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Ossification Ligamentum Flavum
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Ossification of ligamentum flavum (OLF), ossification of vertebral arch ligaments (OVAL), ligamentum flavum "pseudogout"
            • Definitions

              • Calcification &/or ossification of ligamentum flavum

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Hou X et al: Clinical Features of Thoracic Spinal Stenosis-associated Myelopathy: A Retrospective Analysis of 427 Cases. J Spinal Disord Tech. ePub, 2014
                                            2. Gao R et al: Clinical features and surgical outcomes of patients with thoracic myelopathy caused by multilevel ossification of the ligamentum flavum. Spine J. 13(9):1032-8, 2013
                                            3. Hirabayashi H et al: Surgery for thoracic myelopathy caused by ossification of the ligamentum flavum. Surg Neurol. 69(2):114-6; discussion 116, 2008
                                            4. Wang VY et al: Removal of ossified ligamentum flavum via a minimally invasive surgical approach. Neurosurg Focus. 25(2):E7, 2008
                                            5. Kong Q et al: COL6A1 polymorphisms associated with ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976). 32(25):2834-8, 2007
                                            6. Yayama T et al: Thoracic ossification of the human ligamentum flavum: histopathological and immunohistochemical findings around the ossified lesion. J Neurosurg Spine. 7(2):184-93, 2007
                                            7. Inamasu J et al: Ossification of the posterior longitudinal ligament: an update on its biology, epidemiology, and natural history. Neurosurgery. 58(6):1027-39; discussion 1027-39, 2006
                                            8. Wang W et al: Thoracic myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor. J Orthop Surg Res. 1:10, 2006
                                            9. Takeuchi A et al: Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. Report of three cases. J Neurosurg. 100(1 Suppl):71-4, 2004
                                            10. Ben Hamouda K et al: Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases. J Neurosurg. 99(2 Suppl):157-61, 2003
                                            11. Miyakoshi N et al: Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg. 99(3 Suppl):251-6, 2003
                                            12. Muthukumar N et al: Tumoral calcium pyrophosphate dihydrate deposition disease of the ligamentum flavum. Neurosurgery. 53(1):103-8; discussion 108-9, 2003
                                            13. Seichi A et al: Image-guided resection for thoracic ossification of the ligamentum flavum. J Neurosurg. 99(1 Suppl):60-3, 2003
                                            14. Akhaddar A et al: Thoracic spinal cord compression by ligamentum flavum ossifications. Joint Bone Spine. 69(3):319-23, 2002
                                            15. Li KK et al: Myelopathy caused by ossification of ligamentum flavum. Spine. 27(12):E308-12, 2002
                                            16. Mizuno J et al: Unilateral ossification of the ligamentum flavum in the cervical spine with atypical radiological appearance. J Clin Neurosci. 9(4):462-4, 2002
                                            17. Vasudevan A et al: Ossification of the ligamentum flavum. J Clin Neurosci. 9(3):311-3, 2002
