Cervical Ossification of Ligamentum Flavum

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A case report of a 57-year-old female patient referred from Neurology for evaluation of cervical myelopathy. The patient reported a two-year history of progressive tetraparesis and mechanical chronic neck pain, predominantly at night. Clinical examination revealed a global motor deficit, symmetric and slow hand movements with claudication (more pronounced in the right hand), a positive Hoffmann sign, limited shoulder abduction, and global hypoesthesia. The patient scored 11/18 on the European Myelopathy Score (NMS 3; NMI 2; sphincter 2; CP 2; pain 2).

Radiological assessment demonstrated mild straightening of the physiological cervical lordosis in the static study. Posterior disc-osteophytic protrusions were observed at C3-C4, C4-C5, and C5-C6, with involvement of the neural foramina. Additionally, there was a significant thickening of the ligamentum flavum from C3-C4 to C6-C7, resulting in severe stenosis of the cervical canal, particularly notable at C5-C6. Subtle signal changes in the spinal cord at this level were suggestive of compressive myelopathy. Mild degenerative changes were noted at the facet joints, while no masses or pathological collections were observed in the epidural or subdural space. Furthermore, no abnormalities were detected in the craniovertebral junction or posterior fossa structures.

Conclusion: The presented case highlights posterior disc-osteophytic protrusions and significant hypertrophy of the yellow ligaments, contributing to severe stenosis of the cervical canal, most prominently at the C5-C6 level. This stenosis is associated with signs of compressive myelopathy, explaining the patient's clinical presentation of progressive tetraparesis and neurological deficits. Further management considerations and interventions should be explored to address the underlying structural abnormalities and alleviate the patient's symptoms.

Zhang B, Chen G, Chen X, Sun C, Chen Z. Cervical Ossification of Ligamentum Flavum: Elaborating an Underappreciated but Occasional Contributor to Myeloradiculopathy in Aging Population Based on Synthesis of Individual Participant Data. Clin Interv Aging. 2021 May 24;16:897-908. doi: 10.2147/CIA.S313357. PMID: 34079239; PMCID: PMC8163622.