Ossification of the Ligamentum Flavum as a Result of Fluorosis Causing Myelopathy: Report of Two Cases

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. E622-E622 ◽  
Author(s):  
Natarajan Muthukumar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ligamentum Flavum ◽  
Neurological Status ◽  
Underlying Disease ◽  
Cord Compression ◽  
X Rays ◽  
Resonance Imaging ◽  
Insidious Onset ◽  
Long Term Follow Up

Abstract OBJECTIVE AND IMPORTANCE: Ossification of the ligamentum flavum (OLF) is increasingly being recognized as a cause of myeloradiculopathy. However, the cause of such OLF has been identified only occasionally. The purpose of this case report is to highlight one more cause of OLF causing myelopathy. CLINICAL PRESENTATION: Two middle-aged men residing in an area endemic for fluorosis presented with the insidious onset of myelopathy. Clinical examination revealed evidence of thoracic cord compression in both patients. Plain x-rays revealed markedly increased bone density characteristic of fluorosis. Magnetic resonance imaging revealed OLF in the lower thoracic region causing cord compression (at one level in the first patient and at three consecutive levels in the second patient). Plain x-rays of the forearm revealed ossification of the interosseous membrane, which is characteristic of fluorosis. INTERVENTION: Both patients underwent decompressive laminectomy with removal of the OLF. The laminae and ossified yellow ligaments formed one mass of bone, which was removed with rongeurs and drills. After surgery, the first patient demonstrated improvement in motor power, whereas the second patient did not demonstrate any change in neurological status. CONCLUSION: Fluorosis should be entertained in the differential diagnosis of OLF, especially in patients from endemic areas. The magnetic resonance imaging appearance of the spine in such cases is characteristic. In properly selected cases of fluorotic myelopathy, surgery is indicated. However, the prognosis is guarded, and long-term follow-up of these patients is necessary given the nature of the underlying disease.

Preoperative Magnetic Resonance Imaging Signal Intensity Classification Is Associated With Clinical Presentation and Surgical Outcomes in Myelopathy Caused by Thoracic Ossification of Ligamentum Flavum: A Multicenter Study

2021 ◽  
pp. 219256822110677
Author(s):  
Chao Zhang ◽  
Shengdong Yang ◽  
Lin Wang ◽  
Nan Wang ◽  
Zhenyong Ke ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Surgical Outcomes ◽  
Signal Intensity ◽  
Ligamentum Flavum ◽  
Cord Compression ◽  
Neurological Recovery ◽  
Resonance Imaging ◽  
Ossification Of Ligamentum Flavum

Study Design Retrospective Cohort Study Objectives To explore whether classification of the increased signal intensity (ISI) on magnetic resonance imaging (MRI) correlates with clinical presentations and outcomes in symptomatic thoracic ossification of ligamentum flavum (T-OLF) patients. Methods All patients with symptomatic T-OLF who underwent laminectomy at four institutions were reviewed. The ISI on preoperative T2-weighted MRI was divided into 3 groups, Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). Neurological function before surgery and at follow-up was evaluated by the revised Japanese Orthopedic Association (JOA) score. Patients’ demographics, clinical manifestations, and surgical outcomes were compared. Results A total of 94 patients were involved. Preoperative MRI showed 32 patients in Grade 0, 39 patients in Grade 1, and 23 patients in Grade 2. Low extremities numbness, weakness, and clinical signs were less frequent in Grade 0 patients. The grade of ISI was correlated with the duration of symptoms and cord compression. Grade 0 patients had a better preoperative JOA score than those with ISI changes, while Grade 2 patients showed worse neurological recovery, longer duration of operation, more intraoperative blood loss, and a higher incidence of perioperative complications. Conclusion The classification of ISI is an effective parameter for preoperatively assessing cord compression, clinical severity, and surgical outcomes in T-OLF patients. Grade 0 patients have relatively mild neurological impairment but are more likely to be misdiagnosed. Grade 2 indicates the worst clinical impairment and neurological recovery, and implies a risky and challenging surgery.

Magnetic Resonance Imaging and Neurological Findings in Dogs with Disc-Associated Cervical Spondylomyelopathy (63 cases)

2020 ◽  
Author(s):  
Marília de Albuquerque Bonelli ◽  
Luciana Bignardi de Soares Brisola Casimiro da Costa ◽  
Ronaldo Casimiro da Costa
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Spinal Cord Compression ◽  
Ligamentum Flavum ◽  
Cord Compression ◽  
Degenerative Changes ◽  
Foraminal Stenosis ◽  
Resonance Imaging ◽  
Cervical Spondylomyelopathy

