Thoracic Spinal Stenosis from Calcified Ligamentum Flavum Co-Existing with L5-S1 Foraminal Stenosis - A Case Report and Literature Review

Abstract Calcification of the ligamentum flavum (LF) is a rare cause of spinal stenosis. The process can occur at any level in the spine, often presents with local pain or radicular symptoms, and is a distinct process from ossification of the spinal ligaments in pathogenesis and treatment approach. Few case reports have described multiple level involvements in the thoracic spine that results in sensorimotor deficits and myelopathy. We reported a 50-year-old male who presented with progressive sensorimotor deficits from T10 distally that resulted in complete sensory deficits and decreased lower extremity strength on the left. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated calcification of the ligamentum flavum from T10-11 and T11-12 with foraminal stenosis of L5-S1 on the left. He underwent endoscopic assisted excision of calcified ligamentum flavum. Postoperatively, he had complete motor strength recovery and was discharged home for outpatient physiotherapy. His residual sensory deficits continued to improve with time after decompression and excision of the calcified ligamentum flavum and decompression of the L5-S1 foramen. This case is unique in that the calcific processes involved multi levels of the thoracic spine. The patient had dramatic improvement in his symptoms following resection of the involved responsible levels. Keywords: Calcification–physiologic, ligamentum flavum, spinal stenosis, spine, thoracic vertebrae, foraminal stenosis. endoscopic-assisted spine surgery.