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THORACIC MYELOPATHY SECONDARY TO OSSIFICATION OF THE LIGAMENTUM FLAVUM

THORACIC MYELOPATHY SECONDARY TO OSSIFICATION OF THE LIGAMENTUM FLAVUM. E.GAMY- J.MAHLAOUI-M.MAHI-S.AKJOUJ-S.CHAOUIR –T.AMIL-A.HANINE Medical Imaging Military Hospital Mohammed V Instruction Rabat. CH3. INTRODUCTION.

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THORACIC MYELOPATHY SECONDARY TO OSSIFICATION OF THE LIGAMENTUM FLAVUM

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  1. THORACIC MYELOPATHY SECONDARY TO OSSIFICATION OF THE LIGAMENTUM FLAVUM E.GAMY- J.MAHLAOUI-M.MAHI-S.AKJOUJ-S.CHAOUIR –T.AMIL-A.HANINE Medical Imaging Military Hospital Mohammed V Instruction Rabat. CH3

  2. INTRODUCTION • The flavum ligamentum ossification (The OLJ) is a rare cause of thoracic myelopathy. • Achieve extended over several thoracic segments remain outstanding •   The purpose of this study is to evaluate the CT and MRI respective roles in the diagnosis and monitoring of the condition ossifying yellow ligament.

  3. Materials and Methods • We report a study of 3 patients (1 man and 2 women), • Mean age = 42 years, • All the patients were admitted for lower limb pain and spastic paraparesis. • We performed a computed tomography (CT) and MRI to establish the diagnosis.

  4. Results • CT images were sufficient to establish the diagnosis (axial acquisitions, and both two and three dimensional recontructions were done). • Cuts from next disks prominently feature a bony posterior bilateral intraductal shaped <V>. • MRI with multiplanar acquisitions: • Demonstrate that the OLJ is in low signal in T1 and T2 sequences and it locate at the upper thoracic spine. • Specifies the lesional topography, and the severity of both dural sac and spinal cord compression • In one case, MRI shows a medullar high signal in T2 SE near to D3-D4 and D4-D5

  5. CT of thoracic spine in axial sections:hyperdense posterior intraductal process shaped <V> next to T9

  6. Sagittal CT reconstruction: exuberant posterior intraductal ossified process.

  7. MRI in thoracic sagittal T2 SP; process projecting intraductal posterior hypointense without sign of suffering spinal cord

  8. DISCUSSION • The OLJ is a condition described in the aboveJapanese literature. • Secondary to a deposit of calcium pyrophosphate crystals • Located especially in the low segment of thoracic spine • Etiology and physiopathology are still controversial.

  9. DISCUSSION • Two clinical presentations are to oppose: • The symptomatic OLJ, • The asymptomatic one. • It depends of the OLJ mainly volume and thickness . • Different radiographic aspects were described.

  10. DISCUSSION • The most common image is the projection in the upper part of the foramen. • Beak appearance; • linear picture, • Nodular or triangular pattern, • The ossification volume is the principal cause of pain,

  11. DISCUSSION • The CT scan is sufficient in OLJ diagnosis. • MRI shows the lesional topography and severity of the compression • The treatment is surgical: Decompressive laminectomy is based on a greater or lesser extent with or without aforaminotomy. • The prognosis depends on the lesion and it extend in order to provide an early diagnosis and treatment.

  12. Conclusion • The OLJ is a rare cause of thoracic myelopathy. • CT with sagittal reconstructions allows a positive diagnosis. • The MRI is useful for finding a precise the exact topography of the lesion spinal cord and

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