Abstract Background: Canine cervical spondylomyelopathy can be separated into osseous and disc-associated (DA-CSM) forms. Our aim was to describe the magnetic resonance imaging (using a high-field scanner) and neurological findings in dogs with DA-CSM and investigate a relationship between these findings.Results: Sixty-three dogs were included: 60/63 (95%) were large breeds, with Doberman Pinschers and males over-represented (70%). Mean and median age at the time of diagnosis was 7.25 and 7.2 years (range 0.41 – 12 years). Chronic signs were noted in 52/63 (83%) dogs, with proprioceptive ataxia the most common. Main site of spinal cord compression was commonly C6-C7 or C5-C6. Thirty-six (57%) dogs had various sites of spinal cord compression. Most dogs younger than 6 years of age had a single affected. Foraminal stenosis was present in 51/63 dogs (81%). T2-weighted hyperintensity was present in 40/63 dogs (63%). Eighty-eight percent of the articular processes showed degenerative changes, which correlated strongly with intervertebral disc degeneration. Ligamentum flavum hypertrophy was seen in 38% of dogs. No correlation was observed between neurologic signs and number of affected sites. A moderate positive correlation was observed between severity of spinal cord compression and neurologic grade (r 0.48; p<0.001).Conclusions: DA-CSM was predominantly observed in older, male Dobermans, with chronic neurologic signs, with compressive lesions located in the caudal cervical vertebral region. Although less common, DA-CSM was also seen in dogs 3 years of age or younger (8%). Single compressive lesions were more common in dogs younger than 6 years of age. Most dogs had concomitant changes (e.g.: ligamentum flavum hypertrophy and foraminal stenosis) that may affect neurologic signs. Most dogs with ligamentum flavum hypertrophy were 6 years or older. A correlation was observed between severity of spinal cord compression and neurologic grade; dogs with more severe spinal cord compression were more likely to have a higher neurologic grade. Dogs with more sites of spinal cord compression did not have more severe neurologic involvement. A very high percentage of dogs had articular process degenerative changes. Possible biomechanical or genetic relationships between degenerative changes in articular processes, ligamentum flavum, and intervertebral discs warrants further investigation.

Cord Compression Secondary to Cervical Disc Herniation Associated with Calcification of the Ligamentum Flavum: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 48 (3) ◽  
pp. 673-676 ◽  
Author(s):  
L. Fernando Ugarriza ◽  
José M. Cabezudo ◽  
Luis F. Porras ◽  
José A. Rodríguez-Sánchez
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Dura Mater ◽  
Disc Herniation ◽  
Ligamentum Flavum ◽  
Cord Compression ◽  
Cervical Disc ◽  
Resonance Imaging ◽  
Total Recovery

Abstract OBJECTIVE AND IMPORTANCE Calcification of the ligamentum flavum is a rare disease that occurs almost exclusively in elderly Japanese people. We report the case of a young Caucasian woman who presented with a C5–C6 disc herniation associated with a cervical calcified ligamentum flavum. CLINICAL PRESENTATION The patient presented with a cord compression syndrome of 76 hours' evolution. At exploration, a Brown-Séquard syndrome at the C6 level was found. Magnetic resonance imaging and computed tomography led to a correct diagnosis and planning for decompression. INTERVENTION We operated on the patient through a combined anterior and posterior approach. After the patient underwent anterior discectomy with intersomatic arthrodesis, we performed posterior decompression. During the operation, we observed that the dura mater could not be separated from the ligamentum, so an en bloc excision of both structures was performed. Microscopic examination indicated that the excised ligamentum had calcification, and total integration of the dura mater into the structure of the ligamentum was demonstrated. To our knowledge, this circumstance has never been described before. A posterior C3–C7 arthrodesis was performed to prevent postoperative kyphosis. Recovery was successful, with total recovery from neurological deficits 4 months later. CONCLUSION Calcification of the ligamentum flavum is a progressive disease that starts early in life and becomes symptomatic later in life when spinal stenosis occurs. Magnetic resonance imaging and computed tomography provide adequate diagnosis and allow proper surgical planning for decompression. The presence of hyperintense areas within the spinal cord parenchyma, in the absence of a traumatic antecedent, does not preclude a complete recovery.

scholarly journals Magnetic resonance imaging and neurological findings in dogs with disc‐associated cervical spondylomyelopathy: a case series

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Marília de Albuquerque Bonelli ◽  
Luciana Bignardi de Soares Brisola da Costa ◽  
Ronaldo Casimiro da Costa
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Spinal Cord Compression ◽  
Ligamentum Flavum ◽  
Cord Compression ◽  
Degenerative Changes ◽  
Foraminal Stenosis ◽  
Resonance Imaging ◽  
Cervical Spondylomyelopathy

