Review of surgical decompression of three cases of ossified ligamentum flavum causing myelopathy

Ossifications of spinal ligaments,such as ossification of ligmenta flava (olf) and ossification of posterior longitudinal ligament (opll) in the cervical spine,is common and usually asymptomatic. once cervical myelopathy and radiculopathy occurs due to the opll,olf or both,surgical managements are often required when conservative treatment is not effective. the diagnosis is based on computed tomographic (ct) scan or magnetic resonance (mri) imaging. the postoperative prognosis depends on the severity and duration of the cervical myelopathy. high cervical ossified ligamentum flavum (olf) is rare and may cause progressive quadriparesis and respiratory failure. in dealing with cervical olf,carefully preserving facets during laminectomy or laminoplasty helps in maintaining normal cervical spinal curvature. in our two patients of olf in cervical spine,evident on mri and saggital reconstruction ct showing lateral bars and ossified ligamentum flavum causing thecal compression and one case of dorsal spine with hypertrophied olf at d9-11 causing canal narrowing and thecal compression were treated by decompressive laminoplasty and laminectomy respectively resulting in appreciable relief in myelopathy in two patients. one of our patient with high cervical olf and opll did not improved in immediate post-op period rather developed respiratory complications and aspiration pneumonia subsequently leading to mortality.