Ossification of the ligamentum flavum as cause of thoracic cord compression: Case report of a Latin American man and review of the literature
A 38-year-old male patient with a normal medical history, presented with a 6 month progressive gait disturbance and urinary incontinence. There was no history of previous trauma. Physical examination showed spastic paraparesis (grade 3/5), bilateral positive Babinski sign, with increased deep tendon reflexes. Sensory level at T9 was ascertained. Rectal sphincter was preserved.\nDorsal spine magnetic resonance imaging (MRI) was obtained, which showed hypertrophy and ossification of the posterior ligamentous complex from T3 to T10 and underlying myelopathy. No discal pathology was reported. Computed tomography (CT) demonstrated bone density all long the posterior segment of the dorsal spinal canal and a 50% reduction of anteroposterior diameter [Figures and ]. Imaging of the cervical and lumbar spine showed no abnormalities.\nSerum calcium, phosphorous, uric acid, and glucose levels were normal. A discrete elevation of alkaline phosphatase level was observed (485 mIU/ml, normal range up to 306 mIU/ml).\nPatient underwent a dorsal approach under general anesthesia in a prone position. A midline incision was made and the T3 to T9 lamina were removed. Extensive drilling of the ossification was performed. Thinned laminas were attached to the spinous process of the superior and inferior vertebrae.\nPatient underwent an intensive care unit stay, complicated with paralytic ileus and respiratory tract infection. At hospital discharge, patient remained paraparetic with a 3/5 muscular strength, mild hypoesthesia in both lower limbs, and bladder incontinence. Rectal sphincter was continent. At 6 months, he was able to walk with a cane, with no sphincter or sensory alterations.