                                            18. Hirai T et al: Ossification of the posterior longitudinal ligament and ligamentum flavum: imaging features. Semin Musculoskelet Radiol. 5(2):83-8, 2001
                                            19. Trivedi P et al: Thoracic myelopathy secondary to ossified ligamentum flavum. Acta Neurochir (Wien). 143(8):775-82, 2001
                                            20. Xiong L et al: CT and MRI characteristics of ossification of the ligamenta flava in the thoracic spine. Eur Radiol. 11(9):1798-802, 2001
                                            21. Muthukumar N et al: Calcium pyrophosphate dihydrate deposition disease causing thoracic cord compression: case report. Neurosurgery. 46(1):222-5, 2000
                                            22. Yamagami T et al: Calcification of the cervical ligamentum flavum--case report. Neurol Med Chir (Tokyo). 40(4):234-8, 2000
                                            23. Ono K et al: Pathology of ossification of the posterior longitudinal ligament and ligamentum flavum. Clin Orthop. (359):18-26, 1999
                                            24. Wang PN et al: Ossification of the posterior longitudinal ligament of the spine. A case-control risk factor study. Spine. 24(2):142-4; discussion 145, 1999
                                            25. al-Orainy IA et al: Ossification of the ligament flavum. Eur J Radiol. 29(1):76-82, 1998
                                            26. Ehara S et al: Paravertebral ligamentous ossification: DISH, OPLL and OLF. Eur J Radiol. 27(3):196-205, 1998
                                            27. Ido K et al: Surgical treatment for ossification of the posterior longitudinal ligament and the yellow ligament in the thoracic and cervico-thoracic spine. Spinal Cord. 36(8):561-6, 1998
                                            28. Fam AG: Calcium pyrophosphate crystal deposition disease and other crystal deposition diseases. Curr Opin Rheumatol. 7(4):364-8, 1995
                                            29. Imai S et al: Cervical radiculomyelopathy due to deposition of calcium pyrophosphate dihydrate crystals in the ligamentum flavum: historical and histological evaluation of attendant inflammation. J Spinal Disord. 7(6):513-7, 1994
                                            30. Delamarter RB et al: Lumbar spinal stenosis secondary to calcium pyrophosphate crystal deposition (pseudogout). Clin Orthop. (289):127-30, 1993
                                            31. Gomez H et al: Myeloradiculopathy secondary to pseudogout in the cervical ligamentum flavum: case report. Neurosurgery. 25(2):298-302, 1989
                                            32. Kawano N et al: Calcium pyrophosphate dihydrate crystal deposition disease in the cervical ligamentum flavum. J Neurosurg. 68(4):613-20, 1988
                                            33. Berghausen EJ et al: Cervical myelopathy attributable to pseudogout. Case report with radiologic, histologic, and crystallographic observations. Clin Orthop. (214):217-21, 1987
                                            34. Resnick D et al: Vertebral involvement in calcium pyrophosphate dihydrate crystal deposition disease. Radiographic-pathological correlation. Radiology. 153(1):55-60, 1984
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Ossification of ligamentum flavum (OLF), ossification of vertebral arch ligaments (OVAL), ligamentum flavum "pseudogout"
                                                      • Definitions

