Recurrence of ossification of ligamentum flavum at the same intervertebral level in the thoracic spine: a report of two cases and review of the literature
Ossification of the ligamentum flavum (OLF) is a possible cause of thoracic myelopathy. We report two rare cases with recurrent thoracic myelopathy caused by OLF markedly re-extended at the same intervertebral level after the primary surgery.
Both patients had thoracic myelopathy caused by OLF and underwent decompressive laminectomy and resection of the OLF in the primary surgery. However, the neurological conditions gradually deteriorated following recovery after the primary surgery due to the recurrent OLF at the same intervertebral level.
These patients were successfully treated by revision surgery via resection of the recurrent OLF and posterior spinal fusion with instrumentation. Two years after the second surgery, the neurological disturbance was resolved satisfactorily, and re-growth of the resected ossified lesion was not observed.
The recurrence of OLF following resection of the ossified lesions is exceedingly rare but should be noted in patients treated surgically for thoracic myelopathy due to OLF.
KeywordsOssification of ligamentum flavum Recurrence Thoracic spine Myelopathy Posterior longitudinal ligament
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Nakata N, Mamada T, Kawasaki Y, Hayasaka G, Kurimoto H (2015) Surgical results of laminectomy without fusion for ossification of ligamentum flavum of thoracic spine. J East Jpn Assoc Orthop Traumatol 27:41–47Google Scholar
- 8.Matsumoto Y, Harimaya K, Okada S (2013) Progression and enlargement of the ossified lesion observed in patients with ossification of ligamentum flavum: a report of 2 cases. Orthop Traumatol 62(Supple):387Google Scholar
- 14.Shinomiya K, Shindo S, Nakamura H, Kurosa Y (1993) Pathomorphology and treatment of OLF. Orthop Surg 44(8):1263–1271Google Scholar
- 19.Ando K, Imagama S, Wakao N, Hirano K, Tauchi R, Muramoto A, Kato F, Yukawa Y, Kawakami N, Sato K, Matsubara Y, Kanemura T, Matsuyama Y, Ishiguro N (2012) Examination of the influence of ossification of the anterior longitudinal ligament on symptom progression and surgical outcome of ossification of the thoracic ligamentum flavum: a multicenter study. J Neurosurg Spine 16(2):147–153. doi: 10.3171/2011.10.SPINE11296 CrossRefPubMedGoogle Scholar
- 22.Suzuki M, Furuya T, Okawa A, Koda M, Takahashi K, Yamazaki M (2013) Ossification of the ligamentum flavum of the lumbar spine after posterior decompression with instrumented fusion for ossification of posterior longitudinal ligament of thoracic spine: a case report. J East Jpn Assoc Orthop Traumatol 25:513–517Google Scholar
- 23.Ikuta Y, Nishikawa K, Inoue A, Nakamura M, Soda Y, Ishida O (2011) Ossification of the ligament flavum of adjacent segment after posterior decompression and fusion for thoracic ossification of posterior longitudinal ligament: a case report. Cent Jpn J Orthop Surg Traumatol 54:1235–1236Google Scholar
- 25.Yamazaki M, Mochizuki M, Ikeda Y, Sodeyama T, Okawa A, Koda M, Moriya H (2006) Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion. Spine 31(13):1452–1460CrossRefPubMedGoogle Scholar