Coexistence of flavum ligament ossification with diffuse idiopathic skeletal hyperostosis in the cervical spine: Review of literature and technical note starting from a rare case - 14/09/22

Doi : 10.1016/j.neuchi.2022.08.002

F. Calvanese ^a,^b,⁎ , G. Capo ^a, T. Picart ^c,^d, E. Durieux ^c, S. Vukusic ^e, D. Di Carlo ^f,^g, C.Y. Barrey ^a,^h
^a Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69677 Lyon-Bron, France
^b Department of Neurosurgery, Spedali Riuniti di Livorno, Viale Vittorio Alfieri, 36, 57124 Livorno, Italy
^c Department of anatomopathology and neuropathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
^d Department of neurosurgery, Hopital Pierre Wertheimer, Hospices Civils de Lyon, 59, boulevard Pinel, 69677 Lyon-Bron, France
^e Department of Neurology A, EDMUS Coordinating Center, INSERM U 842, Hôpital Neurologique Pierre Wertheimer, Lyon, France
^f Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100 Pisa, Italy
^g Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
^h Laboratory of Biomechanics, ENSAM, Arts et Metiers Paris Tech, 153, boulevard de l’Hôpital, 75013 Paris, France

^⁎Corresponding author. Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France.Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon59, boulevard PinelLyon69677France

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Wednesday 14 September 2022
This article has been published in an issue click here to access

Abstract

Background

Cervical flavum ligament ossification (C-OLF) is very rare source of myeloradiculopathy. Less than 100 cases have been reported in modern English literature up to 2020. Association between C-OLF and Diffuse Idiopathic Skeletal Hyperostosis (DISH) at cervical level has never been described.

Methods

In this article we performed a systematic review about epidemiology, physiopathology, clinical and surgical management of C-OLF. Moreover, we research its possible association with other cervical spine ligament ossification and in particular with anterior longitudinal ligament ossification. We report a case of 73 years-old woman experiencing mild cervical myeloradiculopathy caused by C6-C7 C-OLF compression and coexistence of DISH at cervico-thoracic level. A brief technical note about intraoperative management of C-OLF has also been described.

Result

Our research found 81 previous reported case of C-OLF. The coexistence of Posterior longitudinal ligament ossification has been reported in 21.3% of C-OLF case. Conversely, we reported the first case describing the association between DISH and C-OLF. Posterior surgical decompression is the only useful treatment providing good long-term functional outcome. Instrumentation should be tailored according to pre-operative findings.

Conclusions

C-OLF is a rare source of myeloradiculopathy and it may coexists with DISH probably due to alteration in the cervical mechanical stress and tendency of bone formation in patients harboring coexistent ligament ossifications. According to our result, skip en-bloc microsurgical laminectomy is safe and less invasive method to avoid complication and to provide optimal cervical spinal cord and nerve decompression avoiding CSF-leak.

El texto completo de este artículo está disponible en PDF.

Keywords : Cervical flavum ligament ossification (C-OLF), Diffuse Idiopathic skeletal hyperostosis (DISH), Coexistence, Myeloradiculopathy, Skip en-bloc microsurgical laminectomy

Abbreviations : C-OLF, DISH, T-OLF, FLO, O-PLL, O-ALL