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Brain and Nerve No to Shinkei Volume 45, Issue 9 （September 1993）

Brain and Nerve 脳と神経 45巻9号（1993年9月発行）

Japanese English

症例報告

頸椎黄色靱帯骨化症，頸椎黄色靱帯石灰化症の各1例 Ossification and Calcification of the Cervical Ligamentum Flavum : Case Reports 高山昌奎 ¹ , 栗林厚介 ¹ , 宮本義久 ² , 中洲庸子 ² , 半田讓二 ² Shoukei Takayama ¹ , Kousuke Kuribayashi ¹ , Yoshihisa Miyamoto ² , Yoko Nakasu ² , Jyoji Handa ² ¹琵琶湖大橋病院脳神経外科 ²滋賀医科大学脳神経外科 ¹Department of Neurosurgery, Biwako Ohashi Hospital ²Department of Neurosurgery, Shiga University of Medical Science キーワード： ossification of ligamentum flavum , calcification of ligamentum flavum , cervical , CT , MRl Keyword: ossification of ligamentum flavum , calcification of ligamentum flavum , cervical , CT , MRl pp.859-863

発行日 1993年9月1日 Published Date 1993/9/1

DOI https://doi.org/10.11477/mf.1406900534

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Abstract 文献概要
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　頸椎黄色靭帯骨化症と頸椎黄色靱帯石灰化症の各1例を経験した。症例1：左上肢のしびれを主訴とする55歳の男性。C3／4,4／5右側黄色靱帯骨化症に対し片側椎弓切除，foraminotomyを行い，骨化した靱帯摘出を行った。症例2：両手のしびれと歩行障害を主訴とする70歳の女性。C4／5,5／6の黄色靱帯石灰化症に対し石灰化巣を含めた黄色靱帯摘出，椎弓形成拡大術を行った。C6／7レベル以上の頸椎黄色靱帯骨化症は8例の報告があるのみで中高年にみられ性差は無い。頸椎黄色靱帯石灰化症は約100例の報告があり，高齢の女性，下部頸椎に多くみられる。骨化巣，石灰化巣の診断にはCTが最も有用である。MRIは脊髄の変形，偏位を示す点で優れている。黄色靭帯骨化症に対しては片側椎弓切除にforaminotomyを加えての摘出術が，手術侵襲少なく，術後安定性に優れていた。

Ossification of ligamentum flavum was reportedusually lower thoracic and lumbar region, and rare-ly seen in the cervical region. Calcificaton of cer-vical ligamentum flavum is also relatively rare. We report a case of ossification and another of calcificaton of cervical ligamentum flavum, and discussed the difference of the clinical and radiological features in these conditions.

Case 1 : A 55-year-old man presented with numb-ness of the left shoulder and urinary dysfunction. Neurological examination revealed weakness, mus-cle atrophy and elevated deep tendon reflexes of the left extremities. CT showed ossified mass protrud-ing into the right side of the canal and compressingthe spinal cord at C 3/4 and C 4/5. MRI showed low intensity mass both on T1- and T2-weighted images and severe compression of the spinal cord. Left side partial hemilaminectomy with foraminotomy, so called "key hole" foraminotomy, satisfactorily decompressed the cord with clinical improvement.

Case 2: A 70-year-old woman compliained numbness of both hands for two years. She had sensory disturbance of both hands and spastic gait disturbance. Cervical X-ray films showed calcified nodules on the inner surface of lamina at C4/5. Axial CT demonstrated calcification in the ligamentum flavum at the C4/5 and C5/6 levels. MRI showed posterior spinal cord compression at the C4/5 and C5/6 levels. Osteoplastic laminotomy and removal of the affected ligamentum flavum were performed with succesful result.

Only 8 cases ossification of cervical ligamentum flavum above C6/7 have been so far reported. All are Japanese ; four male and four female cases. Age ranges from 47 to 75. On the other hand, about 100 cases of calcification of cervical ligamentum flavum have been reported. It must often occurs in the lower cervical region of older women.

CT is most useful in demonstrating the ossi-fication and calcification of ligaments in relation to the lamina and spinal cord. Ossification or calcification is demonstrated as a low signal inten-sity mass on T1- and T2-weighted MRI. MRI also clearly demonstrates degree and extent of spinal compression without contrast medium.