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Acute Quadriparesis Caused by Calcification of the Entire Cervical Ligamentum Flavum in a White Female—Report of An Unusual Case And A Brief Review of the Literature: Case Report

Khan, Mustafa H., MD; Smith, Patrick N., MD; Donaldson, William F. III, MD

doi: 10.1097/01.brs.0000186472.88141.38
Case Report

Study Design. Case report.

Objectives. To describe an extremely unusual case of acute quadriparesis in a white female caused by calcification of the ligamentum flavum (LF) from C1 to T2, and to review briefly the pertinent literature.

Summary of Background Data. Diseases characterized by abnormal calcium deposition on the spinal ligaments have an unclear etiology. The overwhelming majority of these cases has been reported in people of Asian descent and has a predilection for the thoracic spine. Multilevel involvement of the cervical LF in white patients is exceptionally rare. To our knowledge, complete calcification of the entire cervical LF has not been previously reported in the literature.

Methods. The history, physical examination, and radiographic studies of a 64-year-old white female with a history of scleroderma are described. The patient presented with neck pain and acute quadriparesis caused by spinal cord impingement by calcified cervical LF from C1 to T2. The patient underwent emergent C3–C7 laminectomy and C2–C7 posterior spinal fusion.

Results. Operative intervention resulted in marked neurologic improvement and relief from neck pain. Histopathologic examination of the calcified LF showed that the deposits consisted of hydroxyapatite crystals exclusively with no heterotopic bone. However, kyphosis did develop in the patient after laminectomy.

Conclusion. To our knowledge, this unusual case of complete calcification of the entire cervical LF has not previously been described. Multilevel laminectomy and fusion can improve neurologic function but may result in kyphosis.

Calcification of the cervical ligamentum flavum is an extremely uncommon entity. This report describes the unique case of a white female who had acute quadriparesis secondary to calcification of the entire cervical ligamentum flavum. Emergent decompression and fusion led to neurologic improvement.

From the Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Acknowledgment date: March 17, 2005. First revision date: May 19, 2005. Acceptance date: May 23, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to William F. Donaldson, MD, Division of Spinal Surgery, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Suite 1010, 3741 Fifth Avenue, Pittsburgh, PA 15213; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.