Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: Report of two cases and literature review
Department of Orthopaedic Surgery, Steel Memorial Muroran Hospital, Chinebetsu 1-45, Muroran, Hokkaido 050-0076, Japan. Electronic address: .The spine journal: official journal of the North American Spine Society (Impact Factor: 2.43). 12/2012; 13(1). DOI: 10.1016/j.spinee.2012.10.038
BACKGROUND CONTEXT: In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature. PURPOSE: We describe two more cases that exhibited cervical myelopathy resulting from the combination of cervical OLF and OPLL and required surgery. A literature review with a comparative analysis between previous reports and present cases was also performed. STUDY DESIGN: Case report and literature review. PATIENT SAMPLE: Two patients with combined OLF and OPLL. OUTCOME MEASURES: Preoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses. METHODS: A 76-year-old man (Case 1) presented with disturbance of gait and fine finger movement. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C3-C4 level. Computed tomography showed OPLL at the C2-C6 levels (segmental type) and OLF at the left C3-C4 level. The patient underwent posterior decompression and OLF resection. A 75-year-old man (Case 2) presented with sensory disturbance and muscle weakness in his bilateral upper extremities and disturbance in fine finger movements. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C2-C3 and C3 levels. Computed tomography showed OPLL at the C3-C7 levels (mixed type) and OLF at the left C2-C3 and C3 levels. The patient also underwent posterior decompression and OLF resection. RESULTS: In both cases, histological examination of the surgical specimens showed osseous tissue and enchondral ossification within the ligamentum flavum, and the diagnosis in each case was OLF. After surgery, both patients' symptoms immediately improved, and no recurrence was observed at 2 years after surgery. CONCLUSIONS: We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor.
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ABSTRACT: BACKGROUND: Destroying posterior stable structure of cervical vertebra may facilitate the ligamentum flavum regeneration. Whether anterior cervical instability can induce the regeneration in posterior and adjacent ligamentum flavum remains unclear. OBJECTIVE: To observe the changes of transforming growth factor-β1 expression and histopathology in the ligamentum flavum of cervical instability animal models. METHODS: Thirty-six New Zealand white rabbits were randomly divided into control group and experimental group, with 18 rabbits in each group. In the experimental group, cervical instability animal models were established made through destroying annulus fibrosus by anterior puncture and absorbing nucleus pulposus in C4/5. And no intervention was given to the control group. RESULTS AND CONCLUSION: Compared with the control group, fibers in the C3/4, 4/5, 5/6 ligamentum flavum arranged disorderly and the glass like degeneration was found in the experimental group. The expression of transforming growth factor-β1 in ligamentum flavum was increased, especially in C4/5, in the experimental group. At 4, 8, 12 weeks, transforming growth factor-β1 expression in the C3/4, 4/5, 5/6 ligamentum flavum segments was similar between the two groups. Experimental findings indicate that, anterior cervical instability can induce the regeneration in posterior ligamentum flavum, especially in the injured segment. © 2015, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.
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