PARAPLEGIA DUE TO OSSIFICATION OF LIGAMENTA-FLAVA IN X-LINKED HYPOPHOSPHATEMIA - A CASE-REPORT

Study Design, Spinal canal decompression at the most prominent of mult iple posterior calcified thoracic lesions in a case of X-linked hypoph osphatemia was undertaken for treatment and diagnosis purposes, as wel l as to assess possible nature of the pathophysiology underlying the p resenting deficits. Objectives. To discuss the clinical assessment dia gnostic and treatment aspects of this rare coincidence of ossification of ligamenta flava in the patient with the skeletal deformities of X- linked hypophosphatemia. Summary of Background Data. The patient with the stigmata and chemical findings of an X-linked hypophosphatemia pre sented with paraplegia and multiple calcified posterior spinal thoraci c lesions. This was studied with magnetic resonance imaging and electr ophysiologic studies of the spinal sensory pathways of the legs. These data constituted the preoperative information required to assess late r results of surgical intervention. Methods. Presurgical clinical, ima ging, and electrophysiologic studies and laboratory and pathologic inv estigations of the surgical specimens. Results. Resolution of the para plegia with walking and return to work in a physically demanding job f or the last 4 or 5 years of postoperative follow-up after surgical dec ompression of the spinal cord, only at the worst and highest of the ef fected spinal levels. Conclusion. The coincidence of X-linked hypophos phatemia and ossification of ligamenta flava has been reported only in two or three cases in the literature. Removal of the offending ossify ing lesion is known to result in resolution of the clinical deficits, but similar lesions at other spinal levels are suspected of producing recurrences. The return of function and of the corresponding electroph ysiologic correlates indicate a neurono-apractic nature of the neurolo gic symptoms.