Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

  • Hur, Hyuk (Department of Neurosurgery, Chonnam National University Hospital and Medical School) ;
  • Lee, Jung-Kil (Department of Neurosurgery, Chonnam National University Hospital and Medical School) ;
  • Lee, Jae-Hyun (Department of Neurosurgery, Chonnam National University Hospital and Medical School) ;
  • Kim, Jae-Hyoo (Department of Neurosurgery, Chonnam National University Hospital and Medical School) ;
  • Kim, Soo-Han (Department of Neurosurgery, Chonnam National University Hospital and Medical School)
  • Published : 2009.09.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : Ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy. The aim of this study was to identify factors associated with the surgical outcome on the basis of preoperative clinical and radiological findings. Methods : Data obtained in 26 patients whot underwent posterior decompression for thoracic myelopathy, caused by thoracic OLF, were analyzed retrospectively. Patient age, duration of symptoms, OLF type, preoperative and postoperative neurological status using the Japanese Orthopedic Association (JOA) scoring system, surgical outcome, and other factors were reviewed. We compared the various factors and postoperative prognosis. All patients had undergone decompressive laminectomy and excision of the OLF. Results : Using the JOA score, the functional improvement was excellent in 8 patients, good in 14, fair in 2, and unchanged in 2. A mean preoperative JOA score of 6.65 improved to 8.17 after an average of 27.3 months. According to our analysis, age, gender, duration of symptoms, the involved spinal level, coexisting spinal disorders, associated trauma, intramedullary signal change, and dural adhesions were not related to the surgical outcome. However, the preoperative JOA score and type of OLF were the most important predictors of the surgical outcome. Conclusion : Early diagnosis and sufficient surgical decompression could improve the functional prognosis for thoracic OLF. The postoperative results were found to be significantly associated with the preoperative severity of myelopathy and type of OLF.

Keywords

References

  1. Ben Hamouda K, Jemel H, Haouet S, Khaldi M : Thoracic myelopathy caused by ossification of the ligamentum flavum : a report of 18 cases. J Neurosurg 99 : 157-161, 2003
  2. Chang UK, Choe WJ, Chung CK, Kim HJ : Surgical treatment for thoracic spinal stenosis. Spinal Cord 39 : 362-369, 2001 https://doi.org/10.1038/sj.sc.3101174
  3. Cho YH, Moon SM, Roh SW, Joen SR, Rhim SC : Surgical outcome and prognostic factors of ossified ligamentum flavum of the thoracic spine. J Korean Neurosurg Soc 32 : 424-430, 2002
  4. Hayashi K, Ishidou Y, Yonemori K, Nagamine T, Origuchi N, Maeda S, et al. : Expression and localization of bone morphogenetic proteins (BMPs) and BMP receptors in ossification of the ligamentum flavum. Bone 21 : 23-30, 1997 https://doi.org/10.1016/S8756-3282(97)00080-X
  5. Hoshi K, Amizuka N, Sakou T, Kurokawa T, Ozawa H : Fibroblasts of spinal ligaments pathologically differentiate into chondrocytes induced by recombinant human bone morphogenetic protein-2 : morphological examinations for ossification of spinal ligaments. Bone 21 : 155-162, 1997 https://doi.org/10.1016/S8756-3282(97)00106-3
  6. Liao CC, Chen TY, Jung SM, Chen LR : Surgical experience with symptomatic thoracic ossification of the ligamentum flavum. J Neurosurg Spine 2 : 34-39, 2005 https://doi.org/10.3171/spi.2005.2.1.0034
  7. Maigne JY, Ayral X, Guérin-Surville H : Frequency and size of ossification in the caudal attachments of the legamentum flavum of the thoracic spine. Role of rotatory strains in their development. An anatomical study of 121 spines. Surg Radiol Anat 14 : 119-124, 1992 https://doi.org/10.1007/BF01794886
  8. Matsui H, Katoh Y, Tsuji H : Untreated hypophosphatemic vitamin D-resistant rickets with symptomatic ossification of the ligamentum flavum. J Spinal Disord 4 : 110-113, 1991
  9. Mimatsu K, Kishi S, Hashizume Y : Experimental chronic compression on the spinal cord of the rabbit by ectopic bone formation in the ligamentum flavum with bone morphogenetic protein. Spinal Cord 35 : 740-746, 1997 https://doi.org/10.1038/sj.sc.3100533
  10. Miyakoshi N, Shimada Y, Suzuki T, Hongo M, Kasukawa Y, Okada K, et al. : Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg 99 : 251-256, 2003
  11. 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 (Phila Pa 1976) 18 : 2267-2270, 1993 https://doi.org/10.1097/00007632-199311000-00021
  12. 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 65 : 377-384; discussion 384, 2006 https://doi.org/10.1016/j.surneu.2005.10.026
  13. Palumbo MA, Hilibrand AS, Hart RA, Bohlman HH : Surgical treatment of thoracic spinal stenosis : a 2- to 9-year follow-up. Spine (Phila Pa 1976) 26 : 558-566, 2001 https://doi.org/10.1097/00007632-200103010-00021
  14. Park BC, Min WK, Oh CW, Jeon IH, Kim SY, Kyung HS et al. : Surgical outcome of thoracic myelopathy secondary to ossification of ligamentum flavum. Joint Bone Spine 74 : 600-605, 2007 https://doi.org/10.1016/j.jbspin.2007.01.033
  15. Pascal-Moussellard H, Cabre P, Smadja D, Catonné Y : Symptomatic ossification of the ligamentum flavum : a clinical series from the French Antilles. Spine (Phila Pa 1976) 30 : E400- E405, 2005 https://doi.org/10.1097/01.brs.0000169450.49181.91
  16. Sato T, Tanaka Y, Aizawa T, Koizumi Y, Kokubun S: [Surgical treatment for ossification of ligamentum flavum in the thoracic spine and its complications.] Spine Spinal Cord 11 : 505-510, 1998
  17. Shiokawa K, Hanakita J, Suwa H, Saiki M, Oda M, Kajiwara M : Clinical analysis and prognostic study of ossified ligamentum flavum of the thoracic spine. J Neurosurg 94 : 221-226, 2001
  18. Taeki Y : Posterior decompression surgery of thoracic myelopathy due to ossification of intraspinal canal ligaments. J Bone Joint Surg Gr 77 : 131-133, 1995
  19. Trivedi P, Behari S, Paul L, Banergi D, Jain VK, Chhabra DK : Thoracic myelopathy secondary to ossified ligamentum flavum. Acta Neurochir (Wien) 143 : 775-782, 2001 https://doi.org/10.1007/s007010170031
  20. Vera CL, Cure JK, Naso WB, Gelven PL, Worsham F, Roof BF, et al. : Paraplegia due to ossification of ligamenta flava in X-linked hypophosphatemia. A case report. Spine (Phila Pa 1976) 22 : 710-715, 1997 https://doi.org/10.1097/00007632-199703150-00027

