Ossification of the ligament flavum in the thoracic spine is an uncommon radiological finding in the Western population but can present with back pain, varying degrees of myelopathy, and even paraplegia on occasion. The authors here present the case of a 50-year-old woman with a history of progressive back pain and symptoms of spontaneous intracranial hypotension who was found to have an ossified ligamentum flavum of the thoracic spine resulting in a dural erosion cerebrospinal fluid leak. Surgery involved removal of the ossified ligament flavum at T10–11, facetectomy, ligation of the nerve root, and primary closure of the dura, which resulted in complete resolution of the patient’s symptoms. Radiological, clinical, and intraoperative findings are discussed to assist surgeons with an accurate diagnosis and treatment in the setting of this unusual presentation.
ABBREVIATIONSCSF = cerebrospinal fluid; OLF = ossification of the ligamentum flavum; SIH = spontaneous intracranial hypotension.
Correspondence Mazda K. Turel: Rush University Medical Center, Chicago, IL. email@example.com.
INCLUDE WHEN CITING Published online January 26, 2018; DOI: 10.3171/2017.8.SPINE17513.
Disclosures Dr. O’Toole is a consultant for Globus Medical Inc., RTI Surgical Inc., Amendia, Bioventus, and the Federal Drug Administration; has received royalties from Globus Medical Inc. and RTI Surgical Inc.; and has direct stock ownership in Theracell Inc.
MiyakoshiNShimadaYSuzukiTHongoMKasukawaYOkadaK: Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg99 (3 Suppl):251–2562003
RettenmaierLAParkBJHollandMTHamadeYJGargSRastogiR: Value of targeted epidural blood patch and management of subdural hematoma in spontaneous intracranial hypotension: case report and review of the literature. World Neurosurg97:27–382017
YayamaTUchidaKKobayashiSKokuboYSatoRNakajimaH: Thoracic ossification of the human ligamentum flavum: histopathological and immunohistochemical findings around the ossified lesion. J Neurosurg Spine7:184–1932007