Multilevel Spinal Canal Stenosis with Ossification of the Ligamentum Flavum in an Achondroplastic Patient : A Case Report

https://doi.org/10.22146/ahj.v4i2.73093

Arya Widyatama(1*), Adam Moeljono(2)

(1) Academic Hospital Gadjah Mada University
(2) Academic Hospital Gadjah Mada University
(*) Corresponding Author

Abstract


Achondroplasia is the most common form of dwarfism in humans. There are abnormalities of intracartilaginous ossification caused by mutation of FGFR 3 gene resulting in a narrow spinal canal accompanied by neurological impairements in some patients. The neurological impairements could be caused by ossification of ligamentum flavum, disc degeneration, kyphosis of lumbar spine, bony spurs, thickened laminae and facet joints. We reported a case of 23-year-old Indonesian male with achondroplasia, spinal canal stenosis accompanied by ossification of ligamentum flavum presented with progressive myelopathy and neurogenic claudication. Spinal canal stenosis with OLF was observed at L2-L5 level of lumbar spine. Laminectomy with decompression and removal of the OLF was performed at L2-L5. There was an improvement on patient's neurological symptoms and function after the surgery. In this report, we describe a rare case of achondroplasia with OLF presenting with neurological symptoms from multiple level of spinal canal stenosis. We perfromed decompressive wide laminectomy and resection of adherent OLF followed by fusion with instrumentation resulted in the improvement of patient's neurological symptoms and function.

Keywords


Achondroplasia, ossification of ligamentum flavum, spinal canal stenosis

Full Text:

PDF


References

Pyeritz R E, Sack G H Jr, Udvarhelyi G B. Thoracolumbosacral laminectomy in achondroplasia: long-term results in 22 patints. Am J Med Gene 1987; 28: 433-44. 2. Ain MC, Chang TL, Schkrohowsky JG, Carlisle ES, Hodor M, Rigamonti D: Rates of perioperative complications associated with laminectomies in patients with achondroplasia. J Bone Joint Surg Am 2008, 90:295–298. 3. Yanagi T, Naito A, Yasuda T: Ossification of the ligamentum flavum of the thoracic spine: correlative CT and pathologic study [in Japanese]. Seikei Geka 1987, 38:297–307 4. Kurihara A, Tanaka Y, Tsumura N, Iwasaki Y: Hyperostotic lumbar spinal stenosis: a review of 12 surgically treated cases with roentgenographic survey of ossification of the yellow ligament at the lumbar spine. Spine (Phila Pa 1976) 1988, 13:1308–1316. 5. Hanakita J, Suwa H, Ohta F, Nishi S, Sakaida H, Iihara K: Neuroradiological examination of thoracic radiculomyelopathy due to ossification of the ligamentum flavum. Neuroradiology 1990, 32:38–42. 6. Muthukumar N. Dural ossification in ossification of the ligamentum flavum: A preliminary report. Spine (Phila Pa 1976) 2009;34:2654–61. 7. Sun J, Zhang C, Ning G, Li Y, Li Y, Wang P, et al. Surgical strategies for ossified ligamentum flavum associated with dural ossification in thoracic spinal stenosis. J Clin Neurosci. 2014;21:2102-6 . 8. Kritsadakorn K, Sombat K, Tinnakorn P, et al. Congenital Spinal Stenosis with Ossification of the Ligamentum Flavum in a Achondroplastic patient : A Case report and Literature Review. Asian J Neurosurg. 2014; 14(4):1231-1235 9. Huet, T., Cohen-Solal, M., Laredo, JD. et al. Lumbar spinal stenosis and disc alterations affect the upper lumbar spine in adults with achondroplasia. Sci Rep 10, 4699 (2020). 10. R. Wynne Davies, WK Walsh, J Gormley. Achondroplasia and Hypochondroplasia Clinical Variation and Spinal Stenosis. The Journal of Bone and Joint Surgery, British Volume, Vol 63-B, No.4 11. Fortuna A, Ferrante L, Acqui M, Santoro A, Mastronardi L. Narrowing of thoraco-lumbar spinal canal in achondroplasia. J Neurosurg Sci 1989; 33: 185-96. 12. Scott CJ (1976) Achondroplastic and hypochondroplastic dwarfism, Clin Orthop 114: 19-28 13. Davies RW, Walsh WK, Gormley J (1981) Achondroplasia and hypochondroplasia, 1 Bone 10int Surg 63B: 508-515 14. Bethem D, Winter RB, Lutter L, Moe JH, Bradford DS, Lonstein JE, et al (1981) Spinal disorders of dwarfism. 1 Bone 10int Surg 63A: 1412-1425 15. Kopits SE (1976) Orthopedic complications of dwarfism. Clin Orthop 114: 153-179 16. Goldberg MJ (1976) Orthopedic aspects of bone dysplasias. Orthop Clin North Am 7: 445-456 17. Rockwood CA Jr, Green DP. Rockwood and Green's Fractures in adults. 4th ed, 2 v. Philadelphia: Lippincott-Raven, 1996:1544–5. 18. OL Jerry, C Michelle. Vertebral Compression Fractures in Elderly. Am Fam Physician. 2004 Jan 1; 69(1) : 111-116 19. Morgan DF, Young RF (1980) Spinal neurological complications of achondroplasia. Results of surgical treatment. 1 Neurosurg 52(4): 463-472. 20. Saito K, Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Shimada Y, et al. Congenital lumbar spinal stenosis with ossification of the ligamentum flavum in achondroplasia: A case report. J Med Case Rep. 2014;8:88. 21. Suzuki K, Kanamori M, Nobukiyo M. Ossification of the thoracic ligamentum flavum in an achondroplastic patient: A case report. J Orthop Surg (Hong Kong) 2008;16:392–5. 22. Lutter LD, Longstein JE, Winter RB, Langer LO. Anatomy of the achondroplastic lumbar canal. Clin Orthop Relat Res. 1977;126:139–42. 23. MacGibbon B, Farfan HF. A radiologic survey of various configurations of the lumbar spine. Spine (Phila Pa 1976) 1979;4:258–66. 24. Ornitz, David M, and Laurence Legeai-Mallet. “Achondroplasia: Development, pathogenesis, and therapy.” Developmental dynamics : an official publication of the American Association of Anatomists vol. 246,4 (2017): 291-309.



DOI: https://doi.org/10.22146/ahj.v4i2.73093

Article Metrics

Abstract views : 18 | views : 4

Refbacks

  • There are currently no refbacks.




Copyright (c) 2023 Academic Hospital Journal

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Currently, Academic Hospital Journal indexed by:

google-scholar

garuda


 

Web
    Analytics

View My Stats

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License