Thoracic myelopathy secondary to ossified ligamentum flavum and dural ossification – A series of 19 cases and review of literature

ConclusionsAll patients with D-OLF and or DO presented with myelopathic features. MRI with concurrent CT spine helps to delineate dural ossification from D-OLF and helped to rule out other differentials. The classical “tram track” and “comma sign” is well noted in CT spine and helps to plan surgical approach and anticipate probable complications.Patients with concurrent D-OLF and DO and long segment pathology had increased risk of intraoperative dural tears and postoperative CSF leaks. These subset of patients had a peaked incidence of bladder involvement or non-improvement of existing bladder dysfunction, postoperatively. Patients with D-OLF and DO seemed to do better after surgical decompression. Surgery should be offered once diagnosis is confirmed on imaging, as all patients in out study, except one, showed postoperative neurological improvement.Our study concluded that patients with prolonged preoperative symptoms persisted to have them even after surgery. Patients with concurrent D-OLF and DO showed more significant improvement, postoperatively, in terms of mJOA – postop with a p = 0.002 as compared to patients with D-OLF alone.We recommend that each case be treated individually and treatment should be planned appropriately, based on the radiology and levels involved, keeping in mind the preoperative symptoms and their duration.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research