Isolated ligamentum flavum ossification in primary hypoparathyroidism

Area of Science:

• Neurology
• Endocrinology
• Orthopedic Surgery

Background:

• Ligamentum flavum ossification (LFO) can cause spinal myelopathy.
• LFO associated with hypoparathyroidism is rare, with few reported cases, often with concurrent spinal ligament ossification.
• This study presents a unique case of LFO causing cervical and thoracic myelopathy solely secondary to hypoparathyroidism.

Observation:

• A 43-year-old male presented with acute neurological deficits including backache, urinary retention, and lower limb weakness.
• MRI revealed ossification of the ligamentum flavum in both cervical and thoracic spine, causing severe spinal stenosis.
• The patient experienced a full recovery after spinal decompressive surgery.

Findings:

• Primary hypoparathyroidism was identified as the underlying cause of the extensive ligamentum flavum ossification.
• The patient's symptoms and imaging findings were directly attributable to LFO-induced spinal cord compression.
• Surgical decompression provided complete neurological recovery, confirming the diagnosis and treatment efficacy.

Implications:

• Hypoparathyroidism should be considered in the differential diagnosis for patients with myelopathy and ligamentum flavum ossification.
• Early diagnosis and management of hypoparathyroidism may prevent or reverse spinal cord compression.
• This case expands the understanding of rare endocrine-related causes of spinal pathology and myelopathy.