Abstract
Calcification of the ligamentum flavum (CLF) can cause myelopathy due to spinal cord compression. Only several cases in Caucasian patients have been described. Neurological deterioration can only be stopped by surgical decompression. We report a 63-year-old Caucasian woman presenting with progressive pins-and-needles sensations in both hands, worsened by painful paresthesia in both lower extremities. MRI showed a dorsal compressive mass extending from C2 to Th3 vertebrae with myelopathy at the level of C6. A laminectomy was performed, which improved clinical symptoms. Histological examination showed CLF. Early recognition of CLF and early spinal cord decompression are needed to improve neurological outcome.
Highlights
Calcification of the ligamentum flavum (CLF) is a rare disease mainly occurring in the cervical spine (Miyasaka et al 1983)
The exact pathophysiology is unknown, findings from multiple case-reports describing CLF suggest that CLF could be a rare manifestation of the deposition of calcium pyrophosphate dehydrate crystals (CPPD) (Berghausen et al 1987; Brown et al 1991; Giulioni et al 2007; Seki et al 2013)
This indicates that calcium pyrophosphate dihydrate crystal deposition disease (CPPD) may be a consequence of degenerative changes in the ligamentum flavum, which might explain the broad extension of the lesion in our since timely decompression results in better neurologic outcome
Summary
Calcification of the ligamentum flavum (CLF) is a rare disease mainly occurring in the cervical spine (Miyasaka et al 1983). CLF results in posterior spinal cord compression, which may cause myelopathy and successive neurological deficits. It mostly occurs in the Asian population (Ahn et al 2014). Case A 63-year-old female presented with progressive pins-andneedles sensations in both hands over the past 3 years, worsened by tingling and burning pain in both lower extremities since 4 weeks. For lower extremities physical examination showed changing hypesthesia on the lateral sides of both legs and feet with a loss in vibration up to the knee. MRI showed an intraspinal extradural compressive mass extending from C2 to Th3 posterior of the spinal cord. Follow‐up One-month MRI follow-up showed no progression of the lesion and a clear decompression of the spinal cord at the operated level (Fig. 5). The tingling sensations and reflexes in her lower extremities persisted
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