Concluded Case

Ligamentum flavum ossification from D5 toD10 with cord compression .

New case. 52 yr ,M, presented with progressive difficulty in walking since 1 month,numbness in the legs 2 weeks, chapels slipping off from feet 2 weeks,increased frequency of micturition 10 days. Known hypertensive, well under control with single dose daily. Non smoker ,not in the habit of ethanol. On exam vitals stable,BP 140/ 80 mmhg . Intact peripheral pulsations. Motor system gr 4/ 5 power in the lower limbs with mild spasticity. DTRShyperactive in the lower limbs with absent abdominal reflexes and extensor plantars . Mild dulling of sensations all modalities from D8 down. MRI done and the patient is with the spinal surgeon and surgery done. Diagnosis and management?

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Concluded answer

Thanks to all answeres. Thanks Dr Malleswararao for the 1st correct answer. MRI dorssl spine shows diffuse ligamentum flavum ossification from D5 to D10 level causing secondary canal stenosis with significant cord compression at D9 and D10 levels and myelomalacic changes at D9-10 level. Surgery done by the Spinal surgeon D5-11 laminectomy ,excision + pedicle to pedicle decompression+ posterior instrumental fusion D5 To D11 under GA.

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Dorsal spine ligamentum flavum hypertrophy/ calcification. Needs surgery in the form of posterior decompression to relieve cord compression. No evidence of kochs or mets i feel. Please tell us what was done.

Goid. Thanks for the appropriate answer.
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it's called spinal enthesiopathy.... post. elements get hypertrophied, calcified and the ossified producing hard masses severely compressing spinal cord... have done many cases...seen in manual labour or hard physical work individuals...female more common, obesity incriminating factor...surgery is a must...delicate surgery as there is no space to enter inside and chances of cord injury and crushing with instrument entry is very high...needs very delicate expert hand to operate... chronic cord compression devitalized cord and post surgery cord oedema may worsen some cases with myelomalacia

Thanks to all answeres. Thanks Dr Malleswararao for the 1st correct answer. MRI dorssl spine shows diffuse ligamentum flavum ossification from D5 to D10 level causing secondary canal stenosis with significant cord compression at D9 and D10 levels and myelomalacic changes at D9-10 level. Surgery done by the Spinal surgeon D5-11 laminectomy ,excision + pedicle to pedicle decompression+ posterior instrumental fusion D5 To D11 under GA.

Look like Ankylosing spondylitis ALL and PLL ossification Canal stenosis and cord compression at multiple thoracic levels Symptoms correlate with MRI findings Decompressive laminectomy will be beneficial Please post details as update

Multiple extradural lesions in dorsal region with mild dorsal cord compression at various levels. Mediastinal LN .paravertebral soft tissue. Few small lung nodules __ possibilty of metastatic disease d/ d lymphoma

Compressive myelopathy at dorsal spine d9 d10 from posterior aspect Need decompression, with tissue biopsy