[A case of nodular calcification of the ligamentum flavum with ossification of the posterior longitudinal ligament in the cervical spine].

A 72-year-old male noted weakness in the right lower extremity in August 1979, and clumsiness of the finger movement in the right hand in April 1980. In June 1980, he became tetraplegic and was unable to stand or walk. He also developed hypesthesia in the four extremities and difficulty in voiding. On admission to this hospital (July 12, 1980), neurological examination showed spastic tetraparesis, more pronounced on the right side. Deep tendon reflexes were markedly increased in the four extremities. Chaddock reflex in the right lower extremity and Trömner reflex in the both upper extremities were elicited. Hypesthesia below the level of C4 was present with anesthesia in the Th9-11 region. Plain film and tomogram of the cervical spine showed ossification of the posterior longitudinal ligament from C3 to C6 and a lobulated nodular calcification in the posterior part of the spinal canal at the level of C4,5 intervertebral space. CT scan revealed nodular calcifications in the ligamentum flavum not only at the level of C4 but also at the level of C6. Laminectomy from C3 to C6 was performed on August 21. The ligamentum flavum with nodular calcifications was removed. His postoperative course was uneventful. Seven weeks postoperatively the patient was able to walk without assistance and had no difficulty in voiding. He was discharged on October 14 with excellent activities of daily life. The content of the nodular calcification was identified as a kind of calcium phosphate by the physico-chemical analysis. Ossification and/or calcification of the ligamentum flavum in the cervical spine is rare, while ossification of the posterior longitudinal ligament is frequently encountered in the cervical spine. Only two cases with nodular calcification of ligamentum flavum in the cervical spine have been reported. To our knowledge, this is the first case of the nodular calcification of the ligamentum flavum in the cervical spine associated with ossification of the posterior longitudinal ligament. Two dimensional analysis by CT scan was very useful in locating the lesion and deciding the operative procedure.