title: Minimally Invasive Surgical Management of Thoracic Ossification of the Ligamentum Flavum Associated with X-linked Hypophosphatemia.
abstract: BACKGROUND
  X-linked hypophosphatemia (XLH) is the most common inherited form of renal phosphate wasting and inherited rickets. Patients have hyperplasia of fibrochondrocytes in tendons and ligaments, causing the structures to thicken and calcify. Thickening of the lamina, hypertrophy of facet joints, and calcification of spinal ligaments are sequelae of this condition and can result in central or foraminal stenosis that compresses nerve roots or the spinal cord. We present a case of XLH with calcification of the ligamentum flavum in which the patient was operated on using minimally invasive posterior decompression.
  
  
  METHODS
  A 49-year-old man with a history of XLH presented to our emergency department with symptomatic myelopathy from multilevel thoracic stenosis. Radiographically, the calcified ligamentum flavum appeared to be the cause of the stenosis at various levels. The patient underwent a posterior decompression at the levels of compression, T4-T5, T8-T9, T9-T10, and T11-T12, via a minimally invasive spine surgery approach. Intraoperatively, the ligamentum flavum appeared to be both calcified and the source of spinal compression. Postoperatively, the patient experienced neurologic and radiographic improvement.
  
  
  CONCLUSIONS
  Patients with a history of XLH and multilevel symptomatic spine stenosis can be treated successfully and safely with a minimally invasive posterior decompression.
authors.affiliation: Department of Neurosurgery, Albany Medical College, Albany, New York, USA. Electronic address: germanj@mail.amc.edu.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Riccio
authors.affiliation: Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
authors.forename: Pouya
authors.initials: P
authors.lastname: Entezami
authors.affiliation: Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, New York, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Giuffrida
authors.affiliation: Department of Medicine, Division of Endocrinology, Albany Medical College, Albany, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Dowling
authors.affiliation: Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, New York, USA.
authors.forename: George
authors.initials: G
authors.lastname: Forrest
authors.affiliation: Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: German
mesh_terms: D002114:Calcinosis / Q000150:complications / Q000235:genetics / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D053098:Familial Hypophosphatemic Rickets / Q000150:complications / Q000235:genetics / Q000601:surgery*; D005260:Female; D040181:Genetic Diseases, X-Linked / Q000150:complications / Q000235:genetics / Q000601:surgery; D006801:Humans; D017843:Ligamentum Flavum / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications / Q000235:genetics / Q000601:surgery*; D013118:Spinal Cord Diseases; D013130:Spinal Stenosis / Q000209:etiology / Q000235:genetics / Q000601:surgery*; D016896:Treatment Outcome
keywords: Decompression; Minimally invasive; Myelopathy; Spine; X-linked hypophosphatemia