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Compressive myelopathy due to ossified yellow ligament among South Asians: analysis of surgical outcome

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Abstract

Background

Ossified yellow ligament (OYL) is a rare, disabling cause of extradural compressive radiculomyelopathy, responding poorly to surgical intervention.

Methods

From January 1999 to December 2008, 16 patients (male/female, 11/5; mean age, 45.7 years; median, 44.5 years) harbouring symptomatic OYL were managed at our center. Radiological investigations including computerised tomography and magnetic resonance imaging scans were performed before undertaking surgical intervention. High-speed drills and operating microscope were put to use in excising these pathological ligaments.

Results

At median follow-up of 16.5 months, all patients had improved to better clinical status. The spasticity was the most resistant to recovery, while motor power improved in 13 cases. Intra-operatively, dural ossification was noted in 50% of the cases, requiring repair or prophylactic cerebrospinal fluid drainage.

Conclusions

The surgical technique of drilling and yellow ligament excision needs precision. Patients with poor neurological status may also benefit from surgical decompression and should be offered the option of surgery.

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References

  1. Ben Hamouda K, Jemel H, Haouet S, Khaldi M (2003) Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases. J Neurosurg 99:157–161

    PubMed  Google Scholar 

  2. Hanakita J, Suwa H, Nagayasu S, Nishi S, Ohta F, Sakaida H (1991) Clinical analysis of ossified thoracic ligaments and thoracic disc hernia. Neurol Med Chir 31:936–942, Japanese

    Article  CAS  Google Scholar 

  3. Inamasu J, Guiot BH (2006) A review of factors predictive of surgical outcome for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg Spine 5:133–139

    Article  PubMed  Google Scholar 

  4. Li F, Chen Q, Xu K (2006) Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum. J Neurosurg Spine 4:191–197

    Article  PubMed  Google Scholar 

  5. Mohindra S, Chhabra R, Mukherjee KK, Gupta SK, Vaiphei K, Khosla VK (2006) Spinal compression due to ossified yellow ligament: a short series of 5 patients and literature review. Surg Neurol 65:377–384, discussion 384

    Article  PubMed  Google Scholar 

  6. Muthukumar N (2005). Ossification of the ligamentum flavum as a result of fluorosis causing myelopathy: report of two cases. Neurosurgery 56: E622; discussion E622.

  7. Muthukumar N (2009) Dural ossification in ossification of the ligamentum flavum: a preliminary report. Spine 34:2654–2661

    Article  PubMed  Google Scholar 

  8. Pantazis G, Tsitsopoulos P, Bibis A, Mihas C, Chatzistamou I, Kouzelis C (2008) Symptomatic ossification of the ligamentum flavum at the lumbar spine: a retrospective study. Spine 33:306–311

    Article  PubMed  Google Scholar 

  9. Park BC, Min WK, Oh CW, Jeon IH, Kim SY, Kyung HS, Oh SH (2007) Surgical outcome of thoracic myelopathy secondary to ossification of ligamentum flavum. Joint Bone Spine 74:600–605

    Article  PubMed  Google Scholar 

  10. Pascal-Moussellard H, Cabre P, Smadja D, Catonné Y (2005) Symptomatic ossification of the ligamentum flavum: a clinical series from the French Antilles. Spine 30:E400–E405

    Article  PubMed  Google Scholar 

  11. Payer M, Bruder E, Fischer JA, Benini A (2000) Thoracic myelopathy due to enlarged ossified yellow ligaments. Case report and review of the literature. J Neurosurg 92:105–108, review

    CAS  PubMed  Google Scholar 

  12. Sanghvi AV, Chhabra HS, Mascarenhas AA, Mittal VK, Sangondimath GM (2010). Thoracic myelopathy due to ossification of ligamentum flavum: a retrospective analysis of predictors of surgical outcome and factors affecting preoperative neurological status. Eur Spine J (in press)

  13. Singhal U, Jain M, Jaiswal AK, Behari S (2009) Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy. Indian J Orthop 43:305–308

    Article  PubMed  Google Scholar 

  14. Trivedi P, Behari S, Paul L, Banerji D, Jain VK, Chhabra DK (2001) Thoracic myelopathy secondary to ossified ligamentum flavum. Acta Neurochir 143:775–782

    Article  CAS  Google Scholar 

  15. Yano T, Doita M, Iguchi T, Kurihara A, Kasahara K, Nishida K, Yoshiya S (2003) Radiculopathy due to ossification of the yellow ligament at the lower lumbar spine. Spine 28:E401–E404

    Article  PubMed  Google Scholar 

  16. Yatsuzuka H, Kitajima T, Taguchi Y, Sakai H, Nakamura N (1986) A case of ossified yellow ligaments (ossified ligamenta flava) of the thoraco-lumbar region and magnetic resonance imaging. No Shinkei Geka 14:1121–1125, Japanese

    CAS  PubMed  Google Scholar 

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Correspondence to Sandeep Mohindra.

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Mohindra, S., Gupta, R., Chhabra, R. et al. Compressive myelopathy due to ossified yellow ligament among South Asians: analysis of surgical outcome. Acta Neurochir 153, 581–587 (2011). https://doi.org/10.1007/s00701-010-0904-2

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  • DOI: https://doi.org/10.1007/s00701-010-0904-2

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