Acute quadriparesis caused by calcification of the entire cervical ligamentum flavum in a white female--report of an unusual case and a brief review of the literature: case report.
METHODS
Case report.


OBJECTIVE
To describe an extremely unusual case of acute quadriparesis in a white female caused by calcification of the ligamentum flavum (LF) from C1 to T2, and to review briefly the pertinent literature.


BACKGROUND
Diseases characterized by abnormal calcium deposition on the spinal ligaments have an unclear etiology. The overwhelming majority of these cases has been reported in people of Asian descent and has a predilection for the thoracic spine. Multilevel involvement of the cervical LF in white patients is exceptionally rare. To our knowledge, complete calcification of the entire cervical LF has not been previously reported in the literature.


METHODS
The history, physical examination, and radiographic studies of a 64-year-old white female with a history of scleroderma are described. The patient presented with neck pain and acute quadriparesis caused by spinal cord impingement by calcified cervical LF from C1 to T2. The patient underwent emergent C3-C7 laminectomy and C2-C7 posterior spinal fusion.


RESULTS
Operative intervention resulted in marked neurologic improvement and relief from neck pain. Histopathologic examination of the calcified LF showed that the deposits consisted of hydroxyapatite crystals exclusively with no heterotopic bone. However, kyphosis did develop in the patient after laminectomy.


CONCLUSIONS
To our knowledge, this unusual case of complete calcification of the entire cervical LF has not previously been described. Multilevel laminectomy and fusion can improve neurologic function but may result in kyphosis.
Khan
Mustafa H
MH
Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Smith
Patrick N
PN
Donaldson
William F
WF
D000208:Acute Disease; D002114:Calcinosis / Q000150:complications*; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D017843:Ligamentum Flavum / Q000473:pathology*; D008875:Middle Aged; D011782:Quadriplegia / Q000209:etiology*; D013116:Spinal Cord / Q000473:pathology