Compressive Thoracic Myelopathy Caused by Combined Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum: A Report of Four Cases and a Literature Review

• Published in: Journal of orthopaedics, trauma and rehabilitation trauma and rehabilitation, 2014-06, Vol.18 (1), p.41-43
• Main Authors: Tong, Jennifer Wing-Sze, Chan, Andrew Pak-Ho, Cheung, Ka-Kin
• Format: Article
• Language: English
• Subjects: ossification of ligamentum flavum; ossification of posterior longitudinal ligament; thoracic myelopathy
• ISSN: 2210-4917; 2210-4925
• DOI: 10.1016/j.jotr.2013.12.002

We describe here the rare condition of compressive thoracic myelopathy and its management in four patients with combined thoracic ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum. One of the four patients underwent decompressive laminectomies only, whereas the other three patients had posterolateral fusion with posterior instrumentation (pedicle screws and rods system) in addition to decompressive laminectomies. All four patients developed transient complete paraplegia after surgery. The three patients who received decompressive laminectomies and posterior instrumentation with posterolateral fusion had improved sensation, motor, and sphincter functions compared with their preoperative neurological state. The patient who underwent laminectomy only showed no neurological gain after 7.5 years. A dural tear was noted in two patients and they recovered without complications after intraoperative repair. Posterior instrumentation with posterolateral fusion in addition to decompression laminectomies and excision of the ossification of the ligamentum flavum seems to have a better outcome than simple decompression laminectomies for this rare cause of compressive thoracic myelopathy. 我們報告一種罕有病例及其治療果效，由合併胸椎後縱韌帶骨化及黃韌帶骨化引致的胸椎壓迫性脊髓病變。在四個病例中，一人只進行了胸椎椎板切除術，其餘三人進行了胸椎椎板切除術，後植入物內固定和後外側脊柱融合術。術後四人均出現暫時性下身癱瘓，三名患者(進行了胸椎椎板切除和後外側脊柱融合術) 的感覺，運動和括約肌功能較術前有改善；另一患者(只進行了胸椎椎板切除術)在七年半後仍沒有神經功能的進步。有兩病例發生硬膜囊撕裂，縫合後順利康復。, 後植入物內固定和後外側脊柱融合術加上減壓胸椎椎板切除及黃韌帶骨化切除術，似乎對這種罕有的胸椎壓迫性脊髓病變，有更好的果效。