Thoracic ligamentum flavum ossification causing progressive myelopathy: a case report

Ossified ligamentum flavum (OLF) in the thoracic segments is a rare but significant cause of progressive myelopathy characterized by spinal canal stenosis. While OLF is commonly reported in East Asian populations, it remains under-recognized in other regions, including India.

We present a case of a 60-year-old Indian male laborer who developed progressive lower-limb weakness, sensory deficits, and immobility over several months. This case is notable for its occurrence in an Indian patient, within a population in which OLF remains significantly underreported, and for advanced neurological compromise (preoperative Medical Research Council [MRC] grade 2/5 bilaterally) and intraoperative dural ossification requiring complex surgical decision-making. Imaging revealed severe spinal cord compression at D10-D11 due to OLF, with associated dural calcification. Surgical decompression via laminectomy resulted in significant neurological improvement, with motor power improving to MRC grade 3/5 bilaterally and complete resolution of sensory deficits, highlighting the importance of timely intervention.

This case highlights the need for increased awareness of OLF in underrepresented populations and emphasizes the critical role of advanced imaging and surgical management in achieving favorable outcomes. The rarity of reported cases of OLF from India and the presence of concurrent dural calcification further distinguish this report and highlight a diagnostic gap that warrants attention.