Ossified Ligamentum Flavum: Epidemiology, Treatment, and Outcomes

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

<p class="first" id="d423819e73">Ossification of the ligamentum flavum (OLF) is an uncommon but potentially serious spinal condition which can cause progressive compression of the spinal canal with associated devastating neurologic compromise. Although debate exists regarding the exact etiology of OLF, overexpression of genes and transcription factors centered around the Notch and Wnt signaling pathways because of increased mechanical stress seems to be related. There are many clinical and radiographic presentations of OLF; however, progressive myelopathy is the most commonly encountered. Radiographic analysis may reveal isolated OLF or OLF combined with ossification of other areas of the spine, such as disk, posterior longitudinal ligament, and dura. When surgery is necessary for OLF, several surgical strategies exist including open laminectomy with excision, endoscopic decompression, Bridge Crane resection, en block resection, and combined anterior and posterior approaches. Resection may be complicated by dural adhesion or dural ossification, and postoperative neurologic deficits are not uncommon. </p>

Related collections

Most cited references 50

Record: found
Abstract: found
Article: not found

Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans.

Jiong Jiong Guo, Keith D K Luk, Jaro Karppinen … (2010)

Large scale, cross-sectional imaging study of a general population. To evaluate the prevalence, morphology, and distribution of ossification of the ligamentum flavum (OLF) in a population, and synthesize the scientific literature on the prevalence of OLF and some factors associated with its occurrence. OLF is a rare disease in which the pathogenesis has not been conclusively established. Little is known about its epidemiology. To date, there is no study that comprehensively assessed the distribution and prevalence of OLF in the whole spine using magnetic resonance imaging (MRI). A total of 1736 southern Chinese volunteers (1068 women; 668 men) between 8 and 88 years of age (mean, 38 years) were recruited by open invitation. MRI was administered to all the participants. T2-weighted, 5-mm spin-echo MRI sequences of the whole spine were obtained. Presence of OLF was identified as an area of low signal intensity in the T2 sagittal sequence located in the posterior part of the spinal canal, and subsequently confirmed by computed tomography scans showing areas of ossification within the ligamentum flavum. The distribution of OLF was classified into 3 types: the isolated type, continuous type, and noncontinuous type. While the morphology of the lesion was classified into triangular, round, and beak shapes based on the pattern of ossification on T2-weighted sagittal MRIs. OLF was identified in a total of 66 subjects or 3.8% of the population (52 women and 14 men). In 45(68.2%) cases, OLF was present at a single-level (isolated type), whereas in 21 (31.8%) cases OLF was present at multiple levels. The isolated type was found in 45 (68.2%) cases, continuous type in 11 (16.7%), and noncontinuous type in 10 (15.2%). The most common site of involvement is the lower thoracic spine, but they can also occur in the upper thoracic spine. The majority of the segments had a round morphology (n = 75: 81.5%), while 17 (18.5%) segments were triangular in shape. A literature review of the past 26 years showed only 4 reports on the prevalence of OLF, all were in special patient groups. Case reports have described postoperative paraplegia from failure to identify and decompress all stenotic segments of OLF. This study demonstrated that OLF is not uncommon, and that some 15% of the lesions are noncontinuous, and therefore could be missed. The authors recommend that for patients undergoing surgical decompression for 1 level of OLF, the whole spine should be routinely screened for other stenotic segments. Failure to do so could result in paraplegia from the nondecompressed levels.

0 comments Cited 86 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Prevalence, Concomitance, and Distribution of Ossification of the Spinal Ligaments: Results of Whole Spine CT Scans in 1500 Japanese Patients.

Motoki Iwasaki, Takenori Oda, Takahito Fujimori … (2016)

Cross-sectional study.

0 comments Cited 74 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population.

Shoichi Kokubun, Tetsuro Sato, H. Sasaki … (2006)

Data obtained in patients with thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) were retrospectively reviewed to clarify clinical features and surgical outcomes in the Japanese population. Seventy-two patients who underwent surgery for OLF-induced myelopathy in the Miyagi Prefecture, Japan, between 1988 and 2002 were observed for at least 2 years. Clinical data were collected from medical and operative records. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors (age, sex, and preoperative duration of symptoms) affecting the preoperative severity of myelopathy and postoperative improvement were also examined. In this series the surgical outcome was relatively good and depended on the severity of myelopathy; thus early and correct diagnosis is required to avoid poorer results. The male/female ratio was 3:2 and the mean patient age at surgery was 61 years for men and 68 for women. The patients commonly noticed numbness or pain in their lower legs or gait disturbances. In a total of 104 decompressed intervertebral disc levels, more than 80% of the ossified ligaments were at the T9-10 level or lower. The mean preoperative JOA score of 5.1 improved to 7.9 after an average of 46 months. The postoperative results statistically depended on the preoperative severity of myelopathy. Among studies of patients with OLF-related myelopathy, the present study had the largest sample size, which should help clarify the clinical features of OLF myelopathy.

0 comments Cited 59 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Title: Journal of the American Academy of Orthopaedic Surgeons

Abbreviated Title: J Am Acad Orthop Surg

Abbreviated Title: JAAOS

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Print): 1067-151X

ISSN (Electronic): 1940-5480

Publication date Created: 2022

Publication date (Print): June 15 2022

Publication date (Electronic): March 15 2022

Volume: 30

Issue: 12

Pages: e842-e851

Article

DOI: 10.5435/JAAOS-D-21-01253

PubMed ID: 35298441

SO-VID: f8c5188f-3e2b-4e3d-bfbb-3994d08aeb40

History

Data availability:

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

Ossified Ligamentum Flavum: Epidemiology, Treatment, and Outcomes

Read this article at

Abstract

Related collections

Karger: Ophthalmology

Most cited references 50

Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans.

Prevalence, Concomitance, and Distribution of Ossification of the Spinal Ligaments: Results of Whole Spine CT Scans in 1500 Japanese Patients.

Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population.

Author and article information

Journal

Article

History

Comments

Comment on this article

Similar content 4,342

Cited by 8

Most referenced authors 1,516