Ultrastructural study of calcification process in the ligamentum flavum of the cervical spine

The ultrastructure of the formation of calcified nodules in three cases of symptomatic calcification of the cervical ligamentum flavum were studied. In some areas of the ligament, extracellular plasma membrane-invested matrix vesicles and thick wall-bound matrix giant bodies with or without mineralized deposits were present. These calcified vesicles and bodies were also encountered in the wide mineralized areas among the collagen and elastic fibers in the ligament. The mineralization process of the calcified nodules in the ligamentum flavum implies that matrix vesicles and matrix giant bodies acquire mineralized precipitates; then some gather in clusters. Calcified deposits may spread to collagen and elastic fibers contiguous with the calcified vesicles and bodies, and some eventually coalesce to make a calcified nodule.