Six cases of cervical ligamentum flavum calcification in Blacks in the French West Indies

Objective. Calcification of the ligamentum flavum at the cervical spine is an uncommon condition reported mainly in Japanese patients. We describe the clinical manifestations, imaging study findings, and outcomes in six cases seen in the French West Indies. Material and methods. We retrospectively r eviewed the medical charts of six patients admitted to an orthopedics depar tment for spinal cord compression shown upon computed tomography to be caus ed by calcification of the ligamentum flavum. There were five women and one man, mean age at admission was 71.7 years (range, 64-79 years), and all si x patients were Black, Results. Five patients had cervical myelopathy and o ne was asymptomatic. All five symptomatic patients had cervical spinal sten osis, explaining the rapid symptom onset (within six and a half months) and severe motor loss. Computed tomography reconstruction in the sagittal plan e ruled out ossification of the ligamentum flavum. Magnetic resonance imagi ng of the neck failed to demonstrate the calcifications but was useful in e valuating the severity of the spinal cord compression. One patient had arti cular chondrocalcinosis in both knees and another had calcifications in the basal ganglia. Surgical decompression by the posterior route was performed in two patients and was effective in both, whereas two of the three sympto matic patients who did not have surgery experienced worsening neurological loss. Analysis of the operative specimens from the two surgically treated p atients showed a mixture of calcium pyrophosphate dihydrate crystals and ap atite microcrystals, Conclusion. Calcification of the ligamentum flavum is probably underrecognized in blacks. This condition causes severe neurologic al lass, Imaging studies provide the diagnosis. The pathogenesis remains un clear. Joint Bone Spine 2001 ; 68 : 158-65. (C) 2001 Editions scientjfiques et medicales Elsevier SAS.