과대학 구로병원 마취통증의학교실)
  • Received : 2009.07.06
  • Accepted : 2009.08.10
  • Published : 2009.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Ossification of the yellow ligament (OYL) is a pathologic condition that causes spinal stenosis, which is a form of ectopic ossification. OYL causes compressive myelopathy and radiculopathy. Although the pathogenesis of OYL is still unclear, diffuse mechanical stresses and degenerative changes caused by extreme ranges of motion may be related to the development of OYL in young sportsmen. Here we report an interesting case of thoracic radiculopathy due to OYL in a 35-year-old male amateur judo player who was successfully treated with continuous thoracic patient controlled epidural analgesia and epidural adhesiolysis.

Keywords

References

  1. Mohindra S, Chhabra R, Mukherjee KK, Gupta SK, Vaiphei K, Khosla VK: Spinal compression due to ossified yellow ligament: a short series of 5 patients and literature review. Surg Neurol 2006; 65: 377-84 https://doi.org/10.1016/j.surneu.2005.10.026
  2. Otani K, Aihara T, Tanaka A, Shibasaki K: Ossification of the ligamentum flavum of the thoracic spine in adult kyphosis. Int Orthop 1986; 10: 135-9 https://doi.org/10.1007/BF00267756
  3. Nakatani T, Marui T, Hitora T, Doita M, Nishida K, Kurosaka M: Mechanical stretching force promotes collagen synthesis by cultured cells from human ligamentum flavum via transforming growth factor-beta1. J Orthop Res 2002; 20: 1380-6 https://doi.org/10.1016/S0736-0266(02)00046-3
  4. Maigne JY, Ayral X, Guérin-Surville H: Frequency and size of ossifications in the caudal attachments of the ligamentum flavum of the thoracic spine. Role of rotatory strains in their development. An anatomic study of 121 spines. Surg Radiol Anat 1992; 14: 119-24 https://doi.org/10.1007/BF01794886
  5. Matsui H, Katoh Y, Tsuji H: Untreated hypophosphatemic vitamin D-resistant rickets with symptomatic ossification of the ligamentum flavum. J Spinal Disord 1991; 4: 110-3
  6. Ono K, Yonenobu K, Miyamoto S, Okada K: Pathology of ossification of the posterior longitudinal ligament and ligamentum flavum. Clin Orthop Relat Res 1999; 359: 18-26 https://doi.org/10.1097/00003086-199902000-00003
  7. Miyamoto S, Yonenobu K, Ono K: Elevated plasma fibronectin concentrations in patients with ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum. Spine 1993; 18: 2267-70 https://doi.org/10.1097/00007632-199311000-00021
  8. Okada K, Oka S, Tohge K, Ono K, Yonenobu K, Hosoya T: Thoracic myelopathy caused by ossification of the ligamentum flavum. Clinicopathologic study and surgical treatment. Spine 1991; 16: 280-7 https://doi.org/10.1097/00007632-199103000-00005
  9. Gupta RK, Agarwal P, Kumar S, Surana PK, Lal JH, Misra UK: Compressive myelopathy in fluorosis: MRI. Neuroradiology 1996; 38: 338-42 https://doi.org/10.1007/BF00596584
  10. Kudo S, Ono M, Russell WJ: Ossification of thoracic ligamenta flava. AJR Am J Roentgenol 1983; 141: 117-21 https://doi.org/10.2214/ajr.141.1.117
  11. Shenoi RM, Duong TT, Brega KE, Gaido LB: Ossification of the ligamentum flavum causing thoracic myelopathy: a case report. Am J Phys Med Rehabil 1997; 76: 68-72 https://doi.org/10.1097/00002060-199701000-00014
  12. Olszewski AD, Yaszemski MJ, White AA 3rd: The anatomy of the human lumbar ligamentum flavum. New observations and their surgical importance. Spine 1996; 21: 2307-12 https://doi.org/10.1097/00007632-199610150-00001
  13. Kaneyama S, Doita M, Nishida K, Shimomura T, Maeno K, Tamura Y, et al: Thoracic myelopathy due to ossification of the yellow ligament in young baseball pitchers. J Spinal Disord Tech 2008; 21: 68-71 https://doi.org/10.1097/BSD.0b013e31811dfc2d
  14. Xiong L, Zeng QY, Jinkins JR: CT and MRI characteristics of ossification of the ligamenta flava in the thoracic spine. Eur Radiol 2001; 11: 1798-802 https://doi.org/10.1007/s003300000788
  15. Maiuri F, Iaconetta G, Gambardella A: Ossification of the yellow ligament causing thoracic cord compression. Arch Orthop Trauma Surg 2000; 120: 346-8 https://doi.org/10.1007/s004020050480
  16. Lee SC, Oh WS, Kim JK, Roh CJ, Son JC: Epidural adhesiolysis in low back pain. Korean J Pain 1997; 10: 214-9
  17. Racz GB, Heavner JE, Trescot A: Percutaneous lysis of epidural adhesions--evidence for safety and efficacy. Pain Pract 2008; 8: 277-86 https://doi.org/10.1111/j.1533-2500.2008.00203.x