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.


METHODS
We retrospectively reviewed the medical charts of six patients admitted to an orthopedics department for spinal cord compression shown upon computed tomography to be caused by calcification of the ligamentu flavum. There were five women and one man, mean age at admission was 71.7 years (range, 64-79 years) and all six patients were Black.


RESULTS
Five patients had cervical myelopathy and one was asymptomatic. All five symptomatic patients had cervical spinal stenosis, explaining the rapid symptom onset (within six and a half months) and severe motor loss. Computed tomography reconstruction in the sagittal plane ruled out ossification of the ligamentum flavum. Magnetic resonance imaging of the neck failed to demonstrate the calcifications but was useful in evaluating the severity of the spinal cord compression. One patient had articular 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 symptomatic patients who did not have surgery experienced worsening neurological loss. Analysis of the operative specimens from the two surgically treated patients showed a mixture of calcium pyrophosphate dihydrate crystals and apatite microcrystals.


CONCLUSIONS
Calcification of the ligamentum flavum is probably underrecognized in blacks. This condition causes severe neurological loss. Imaging studies provide the diagnosis. The pathogenesis remains unclear.
Cabre
P
P
Service de neurologie, h pital Pierre-Zobda-Quitmann, CHRU Fort de France, Martinique. Pcabre@outremer.com
Pascal-Moussellard
H
H
Kaidomar
S
S
Bucki
B
B
Bardin
T
T
Smadja
D
D
Arfi
S
S
D000368:Aged; D044383:Black People; D002114:Calcinosis / Q000208:ethnology* / Q000473:pathology*; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D017843:Ligamentum Flavum / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000208:ethnology / Q000473:pathology; D014900:West Indies