Skip to main content
Book cover

OPLL pp 243–248Cite as

Surgery for Ossification of the Ligamentum Flavum: Posterior Decompression with or Without Fusion

  • Chapter
  • First Online:
  • 290 Accesses

Abstract

Ossification of the ligamentum flavum (OLF) is a major cause of thoracic myelopathy. Surgical treatment is indicated when conservative treatment loses efficacy and symptoms of myelopathy appear. Either of the two surgical techniques are usually employed based on the observed ossification type after resection or division and thinning of the laminae. They include the double open-door and en bloc resection techniques, which are indicated in cases without and with bony fusion in the midline, respectively. The surgical outcomes are generally good. However, the presence of dural ossification has a negative impact on treatment outcomes and is related to a higher risk of surgical complications. The preoperative diagnosis of dural ossification is of considerable value, as it prepares surgeons for possible complications.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kudo S, Ono M, Russell WJ. Ossification of thoracic ligamenta flava. AJR Am J Roentgenol. 1983;141(1):117–21.

    Article  CAS  Google Scholar 

  2. Williams DM, Gabrielsen TO, Latack JT, Martel W, Knake JE. Ossification in the cephalic attachment of the ligamentum flavum. An anatomical and CT study. Radiology. 1984;150:423–6.

    Article  CAS  Google Scholar 

  3. Guo JJ, Luk KD, Karppinen J, Yang H, Cheung KM. Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine. 2010;25:51–6.

    Article  Google Scholar 

  4. Mori K, Kasahara T, Mimura T, Nishizawa K, Murakami Y, Matsusue Y, Imai S. Prevalence, distribution, and morphology of thoracic ossification of the yellow ligament in Japanese: results of CT-based cross-sectional study. Spine (Phila Pa 1976). 2013;38(19):E1216–22.

    Article  Google Scholar 

  5. Fujimori T, Watabe T, Iwamoto Y, Hamada S, Iwasaki M, Oda T. Prevalence, concomitance, and distribution of ossification of the spinal ligaments: results of whole spine CT scans in 1500 Japanese patients. Spine (Phila Pa 1976). 2016;41(21):1668–76.

    Article  Google Scholar 

  6. Otani K, Aihara T, Tanaka A, Shibasaki K. Ossification of the ligamentum flavum of the thoracic spine in adult kyphosis. Int Orthop. 1986;10(2):135–9.

    Article  CAS  Google Scholar 

  7. Aizawa T, Sato T, Sasaki H, Kusakabe T, Morozumi N, Kokubun S. Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. J Neurosurg Spine. 2006;5(6):514–9.

    Article  Google Scholar 

  8. Ju JH, Kim SJ, Kim KH, Ryu DS, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU. Clinical relation among dural adhesion, dural ossification, and dural laceration in the removal of ossification of the ligamentum flavum. Spine J. 2018;18(5):747–54.

    Article  Google Scholar 

  9. Yu L, Li B, Yu Y, Li W, Qiu G, Zhao Y. The relationship between dural ossification and spinal stenosis in thoracic ossification of the ligamentum flavum. J Bone Joint Surg Am. 2019;107(7):606–12.

    Article  Google Scholar 

  10. Muthukumar N. Dural ossification in ossification of the ligamentum flavum: a preliminary report. Spine. 2009;34:2654–61.

    Article  Google Scholar 

  11. Sato T, Kokubun S, Ishii Y. Choice of operative method for ossification of ligamentum flavum based on CT findings. Rinshoseikeigeka. 1996;31(4):541–5. Japanese.

    Google Scholar 

  12. Yu S, Wu D, Li F, Hou T. Surgical results and prognostic factors for thoracic myelopathy caused by ossification of ligamentum flavum: posterior surgery by laminectomy. Acta Neurochir (Wien). 2013;155(7):1169–77.

    Article  Google Scholar 

  13. Li Z, Ren D, Zhao Y, Hou S, Li L, Yu S, Hou T. Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases. Spinal Cord. 2016;54(3):188–96.

    Article  CAS  Google Scholar 

  14. Onishi E, Yasuda T, Yamamoto H, Iwaki K, Ota S. Outcomes of surgical treatment for thoracic myelopathy: a single-institutional study of 73 patients. Spine (Phila Pa 1976). 2016;41(22):E1356–63.

    Article  Google Scholar 

  15. Kawaguchi Y, Yasuda T, Seki S, Nakano M, Kanamori M, Sumi S, Kimura T. Variables affecting postsurgical prognosis of thoracic myelopathy caused by ossification of the ligamentum flavum. Spine J. 2013;13(9):1095–107.

    Article  Google Scholar 

  16. Tang CYK, Cheung JPY, Samartzis D, Leung KH, Wong YW, Luk KDK, Cheung KMC. Predictive factors for neurological deterioration after surgical decompression for thoracic ossified yellow ligament. Eur Spine J. 2017;26(10):2598–605.

    Article  Google Scholar 

  17. Wang H, Wei F, Long H, Han G, Sribastav SS, Li Z, Huang Y, Zhu R, Liang C. Surgical outcome of thoracic myelopathy caused by ossification of ligamentum flavum. J Clin Neurosci. 2017;45:83–8.

    Article  Google Scholar 

  18. Sun X, Sun C, Liu X, Liu Z, Qi Q, Guo Z, Leng H, Chen Z. The frequency and treatment of dural tears and cerebrospinal fluid leakage in 266 patients with thoracic myelopathy caused by ossification of the ligamentum flavum. Spine (Phila Pa 1976). 2012;37(12):E702–7.

    Article  Google Scholar 

  19. Zhang J, Wang L, Li J, Yang P, Shen Y. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity. Sci Rep. 2016;6:23019. https://doi.org/10.1038/srep23019.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ando K, Imagama S, Ito Z, Hirano K, Muarmoto A, Kato F, Yukawa Y, Kawakami N, Sato K, Matsubara Y, Kanemyura T, Matsuyama Y, Ishiguro N. Predictive factors for a poor surgical outcome with thoracic ossification of the ligamentum flavum by multivariate analysis: a multicenter study. Spine. 2013;38(129):E748–54.

    Article  Google Scholar 

  21. Kang KC, Lee CS, Shin SK, Park SJ, Chung CH, Chung SS. Ossification of the ligamentum flavum of the thoracic spine in the Korean population. J Neurosurg Spine. 2011;14(4):513–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Takashi Kaito .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kaito, T. (2020). Surgery for Ossification of the Ligamentum Flavum: Posterior Decompression with or Without Fusion. In: Okawa, A., Matsumoto, M., Iwasaki, M., Kawaguchi, Y. (eds) OPLL. Springer, Singapore. https://doi.org/10.1007/978-981-15-3855-1_31

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-3855-1_31

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-3854-4

  • Online ISBN: 978-981-15-3855-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics