Ossification of multi-vertebral ligaments. Case report

Abstract

A case of radiculo-myelopathy due to ossifications of multi-vertebral ligaments is reported. A 50year-old female had vague symptoms, such as radiating pain in the right back, sudden onset of muscle weakness and spasticity in both legs. She had been known to be hypertensive and diabetic for years. Neurological examination revealed moderate myelopathy from the cervical level down, with marked radiculopathy in the lower thoracic level and sphincter impairment. Routine laboratory examination results were within normal limits, except for 50 g oral glucose tolerance test. Vertebral plain roentgenograms and tomograms demonstrated ossifications of the posterior longitudinal ligament (OPLL) of C2-6, Th2-4, Th5-10, Th12-L1 and L2-3, and ossification of the yellow ligament (OYL) of Th8-9 and Th9-10 interspaces. Myelography demonstrated an incomplete block at the level of Th8-10. Spinal plain and metrizamide computerized tomography scans clearly demonstrated these ossifications, especially at the lower thoracic level where the spinal cord was markedly strangled by the OPLL and OYL. Total laminectomy of Th8 and Th9 was performed and OYLs were subtotally removed. Foraminotomy at the level of right Th7-8 and Th8-9 was added. Histological examination showed this to be OYL. Postoperatively, the radiculopathy of the lower thoracic level and urinary disturbances improved. The authors discuss the problems of the ossification of multi-vertebral ligaments.