Case of ossification of the ligamentum flavum causing cauda equina compression

Background: Ossification of the ligamentum flavum (OLF) is characterized by heterotopic bone formation within the ligamentum flavum. It typically causes progressive, chronic spinal canal stenosis, but only rarely acute cauda equina syndromes. Case Description: A 29-year-old patient presented with cauda equina syndrome characterized by saddle numbness, urinary incontinence, and bilateral foot drop. She underwent an urgent decompression for a disc herniation, at which time the surgeons encountered severe OLF, causing cauda equina compression. After performing a computed tomography scan to assess the extent of ossification, the patient was taken back to the operating room for completion of the original laminectomy with extension to an adjacent level. Her postoperative recovery was uneventful. Conclusion: Here, a 29-year-old presented with cauda equina syndrome attributed to a herniated lumbar disc and single-level OLF.