Background: Ossification of the ligamentum flavum (OLF) has been well characterized as a distinct entity but also in tandem with ossification of the posterior longitudinal ligament (OPLL) in noncontiguous spinal regions. The majority of OLF cases are reported from East Asian countries where prevalent, but such cases are rarely reported in the North American population.
Observations: The authors present a case of a Thai-Cambodian American who presented with symptomatic thoracic OLF in tandem with asymptomatic cervical OPLL. A "floating" thoracic laminectomy, resection of OLF, and partial dural ossification (DO) resection with circumferential release of ossified dura were performed. Radiographic dural reexpansion and spinal cord decompression occurred despite the immediate intraoperative appearance of persistent thecal sac compression from retained DO.
Lessons: Entire spinal axis imaging should be considered for patients with spinal ligamentous ossification disease, particularly in those of East Asian backgrounds. A floating laminectomy is one of several surgical approaches for OLF, but no consensus approach has been clearly established. High surgical complication rates are associated with thoracic OLF, most commonly dural tears/cerebrospinal fluid (CSF) leaks. DO commonly coexists with OLF, is recognizable on computed tomographic scans, and increases the risk of CSF leaks.
Keywords: BMP = bone morphogenetic protein; CSF = cerebrospinal fluid; CT = computed tomography; DO = dural ossification; JOA = Japanese Orthopedic Association; MRI = magnetic resonance imaging; OLF; OLF = ossification of the ligamentum flavum; OPLL; OPLL = ossification of the posterior longitudinal ligament; dural ossification; floating laminectomy; miR = microRNA; ossification of ligamentum flavum; ossification of posterior longitudinal ligament.
© 2021 The authors.