Spinal Cord Kinking in Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

• Published in: Chinese medical journal Vol. 128; no. 19; pp. 2595 - 2598
• Main Authors: Wang, Ting, Pan, Min, Yin, Chu-Qiang, Zheng, Xiu-Jun, Cong, Ya-Nan, Wang, De-Chun, Li, Shu-Zhong
• Format: Journal Article
• Language: English
• Published: China Medknow Publications Pvt Ltd 05.10.2015; Medknow Publications and Media Pvt. Ltd; Lippincott Williams & Wilkins Ovid Technologies; Department of Spine Surgery,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266003,China%Campus Clinic,Normal College,Qingdao University,Qingdao,Shandong 266071,China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Causes of; Complications and side effects; Female; Health aspects; Hospitals; Humans; Ligaments; Ligamentum Flavum - pathology; Magnetic Resonance Imaging; Male; Middle Aged; NMR; Nuclear magnetic resonance; Original; Ossification; Ossification of Ligamentum Flavum; Spinal Cord Kinking; Thoracic Myelopathy; Ossification, Heterotopic - complications; Radiography; Spinal cord; Spinal Cord Compression - diagnosis; Spinal Cord Compression - diagnostic imaging; Spinal Cord Compression - surgery; Spinal cord diseases; Spinal Cord Diseases - diagnosis; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - etiology; Spinal Cord Diseases - surgery; Surgery; Surgical outcomes; 临床资料; 平均年龄; 扭结; 痉挛性截瘫; 磁共振成像; 胸椎; 脊髓; 韧带; China; Spinal Cord Kinking; Ossification of Ligamentum Flavum; Thoracic Myelopathy
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.166042

Background：Ossification of the ligamentum flavum （OLF） is being increasingly recognized as a cause of thoracic myelopathy.This study was to describe a rare clinical entity of spinal cord kinking （SK） in thoracic myelopathy secondary to OLF.Methods：The data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively.The incidence and location of SK were determined using preoperative magnetic resonance imaging （MRI）.The clinical presentation and radiological characteristics in patients with SK were analyzed.Posterior en bloc laminectomy with OLF was performed,and the surgical results were evaluated.Results：SK was found in seven patients （7.4％） based on preoperative MRI.The patients included one male and six females with an average age of 55.6 years （range,48-64 years）.Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis.In all cases,the kinking was located just above the end of the spinal cord where the conus medullaris （CM） was compressed by the OLF.The degree of SK varied from mild to severe.The tip of the CM was located between the upper third of T1 1 to the lower third of L 1,above the lower edge of L 1.With an average follow-up of 30.4 months,the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively （t =12.05;P ＜ 0.0001） with an improvement rate of 63.1 ± 12.3％.Conclusions：SK is a rare radiological phenomenon.It is typically located at the thoracolumbar junction,where the CM is compressed by the OLF.Our findings indicate that these patients may benefit from a posterior decompressive procedure.