Ossification of the ligamentum flavum

Last revised by Dr Rohit Sharma on 15 Feb 2022

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

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

The clinical presentation may vary, but typically sensory symptoms are the first to manifest (mimicking an intrinsic posterior cord syndrome) before motor symptoms 9.

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

In the cervical region, it can uncommonly be associated with ossification of the posterior longitudinal ligament 8.

Management options vary from being conservative to surgical decompression. Some authors propose a laminectomy combined with lateral fusion at the treatment of choice 3. The postoperative outcome is generally considered good 3.

It is thought to have been first reported by Polgar on a lateral radiograph 1

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