THORACIC MYELOPATHY SECONDARY TO OSSIFICATION OF THE LIGAMENTUM FLAVUM

 

E.GAMY- J.MAHLAOUI-M.MAHI-S.AKJOUJ-S.CHAOUIR –T.AMIL-A.HANINE

Medical Imaging Military Hospital Mohammed V Instruction Rabat.

CH3

The flavum ligamentum ossification (The OLJ) is a rare cause

of thoracic myelopathy.

Achieve extended over several thoracic segments remain

outstanding

  The purpose of this study is to evaluate the CT and MRI

respective roles in the diagnosis and monitoring of the

condition ossifying yellow ligament.

INTRODUCTION

We report a study of 3 patients (1 man and 2 women),

Mean age = 42 years,

All the patients were admitted for lower limb pain and spastic

paraparesis.

We performed a computed tomography (CT) and MRI to

establish the diagnosis.

Materials and Methods

CT images were sufficient to establish the diagnosis (axial acquisitions, and both two

and three dimensional recontructions were done).

Cuts from next disks prominently feature a bony posterior bilateral intraductal

shaped <V>.

MRI with multiplanar acquisitions:

Demonstrate that the OLJ is in low signal in T1 and T2 sequences and it locate at the upper thoracic

spine.

Specifies the lesional topography, and the severity of both dural sac and spinal cord compression

In one case, MRI shows a medullar high signal in T2 SE near to D3-D4 and D4-D5

Results

CT of thoracic spine in axial sections:hyperdense posterior intraductal process shaped <V> next to T9

Sagittal CT reconstruction: exuberant posterior intraductal ossified process.

MRI in thoracic sagittal T2 SP; process projecting intraductal posterior hypointense without sign of suffering spinal cord

The OLJ is a condition described in the above

Japanese literature.

Secondary to a deposit of calcium pyrophosphate crystals

Located especially in the low segment of thoracic spine

Etiology and physiopathology are still controversial.

DISCUSSION

Two clinical presentations are to oppose:

The symptomatic OLJ,

The asymptomatic one.

It depends of the OLJ mainly volume and thickness .

Different radiographic aspects were described.

DISCUSSION

The most common image is the projection in the upper part of the foramen.

Beak appearance;

linear picture,

Nodular or triangular pattern,

The ossification volume is the principal cause of pain,

DISCUSSION

The CT scan is sufficient in OLJ diagnosis.

MRI shows the lesional topography and severity of the compression

The treatment is surgical: Decompressive laminectomy is based on a

greater or lesser extent with or without a foraminotomy.

The prognosis depends on the lesion and it extend in order to provide an

early diagnosis and treatment.

DISCUSSION

The OLJ is a rare cause of thoracic myelopathy.

CT with sagittal reconstructions allows a positive diagnosis.

The MRI is useful for finding a precise the exact topography of the lesion

spinal cord and

Conclusion