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