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Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum (TOLF) Using Ultrasonic and Conventional Osteotomes
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A case study of unusual benign osseous lesion of the L5 lamina
Matthew B Sonagere1, Andrew J Haig2, Rakish Patel3
1College of Osteopathic Medicine, University of New England, Biddeford, ME, USA.
Background:
The differential diagnosis of benign-appearing posterior element lesions is complex.
Objective:
To explore the etiology of an unusual benign lesion found on the lamina of L5 described in a case report.
Methods:
Case report. The patient's medical, surgical and imaging histories as well as medical literature were reviewed.
Results:
A 35-year old male complained of low back pain radiating to both legs for 5 months. Abdominal CT scan 1 year prior as well as post symptom-onset CT and MRI showed a well-corticated lesion lateral to the spinous process of L5. After failed rehabilitation and injection, operation revealed normal cortical bone. Pain was not markedly relieved post-operatively.
Conclusion:
The pre-surgical differential diagnosis of this lesion included osteosarcoma and osteoid osteoma, however benign pathological results suggest the possibility of atypical spina bifida occulta, Baastrup changes, atypical sacralization of L5, or a resolved fracture with heterotopic ossification.
