Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: report of two cases and literature review |
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| Authors: | Yoshihisa Kotani Masahiko Takahata Kuniyoshi Abumi Manabu Ito Hideki Sudo Akio Minami |
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| Institution: | 1. Department of Orthopaedic Surgery, Steel Memorial Muroran Hospital, Chinebetsu 1-45, Muroran, Hokkaido 050-0076, Japan;2. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kitaku, Sapporo 060-8638, Japan;3. Department of Spinal Reconstruction, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kitaku, Sapporo 060-8638, Japan;4. Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kitaku, Sapporo 060-8638, Japan;1. Department of Anesthesiology, Peking University Third Hospital, Beijing, China;2. Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China;1. Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, New York;2. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA;3. Department of Cardiovascular Medicine, Heart & Vascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY;4. Department of Medicine, James J. Peters VA Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY;5. Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH;6. Division of Cardiology, Texas Tech University, El Paso;1. Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, 116011 Dalian, Liaoning, People’s Republic of China;2. Department of Orthopaedics, The Third Affiliated Hospital of Dalian Medical University, Jinpu New Area, Liaoning, People’s Republic of China;3. Department of Nursing, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, 116011 Dalian, Liaoning, People’s Republic of China;4. Operation Room, The First Affiliated Hospital of Dalian Medical University, 222 Zhong Shan Road, 116011 Dalian, Liaoning, People’s Republic of China;1. Department of Stomatology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;2. Department of Orthopaedic Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;1. Hospices civils de Lyon, fédération d’endocrinologie, groupement hospitalier Est, 59, boulevard Pinel, 69677 Lyon, France;2. Université Lyon 1, 69372 Lyon, France;3. Cancer center of Lyon, Inserm U1052, CNRS UMR5286, signaling, metabolism and tumor progression, 69372 Lyon, France |
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| Abstract: | Background contextIn 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.PurposeWe 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 designCase report and literature review.Patient sampleTwo patients with combined OLF and OPLL.Outcome measuresPreoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses.MethodsA 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.ResultsIn 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.ConclusionsWe 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. |
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