Treatment of posttraumatic lumbar interspinous ligament calcification with partial resection of spinous processes and calcified interspinous ligaments: case report

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The authors report on the first surgical treatment for traumatic interspinous ligament calcification, with significant radiographic and symptomatic improvements at long-term follow-up. Heterotopic ossification occurs following traumatic injury but does not typically affect the interspinous ligaments. While these ligaments can calcify with age, this is rarely seen in patients younger than 50 years of age. The authors present the unusual case of a 31-year-old man who suffered traumatic fractures of thoracic and lumbar spinous processes. He developed progressive low-back pain that failed to respond to conservative treatments. At presentation, he was neurologically intact. CT scanning demonstrated partial calcification of the interspinous ligaments at L2–3, L3–4, and L4–5 with significant hypertrophy of the spinous processes at those levels. He did not have significant disc pathology, and his symptoms were attributed to the limited range of motion caused by the enlarged spinous processes. Partial resection of the spinous processes and calcified interspinous ligaments was performed to remove the heterotopic bone. The patient was seen in follow-up at 5 months postoperatively for imaging, and he was interviewed at 1 and 2 years postoperatively. He is doing well with significant pain relief and an improved range of motion. His Oswestry Disability Index improved from 25 preoperatively to 18 at 2 years postoperatively.

ABBREVIATIONS ODI = Oswestry Disability Index.

Article Information

Correspondence Angela M. Richardson: University of Miami, Jackson Memorial Hospital, Miami, FL. angela.richardson@jhsmiami.org.

INCLUDE WHEN CITING Published online December 21, 2018; DOI: 10.3171/2018.9.SPINE18401.

Disclosures Dr. Vanni serves as a consultant to NuVasive Inc., Globus Medical Inc., and Spine Wave Inc.

© AANS, except where prohibited by US copyright law.

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Figures

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    Abdominal CT obtained at presentation. A: Sagittal view demonstrating an L2 spinous process fracture. B: Axial view through the fractured L2 spinous process. C: Sagittal view demonstrating an L3 spinous process fracture. D: Axial view through the fractured L3 spinous process.

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    Sagittal T2-weighted MR image of the lumbar spine demonstrating a patent spinal canal with a black disc at L5–S1 with a mild bulge posteriorly. No significant compression of the thecal sac is visible.

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    Preoperative sagittal (A), coronal (B), and axial (C) lumbar spine CT scans without contrast showing calcification of the interspinous and paraspinal ligaments with close apposition of adjacent spinous processes. Representative sagittal image (D) obtained at 2 years postoperatively, demonstrating the extent of resection of hypertrophic spinous processes and surrounding tissues.

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    Preoperative lateral radiographs of the lumbar spine obtained on flexion (A), in the neutral position (B), and on extension (C), showing a limited range of motion on extension. Five-month postoperative radiographs obtained on flexion (D), in the neutral position (E), and on extension (F), showing a notably increased range of motion on extension.

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    Two-year postoperative lateral radiographs of the lumbar spine obtained on flexion (A) and extension (B), showing preserved range of motion.

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