Case report

Ossification of the yellow ligament in the cervical spine – an unusual location

¹ Department of Orthopaedic Surgery, Spine Division, Tan Tock Seng Hospital, Singapore
² Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
³ Department of Orthopaedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical sciences and Research, Affiliated to the Tamil Nadu Dr MGR Medical University, Tamil Nadu, India
⁴ Pinnacle Spine and Scoliosis Centre, Mount Elizabeth Medical Centre, Singapore

^* Corresponding author. Department of Orthopaedic Surgery, Spine Division, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. E-mail address: jacob_oh@yahoo.com (J. Y. L. Oh)

Received: 31 December 2018
Accepted: 21 January 2019

Abstract

Ossification of the yellow ligament (OYL) or ligamentum flavum, usually occurs in the thoracic spine. Focal OYL occurring in the cervical spine is considered rare and is sparsely reported in the literature. We came across a 30-year-old male patient with progressive left upper limb and bilateral lower limb weakness over a period of 3 months, associated with an unsteady gait. Clinical examination revealed bilateral generalized hyper-reflexia in both upper and lower limbs, inverted supinator jerk, Hoffman’s sign and clonus. Myelopathy due to cord compression was suspected and further investigations were done. MRI and CT scans revealed a bony mass in relation to the C6 spinous process projecting anterosuperiorly and narrowing the cervical spinal canal causing cord signal changes from C4 to C6 levels. In view of the deteriorating neurological status, immediate surgery in the form of decompression and posterior stabilization from C4-C6 was performed. Patient gradually recovered after surgery and attained full functional status. We report this case considering the unusual location of OYL and its successful management.