Cited by

  1. Ossification of the ligamentum flavum of the thoracic spine in the Korean population : Clinical article vol.14, pp.4, 2009, https://doi.org/10.3171/2010.11.spine10405
  2. Thoracic myelopathy due to ossification of ligamentum flavum: a retrospective analysis of predictors of surgical outcome and factors affecting preoperative neurological status vol.20, pp.2, 2011, https://doi.org/10.1007/s00586-010-1423-9
  3. Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion vol.20, pp.2, 2011, https://doi.org/10.1007/s00586-010-1515-6
  4. Ossification of the ligamentum flavum as cause of thoracic cord compression: Case report of a Latin American man and review of the literature vol.4, pp.None, 2009, https://doi.org/10.4103/2152-7806.118489
  5. Surgical results and prognostic factors for thoracic myelopathy caused by ossification of ligamentum flavum: posterior surgery by laminectomy vol.155, pp.7, 2013, https://doi.org/10.1007/s00701-013-1694-0
  6. Thoracic myelopathy secondary to ossification of ligamentum flavum - Short case series and review of literature vol.10, pp.3, 2013, https://doi.org/10.1016/j.apme.2013.05.016
  7. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity vol.6, pp.None, 2009, https://doi.org/10.1038/srep23019
  8. Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases vol.54, pp.3, 2016, https://doi.org/10.1038/sc.2015.139
  9. Isolated ligamentum flavum ossification in primary hypoparathyroidism vol.9, pp.1, 2018, https://doi.org/10.4103/sni.sni_364_17
  10. Design of mulitlevel OLF approach (“V”-shaped decompressive laminoplasty) based on 3D printing technology vol.27, pp.suppl3, 2009, https://doi.org/10.1007/s00586-017-5234-0
  11. Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum: A Systematic Review and Meta-Analysis vol.43, pp.14, 2009, https://doi.org/10.1097/brs.0000000000002563
  12. Clinical Outcomes and Prognostic Factors in Patients With Myelopathy Caused by Thoracic Ossification of the Ligamentum Flavum vol.15, pp.3, 2009, https://doi.org/10.14245/ns.1836128.064
  13. Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum vol.28, pp.3, 2019, https://doi.org/10.1007/s00586-018-05866-2
  14. Full-endoscopic decompression for thoracic ossification of ligamentum flavum: surgical techniques and clinical outcomes : A retrospective clinical study vol.99, pp.44, 2009, https://doi.org/10.1097/md.0000000000022997
  15. A systematic review of surgical procedures on thoracic myelopathy vol.15, pp.None, 2020, https://doi.org/10.1186/s13018-020-02081-y
  16. Microendoscopic Posterior Decompression for Treating Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Case Series vol.56, pp.12, 2009, https://doi.org/10.3390/medicina56120684