ossification of the ligamentum flavum

Thoracic

myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor. a, b. T1 and T2 weight MRI of thoracic spine showed continuous multi-level ossification of ligamentum flavum between T7–12. c. CT scan showed ossified ligamentum flavum, note that there was a thin gap between the ossified ligament and the lamina.

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Extensive

calcification of the ligamentum flavum causing cervical myelopathy in a Caucasian woman. Sagittal MRI in T1- (a) and T2- (b) weighted sequences. c T1-weighted sequence with heterogeneous gadolinium uptake. d Extensive spinal cord compression at C6

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Extensive

calcification of the ligamentum flavum causing cervical myelopathy in a Caucasian woman. Axial CT-scan showing a hyperdense dorsal intraspinal extradural lesion at C7

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Extensive

calcification of the ligamentum flavum causing cervical myelopathy in a Caucasian woman. Sagittal CT-scan showing oval nodular densities partially connected with the laminae

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Extensive

calcification of the ligamentum flavum causing cervical myelopathy in a Caucasian woman. Sagittal MRI in T2-weighted sequence showing decompression of the spinal cord after laminectomy

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Congenital

lumbar spinal stenosis with ossification of the ligamentum flavum in achondroplasia: a case report. Preoperative computed tomography. (A) through (E) Preoperative computed tomographic scans show congenital spinal stenosis from L1 to L5, respectively. Axial images show ossification of the ligamentum flavum (OLF) at L1/2 (A), L2/3 (B) and L3/4 (C) (arrowheads). (F) Sagittal scan shows OLF at L1/2 (A) to L3/4 (C) and spinal stenosis with thickened lamina and narrowing of the lateral recess at L4/5 and L5/S (arrowheads).

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Congenital

lumbar spinal stenosis with ossification of the ligamentum flavum in achondroplasia: a case report. Preoperative magnetic resonance images. (A) through (E) Preoperative magnetic resonance imaging scans show extensive spinal stenosis from L1/2 (A), L2/3 (B), L3/4 (C), L4/5 (D) and L5/S1 (E). (F) Sagittal T2-weighted image reveals multiple stenosis at L1/2-L5/S (arrowheads).

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Radiopaedia • CC-by-nc-sa 3.0 • de

Ossification of the ligamentum flavum (OLF) is a phenomenon where there is a formation of ossific-calcific components in the ligamentum flavum. It is recognized causes of myelopathy (especially in the thoracic and to a lesser degree the cervical region).

Epidemiology

The condition as a whole is uncommon. There is a higher prevalence in East Asian ethnic groups (especially Japan).

Pathology

Both intrinsic (genetic and dietary factors) and extrinsic causes (biomechanical alterations) have been postulated. The spinal cord tends to usually get compressed from the posterior side and patients, therefore, tend to show symptoms such as loss of balanced walking (similar to posterior cord syndrome).

Associations

In the cervical region, it can uncommonly be associated with ossification of the posterior longitudinal ligament .

Treatment and prognosis

Management options vary from being conservative to surgical decompression. Some authors propose a laminectomy combined with lateral fusion at the treatment of choice . The postoperative outcome is generally considered good .