Thoracic myelopathy caused by calcification of the ligamentum flavum

Kousei Miura; Masao Koda; Tetsuya Abe; Toru Funayama; Hiroshi Noguchi; Hiroshi Kumagai; Katsuya Nagashima; Kentaro Mataki; Yosuke Shibao; Masashi Yamazaki

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Thoracic myelopathy caused by calcification of the ligamentum flavum

VernacularTitle:Thoracic myelopathy caused by calcification of the ligamentum flavum
Author: Kousei MIURA ¹ ; Masao KODA ² ; Tetsuya ABE ¹ ; Toru FUNAYAMA ¹ ; Hiroshi NOGUCHI ¹ ; Hiroshi KUMAGAI ¹ ; Katsuya NAGASHIMA ¹ ; Kentaro MATAKI ¹ ; Yosuke SHIBAO ¹ ; Masashi YAMAZAKI ¹
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1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
2. Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Japan
Keywords: calcification of the ligamentum flavum; thoracic myelopathy; decompression with fusion surgery
From:Journal of Rural Medicine 2020;15(2):65-67
CountryJapan
Language:English
Abstract: Calcification of the ligamentum flavum (CLF), which is a rare disorder that can potentially cause myelopathy, occurs uncommonly in the thoracic spine. Here, we report a rare case of thoracic myelopathy caused by CLF in a 78-year-old man. Magnetic resonance imaging (MRI) showed posterior spinal cord compression by a hypo-signal intense mass, and computed tomography (CT) revealed CLF and vacuum disc phenomenon at T10/11. After undergoing posterior decompression and instrumented fusion (T9–T12), the patient’s gait difficulties improved. The pathogenesis of CLF is largely unknown; however, it involves accumulation of calcium pyrophosphate dehydrate crystals (CPPD), and CLF from CPPD deposition tends to occur within a thickened and hypertrophic ligament. CLF occurs predominantly in the cervical spine and less frequently in the lumbar spine, with few cases involving the thoraco-lumbar spine. The thoracic spine is characterized by hypomobility; however, the thoraco-lumbar spine has a mobile segment which may potentiate CLF formation. Decompression with fusion surgery can be useful for treating patients with thoraco-lumbar CLF.