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Symptomatic Ossification of the Ligamentum Flavum at the Lumbar Spine: A Retrospective Study

Pantazis, Georgios, MD*; Tsitsopoulos, Parmenion, MD; Bibis, Alexios, MD*; Mihas, Constantinos, MD; Chatzistamou, Ioulia, MD§; Kouzelis, Constantinos, MD*

doi: 10.1097/BRS.0b013e3181624535

Study Design. A retrospective study on 9 patients treated for ossification of the ligamentum flavum (OLF) at the lumbar spine.

Objective. To evaluate the clinical and radiologic findings as well as the postoperative results of the patients.

Summary of Background Data. Ossification of ligamentum flavum (OLF) in the lumbar region causing neurologic impairment is a rare pathologic entity described mainly in Japanese literature. The present study represents the largest surgical series of European patients with OLF at the lumbar spine.

Methods. A retrospective study of 9 consecutive patients was conducted between 2000 and 2005. The clinical status was evaluated according to the Japanese Orthopedic Association scale. Potential associated disorders were also recorded. Diagnosis in each case was established using computed tomography and magnetic resonance imaging. Whole-spine magnetic resonance imaging was routinely used in order to reveal possible coexisting spinal lesions. Pathologic confirmation was available in all cases.

Results. Radicular pain was the most common presenting symptom. Myotomal weakness was found in most of the cases. A majority of our patients had lesions located at the L3–L5 levels. Thoracic OLF was recorded as a spinal coexisting ossified lesion. Surgery led to neurologic improvement with a statistically significant increase in the Japanese Orthopedic Association score (P = 0.007). The median recovery rate was 91.60% ± 43.85%.

Conclusion. It is possible that OLF is underreported in the Greek population. Surgical treatment is important in order to improve functional outcomes.

Symptomatic lumbar OLF is a rare pathologic entity leading to severe motor palsies and sphincter disturbances. Whole-spine MRI is helpful in order to reveal coexisting spinal lesions. Early surgical treatment leads to significant postoperative improvement. It is possible that OLF is underreported in the Greek population.

From the *Department of Neurosurgery, Thriassio General Hospital, Athens, Greece; †Department of Neurosurgery, Hippokrateio General Hospital, Aristotle University Medical School, Thessaloniki, Greece; ‡Department of Internal Medicine, Kimi General Hospital, Kimi, Greece; and §Department of Histology and Embryology, University of Athens Medical School, Athens, Greece.

Acknowledgment date: March 30, 2007. Revision date: June 27, 2007. Acceptance date: August 15, 2007.

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 Georgios Pantazis, MD, Klius 10, 17778 Tavros, Athens, Greece; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.