Surgical Treatments of Myelopathy Caused by Cervical Ligamentum Flavum Ossification

• Published in: World neurosurgery Vol. 75; no. 3; pp. 546 - 550
• Main Authors: Yang, Jian, Ni, Bin, Xie, Ning, Guo, Qunfeng, Wang, Liangzhe
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier
• Subjects: Adult; Aged; Asian Continental Ancestry Group; Biological and medical sciences; Cervical; Decompression, Surgical; Dura Mater - pathology; External Fixators; Female; Follow-Up Studies; Humans; Laminectomy; Ligamentum Flavum - pathology; Ligamentum Flavum - surgery; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neurosurgery; Neurosurgical Procedures - methods; Ossification of the ligamentum flavum; Ossification, Heterotopic - complications; Ossification, Heterotopic - pathology; Ossification, Heterotopic - surgery; Recovery of Function; Spinal Cord Diseases - etiology; Spinal Cord Diseases - pathology; Spinal Cord Diseases - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical treatment; Tomography, X-Ray Computed; Treatment Outcome; OPLL; MRI; OLF; Cerebrospinal fluid; CT; Computed tomography; Magnetic resonance imaging; Ossification of the ligamentum flavum; Surgical treatment; Cervical; CSF; Ossification of the posterior longitudinal ligament; JOA; Japanese Orthopaedic Association; Cervical myelopathy; Nervous system diseases; Treatment; Surgery; Ossification
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2010.10.041

Objective To present a small case series reporting the outcomes of surgical treatment for myelopathy caused by cervical ossification of the ligamentum flavum (OLF). Methods The authors assessed 15 cases of myelopathy caused by cervical OLF. Patients were eight women and seven men 37–75 years old (mean age 59.7 years). All patients underwent bilateral laminectomy, and the lesions were removed. The decompression range was confined within the medial sides of the bilateral facets and within the involved segments. Intraoperative specimens were examined histologically to confirm the diagnosis. During the operation, the extent of adherence of the lesions to the dura was recorded. The patients were followed for 3–70 months. Neurofunctional improvements were evaluated with the Japanese Orthopaedic Association (JOA) score. Results Definite adherences were present in 67.7% of all cases. JOA score showed a 71.5% improvement after operation from a preoperative score of 5–8 (mean 6.4) to a postoperative score of 10–14 (mean 13.5). The operative outcomes were satisfactory without extensive decompression of adjacent segments. Conclusions A high rate of adherence to the dura was observed in patients with myelopathy caused by cervical OLF. Bilateral laminectomy and removal of the lesions, without extensive decompression of adjacent segments, provides an optimistic prognosis.