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Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: report of two cases and literature review.
Spine J 2013; 13(1):e1-6SJ

Abstract

BACKGROUND CONTEXT

In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature.

PURPOSE

We describe two more cases that exhibited cervical myelopathy resulting from the combination of cervical OLF and OPLL and required surgery. A literature review with a comparative analysis between previous reports and present cases was also performed.

STUDY DESIGN

Case report and literature review.

PATIENT SAMPLE

Two patients with combined OLF and OPLL.

OUTCOME MEASURES

Preoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses.

METHODS

A 76-year-old man (Case 1) presented with disturbance of gait and fine finger movement. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C3-C4 level. Computed tomography showed OPLL at the C2-C6 levels (segmental type) and OLF at the left C3-C4 level. The patient underwent posterior decompression and OLF resection. A 75-year-old man (Case 2) presented with sensory disturbance and muscle weakness in his bilateral upper extremities and disturbance in fine finger movements. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C2-C3 and C3 levels. Computed tomography showed OPLL at the C3-C7 levels (mixed type) and OLF at the left C2-C3 and C3 levels. The patient also underwent posterior decompression and OLF resection.

RESULTS

In both cases, histological examination of the surgical specimens showed osseous tissue and enchondral ossification within the ligamentum flavum, and the diagnosis in each case was OLF. After surgery, both patients' symptoms immediately improved, and no recurrence was observed at 2 years after surgery.

CONCLUSIONS

We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Steel Memorial Muroran Hospital, Chinebetsu 1-45, Muroran, Hokkaido 050-0076, Japan. yoshi96k@ja2.so-net.ne.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

23266147

Citation

Kotani, Yoshihisa, et al. "Cervical Myelopathy Resulting From Combined Ossification of the Ligamentum Flavum and Posterior Longitudinal Ligament: Report of Two Cases and Literature Review." The Spine Journal : Official Journal of the North American Spine Society, vol. 13, no. 1, 2013, pp. e1-6.
Kotani Y, Takahata M, Abumi K, et al. Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: report of two cases and literature review. Spine J. 2013;13(1):e1-6.
Kotani, Y., Takahata, M., Abumi, K., Ito, M., Sudo, H., & Minami, A. (2013). Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: report of two cases and literature review. The Spine Journal : Official Journal of the North American Spine Society, 13(1), pp. e1-6. doi:10.1016/j.spinee.2012.10.038.
Kotani Y, et al. Cervical Myelopathy Resulting From Combined Ossification of the Ligamentum Flavum and Posterior Longitudinal Ligament: Report of Two Cases and Literature Review. Spine J. 2013;13(1):e1-6. PubMed PMID: 23266147.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: report of two cases and literature review. AU - Kotani,Yoshihisa, AU - Takahata,Masahiko, AU - Abumi,Kuniyoshi, AU - Ito,Manabu, AU - Sudo,Hideki, AU - Minami,Akio, Y1 - 2012/12/21/ PY - 2011/10/13/received PY - 2012/08/05/revised PY - 2012/10/26/accepted PY - 2012/12/26/entrez PY - 2012/12/26/pubmed PY - 2013/7/24/medline SP - e1 EP - 6 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 13 IS - 1 N2 - BACKGROUND CONTEXT: In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature. PURPOSE: We describe two more cases that exhibited cervical myelopathy resulting from the combination of cervical OLF and OPLL and required surgery. A literature review with a comparative analysis between previous reports and present cases was also performed. STUDY DESIGN: Case report and literature review. PATIENT SAMPLE: Two patients with combined OLF and OPLL. OUTCOME MEASURES: Preoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses. METHODS: A 76-year-old man (Case 1) presented with disturbance of gait and fine finger movement. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C3-C4 level. Computed tomography showed OPLL at the C2-C6 levels (segmental type) and OLF at the left C3-C4 level. The patient underwent posterior decompression and OLF resection. A 75-year-old man (Case 2) presented with sensory disturbance and muscle weakness in his bilateral upper extremities and disturbance in fine finger movements. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C2-C3 and C3 levels. Computed tomography showed OPLL at the C3-C7 levels (mixed type) and OLF at the left C2-C3 and C3 levels. The patient also underwent posterior decompression and OLF resection. RESULTS: In both cases, histological examination of the surgical specimens showed osseous tissue and enchondral ossification within the ligamentum flavum, and the diagnosis in each case was OLF. After surgery, both patients' symptoms immediately improved, and no recurrence was observed at 2 years after surgery. CONCLUSIONS: We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/23266147/Cervical_myelopathy_resulting_from_combined_ossification_of_the_ligamentum_flavum_and_posterior_longitudinal_ligament:_report_of_two_cases_and_literature_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(12)01314-9 DB - PRIME DP - Unbound Medicine ER -