Anterior cervical corpectomy and fusion : Spinal cord compression caused by buckled ligamentum flavum

Anterior cervical corpectomy and fusion (ACCF) is a commonly performed surgical procedure for cervical spondylotic myelopathy (CSM). Various complications associated with ACCF have been reported; however, spinal cord compression caused by buckling of the ligamentum flavum (LF) after ACCF has not yet been well recognized. This article describes the case of a 59-year-old man who underwent ACCF at C5 for treatment of CSM. Although numbness and weakness of the upper extremities were relieved 2 weeks after the operation, gait imbalance persisted and worsened at 7 months. Magnetic resonance imaging (MRI) performed at 12 months revealed buckling of the LF into the spinal canal at the C5/6 level, compressing the spinal cord; moreover, high signal intensity in the spinal cord was observed beneath the buckling area on T2-weighted images. The secondary laminoplasty at C5 and C6 was performed 13 months after primary surgery and MRI showed that the spinal canal was widened at the C5 and C6 levels and the spinal cord was decompressed.