                                                        • Calcification &/or ossification of ligamentum flavum

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Nonvascular Interventions

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Hou X et al: Clinical Features of Thoracic Spinal Stenosis-associated Myelopathy: A Retrospective Analysis of 427 Cases. J Spinal Disord Tech. ePub, 2014
                                                                                      2. Gao R et al: Clinical features and surgical outcomes of patients with thoracic myelopathy caused by multilevel ossification of the ligamentum flavum. Spine J. 13(9):1032-8, 2013
                                                                                      3. Hirabayashi H et al: Surgery for thoracic myelopathy caused by ossification of the ligamentum flavum. Surg Neurol. 69(2):114-6; discussion 116, 2008
                                                                                      4. Wang VY et al: Removal of ossified ligamentum flavum via a minimally invasive surgical approach. Neurosurg Focus. 25(2):E7, 2008
                                                                                      5. Kong Q et al: COL6A1 polymorphisms associated with ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976). 32(25):2834-8, 2007
                                                                                      6. Yayama T et al: Thoracic ossification of the human ligamentum flavum: histopathological and immunohistochemical findings around the ossified lesion. J Neurosurg Spine. 7(2):184-93, 2007
                                                                                      7. Inamasu J et al: Ossification of the posterior longitudinal ligament: an update on its biology, epidemiology, and natural history. Neurosurgery. 58(6):1027-39; discussion 1027-39, 2006
                                                                                      8. Wang W et al: Thoracic myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor. J Orthop Surg Res. 1:10, 2006
                                                                                      9. Takeuchi A et al: Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. Report of three cases. J Neurosurg. 100(1 Suppl):71-4, 2004
                                                                                      10. Ben Hamouda K et al: Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases. J Neurosurg. 99(2 Suppl):157-61, 2003
                                                                                      11. Miyakoshi N et al: Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg. 99(3 Suppl):251-6, 2003
                                                                                      12. Muthukumar N et al: Tumoral calcium pyrophosphate dihydrate deposition disease of the ligamentum flavum. Neurosurgery. 53(1):103-8; discussion 108-9, 2003
                                                                                      13. Seichi A et al: Image-guided resection for thoracic ossification of the ligamentum flavum. J Neurosurg. 99(1 Suppl):60-3, 2003
                                                                                      14. Akhaddar A et al: Thoracic spinal cord compression by ligamentum flavum ossifications. Joint Bone Spine. 69(3):319-23, 2002
                                                                                      15. Li KK et al: Myelopathy caused by ossification of ligamentum flavum. Spine. 27(12):E308-12, 2002
                                                                                      16. Mizuno J et al: Unilateral ossification of the ligamentum flavum in the cervical spine with atypical radiological appearance. J Clin Neurosci. 9(4):462-4, 2002
                                                                                      17. Vasudevan A et al: Ossification of the ligamentum flavum. J Clin Neurosci. 9(3):311-3, 2002
                                                                                      18. Hirai T et al: Ossification of the posterior longitudinal ligament and ligamentum flavum: imaging features. Semin Musculoskelet Radiol. 5(2):83-8, 2001
                                                                                      19. Trivedi P et al: Thoracic myelopathy secondary to ossified ligamentum flavum. Acta Neurochir (Wien). 143(8):775-82, 2001
                                                                                      20. Xiong L et al: CT and MRI characteristics of ossification of the ligamenta flava in the thoracic spine. Eur Radiol. 11(9):1798-802, 2001
                                                                                      21. Muthukumar N et al: Calcium pyrophosphate dihydrate deposition disease causing thoracic cord compression: case report. Neurosurgery. 46(1):222-5, 2000
                                                                                      22. Yamagami T et al: Calcification of the cervical ligamentum flavum--case report. Neurol Med Chir (Tokyo). 40(4):234-8, 2000
                                                                                      23. Ono K et al: Pathology of ossification of the posterior longitudinal ligament and ligamentum flavum. Clin Orthop. (359):18-26, 1999
                                                                                      24. Wang PN et al: Ossification of the posterior longitudinal ligament of the spine. A case-control risk factor study. Spine. 24(2):142-4; discussion 145, 1999
                                                                                      25. al-Orainy IA et al: Ossification of the ligament flavum. Eur J Radiol. 29(1):76-82, 1998
                                                                                      26. Ehara S et al: Paravertebral ligamentous ossification: DISH, OPLL and OLF. Eur J Radiol. 27(3):196-205, 1998
                                                                                      27. Ido K et al: Surgical treatment for ossification of the posterior longitudinal ligament and the yellow ligament in the thoracic and cervico-thoracic spine. Spinal Cord. 36(8):561-6, 1998
                                                                                      28. Fam AG: Calcium pyrophosphate crystal deposition disease and other crystal deposition diseases. Curr Opin Rheumatol. 7(4):364-8, 1995
                                                                                      29. Imai S et al: Cervical radiculomyelopathy due to deposition of calcium pyrophosphate dihydrate crystals in the ligamentum flavum: historical and histological evaluation of attendant inflammation. J Spinal Disord. 7(6):513-7, 1994
                                                                                      30. Delamarter RB et al: Lumbar spinal stenosis secondary to calcium pyrophosphate crystal deposition (pseudogout). Clin Orthop. (289):127-30, 1993
                                                                                      31. Gomez H et al: Myeloradiculopathy secondary to pseudogout in the cervical ligamentum flavum: case report. Neurosurgery. 25(2):298-302, 1989
                                                                                      32. Kawano N et al: Calcium pyrophosphate dihydrate crystal deposition disease in the cervical ligamentum flavum. J Neurosurg. 68(4):613-20, 1988
                                                                                      33. Berghausen EJ et al: Cervical myelopathy attributable to pseudogout. Case report with radiologic, histologic, and crystallographic observations. Clin Orthop. (214):217-21, 1987
                                                                                      34. Resnick D et al: Vertebral involvement in calcium pyrophosphate dihydrate crystal deposition disease. Radiographic-pathological correlation. Radiology. 153(1):55-60, 1984