Document Detail

Thoracic ossification of ligamentum flavum caused by skeletal fluorosis.
MedLine Citation:
PMID:  17075705     Owner:  NLM     Status:  MEDLINE    
Thoracic ossification of ligamentum flavum (OLF) caused by skeletal fluorosis is rare. Only six patients had been reported in the English literature. This study reports findings from the first clinical series of this disease. This was a retrospective study of patients with thoracic OLF due to skeletal fluorosis who underwent surgical management at the authors' hospital between 1993 and 2003. Diagnosis of skeletal fluorosis was made based on the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis was present. Neurological status was evaluated preoperatively, at the third day postoperatively, and at the end point of follow-up using the Japanese Orthopaedic Association (JOA) scoring system of motor function of the lower extremities. A total of 23 cases were enrolled, 16 (69.6%) males and 7 (30.4%) females, age ranging from 42 to 72 years (mean 54.8 years). All patients came from a high-fluoride area, and 22 (95.7%) had dental fluorosis. Medical imaging showed OLF together with ossification of many ligaments and interosseous membranes, including interosseous membranes of the forearm (18/23 patients 78.3%), leg (14/23 patients 60.9%), and ribs (11/23 patients 47.8%). OLF was classified into five types based on MRI findings: localized (4/23 patients 17.4%), continued (12/23 patients 52.2%), skip (3/23 patients 13.0%), combining with anterior pressure (2/23 patients 8.7%), and combining with cervical and/or lumbar stenosis (2/23 patients, 8.7%). Urinalysis showed a markedly high urinary fluoride level in 14 of 23 patients (60.9%). Patients were followed up for an average duration of 4 years, 5 months. Paired t-test showed that the JOA score was slightly but nonsignificantly increased relative to preoperative measurement 3 days after surgery (P = 0.0829) and significantly increased at the end of follow-up (P = 0.0001). In conclusion, Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. Comparing with other OLF series, a larger number of spinal segments were involved. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptom, imaging study findings, and urinalysis. En bloc laminectomy decompression was an effective method.
Wenbao Wang; Linghua Kong; Heyuan Zhao; Ronghua Dong; Jianjiang Li; Zhanhua Jia; Ning Ji; Shucai Deng; Zhiming Sun; Jing Zhou
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Publication Detail:
Type:  Journal Article     Date:  2006-10-31
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  16     ISSN:  0940-6719     ISO Abbreviation:  Eur Spine J     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-16     Completed Date:  2007-11-27     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1119-28     Citation Subset:  IM    
Spinal Surgery Department, Tianjin Hospital, No. 406 Jiefangnan Road, Hexi District, Tianjin City 300211, People's Republic of China.
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MeSH Terms
Decompression, Surgical / methods
Fluorides / adverse effects*
Laminectomy / methods
Ligamentum Flavum / pathology*,  surgery
Magnetic Resonance Imaging
Middle Aged
Ossification, Heterotopic / chemically induced*,  pathology,  surgery
Retrospective Studies
Spinal Stenosis / chemically induced*,  pathology,  surgery
Thoracic Vertebrae / pathology*,  surgery
Treatment Outcome
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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