Abstract Background Canine cervical spondylomyelopathy can be separated into osseous and disc-associated (DA-CSM) forms. Our aim was to describe the magnetic resonance imaging (using a high-field scanner) and neurological findings in dogs with DA-CSM and investigate a relationship between these findings. Results Sixty-three dogs were included: 60/63 (95 %) were large breeds, with Doberman Pinschers and males over-represented (70 %). Mean and median age at the time of diagnosis was 7.25 and 7.2 years (range 0.41–12 years). Chronic signs were noted in 52/63 (83 %) dogs, with proprioceptive ataxia the most common. Main site of spinal cord compression was commonly C6-7 or C5-6. Thirty-six (57 %) dogs had various sites of spinal cord compression. Most dogs younger than 6 years of age had a single affected site. Foraminal stenosis was present in 51/63 dogs (81 %). T2-weighted hyperintensity was present in 40/63 dogs (63 %). 88 % of the articular processes showed degenerative changes, which correlated strongly with intervertebral disc degeneration. Ligamentum flavum hypertrophy was seen in 38 % of dogs. No correlation was observed between neurologic signs and number of affected sites. A moderate positive correlation was observed between severity of spinal cord compression and neurologic grade (r 0.48; p < 0.001). Conclusions DA-CSM was predominantly observed in older, male Dobermans, with lesions located in the caudal cervical vertebral region. It was also seen in dogs 3 years of age or even younger (8 %). Single compressive lesions were more common in dogs younger than 6 years of age. Many dogs had concomitant changes (e.g.: ligamentum flavum hypertrophy and foraminal stenosis). Most dogs with ligamentum flavum hypertrophy were 6 years or older. A positive correlation was observed between severity of spinal cord compression and neurologic grade, but multilevel compression was not associated with more severe neurologic signs. A very high percentage of dogs had articular process degenerative changes. Possible biomechanical or genetic relationships between degenerative changes in articular processes, ligamentum flavum, and intervertebral discs warrants further investigation.

scholarly journals Pyogenic and tuberculous discitis: magnetic resonance imaging findings for differential diagnosis

2013 ◽  
Vol 46 (3) ◽  
pp. 173-177 ◽  
Author(s):  
Cristiano Gonzaga de Souza ◽  
Emerson Leandro Gasparetto ◽  
Edson Marchiori ◽  
Paulo Roberto Valle Bahia
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Correct Diagnosis ◽  
Cord Compression ◽  
Intervertebral Discs ◽  
University Hospital ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Radiographic Findings ◽  
Vertebral Bodies

Spondylodiscitis represents 2%–4% of all bone infections cases. The correct diagnosis and appropriate treatment can prevent complications such as vertebral collapse and spinal cord compression, avoiding surgical procedures. The diagnosis is based on characteristic clinical and radiographic findings and confirmed by blood culture and biopsy of the disc or the vertebra. The present study was developed with Clementino Fraga Filho University Hospital patients with histopathologically and microbiologically confirmed diagnosis of spondylodiscitis, submitted to magnetic resonance imaging of the affected regions. In most cases, pyogenic spondylodiscitis affects the lumbar spine. The following findings are suggestive of the diagnosis: segmental involvement; ill-defined abscesses; early intervertebral disc involvement; homogeneous vertebral bodies and intervertebral discs involvement. Tuberculous spondylodiscitis affects preferentially the thoracic spine. Most suggestive signs include: presence of well-defined and thin-walled abscess; multisegmental, subligamentous involvement; heterogeneous involvement of vertebral bodies; and relative sparing of intervertebral discs. The present pictorial essay is aimed at showing the main magnetic resonance imaging findings of pyogenic and tuberculous discitis.

scholarly journals Dorsal Spinal Ligamentum Flavum Thickening: A Magnetic Resonance Imaging Study

2018 ◽  
Vol 12 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Amarnath Chelladurai ◽  
Suhasini Balasubramaniam ◽  
Sarenya Preyah Anbazhagan ◽  
Sathyan Gnanasihamani ◽  
Sukumar Ramaswami
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ligamentum Flavum ◽  
Imaging Study ◽  
Mean Value ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Compressive Myelopathy ◽  
Relationship Of ◽  
Dorsal Spinal

<sec><title>Study Design</title><p>A retrospective radiological study of the ligamentum flavum (LF).</p></sec><sec><title>Purpose</title><p>We determined the relationship of dorsal spinal LF thickening with age and sex using magnetic resonance imaging (MRI). We also determined whether LF thickening has a predominant tendency to occur at a specific dorsal level and on a specific side.</p></sec><sec><title>Overview of Literature</title><p>Many researchers have studied LF thickness at dorsal levels in patients with compressive myelopathy. However, there is a dearth of literature pertaining to the study of dorsal LF thickness in patients without myelopathy.</p></sec><sec><title>Methods</title><p>LF thickness was measured at dorsal levels from T1 to T12 on both sides using MRI in 100 individuals. The patients were divided into three groups based on age: 20 to 40, 41 to 60, and &gt;60 years. On axial T2-weighted imaging at the mid-disc level, LF thickness was measured perpendicular to the lamina border, either at half the length of LF or at maximum thickness, whichever was greater.</p></sec><sec><title>Results</title><p>We found that LF thickness does not increase significantly with increasing age and there was no significant disparity in LF thickness between the sides and sexes. We also found that there was a significant increase in LF thickness at the T10–T11 level (mean value, 3.27±0.94 mm).</p></sec><sec><title>Conclusions</title><p>LF thickness does not appear to have any side/sex dominance. LF thickening has a predominant tendency to occur specifically at the T10–T11 level. This may be due to maximum tensile strength and mobility at this level. Because there is an increased tendency for LF thickening at the T10–T11 level, this may be used as a reference point for counting the vertebral levels.</p></sec>

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