Calcification of the Ligamentum Flavum in the Cervical Spine―Our Experiences and a Review of the Literatures―

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  • 頚椎黄色靭帯石灰化症―自験例の報告と文献的考察―

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<p>  Purpose : We report 10 cases of calcification of the cervical ligamentum flavum (CCLF). We sought to examine the clinical features, radiological findings, surgical management, and pathogenesis of CCLF based on the pathological findings in all 10 cases. The pathogenesis of CCLF was then compared with that of the ossification of the ligamentum flavum in the thoracic spine.</p><p>  Materials and Methods : In all 10 cases, either expansive laminoplasty or laminectomy were performed. Neurological symptoms and the Japanese Orthopaedic Association (JOA) score were examined before and after the operation. The recovery rate of the JOA score (R. R.%) was calculated after the operation. Neuroradiological examinations were performed using computed tomography (CT) and magnetic resonance imaging (MRI). Pathological findings of the specimens were also reviewed.</p><p>  Results : Almost all the patients in this series were females in the seventh or eighth decade of life. The lesions were located in the middle cervical spine. Cervical myelopathy developed in all 10 cases. CT revealed egg-shaped or speck-like calcification in the ligamentum flavum. MRI demonstrated a low intensity round lesion resembling an island in the ligamentum flavum. The JOA scores before the operation ranged from 5 to 10 (mean : 7.6±2.1). However, one year after the operation, the JOA score increased, and ranged from 13.5 to 16 (mean : 14.4±1.5) ; the R. R.% ranged from 66.7% to 87.5% (mean : 72.0%). Pathological findings included islands of calcification, and hydroxyapatite and calcium pyrophosphate dihydrate (CPPD) deposition in the ligamentum flavum. The presence of chondrocytes and the expression of growth factors (bone morphogenic protein) inducing bone formation could not be confirmed.</p><p>  Conclusions : CCLF should be considered an independent entity of spondylotic changes and ossification of spine ligaments after considering clinical features, neurological findings, and pathogenesis. The radiological and pathological findings suggest that both metabolic and dystrophic pathogenesis, in addition to chronic mechanical stimulation of the ligament, cause the accumulation of calcium, hydroxyapatite, and/or pyrophosphate dihydrate.</p>

Journal

  • Spinal Surgery

    Spinal Surgery 32 (1), 46-55, 2018

    The Japanese Society of Spinal Surgery

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