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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(04): e399-e403
DOI: 10.1055/s-0041-1739276
Case Report | Relato de Caso

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Flambagem do ligamento amarelo como uma rara complicação da corpectomia cervical anterior e fusão: um relato de caso
Omar F. Jbarah 
1   Division of Neurosurgery, Department of Neuroscience, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Sultan Jarrar 
1   Division of Neurosurgery, Department of Neuroscience, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Hassan M. Abushukair 
2   Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Sebawe S. Syaj 
2   Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
› Author Affiliations Funding The authors received no funding.
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Abstract

Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion.

Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5-C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed.

Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk.

Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, which may be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

Resumo

Introdução e importância Deterioração neurológica devido à flambagem do ligamento amarelo (LA) é uma complicação incomum após corpectomia cervical anterior ou discectomia com fusão.

Apresentação do caso Neste relato, apresentamos o caso de um homem de 66 anos que foi submetido a corpectomia cervical anterior parcial de C5 e discectomia de C5 prolapso C6 com fusão. Após a cirurgia, o paciente apresentou sinais de deterioração neurológica. Após a ressonância magnética cervical imediata, estenose do canal posterior e compressão severa com sinal de corda devido a flambagem LF foram detectadas. Um procedimento de aminectomia posterior e descompressão do canal no nível C5-C6 com fusão óssea foram realizados.

Discussão clínica O paciente apresentou dificuldade de locomoção e, em seguida, deficiência para locomoção, seguida de parestesia bilateral dos membros superiores e inferiores com sensação de queimação. O exame mostrou ⅘ de força muscular em ambas as empunhaduras. Investigação aprofundada mostrou reflexos tendinosos profundos e vivos, sinal de Hoffman positivo unilateralmente, ambíguo sinal de Babinski e quadriparesia progressiva. A ressonância magnética mostrou construção leve e difusa de alguns discos cervicais, com progressão da medula espinhal. Nós realizamos uma corpectomia cervical anterior e fusão e discectomia cervical anterior e fusão; uma malha de titânio com placas e parafusos foi usada para fusão, com remoção de disco subligamentar calcificado e herniado. No pós-operatório, resistência dos membros superiores e inferiores se mostrou deteriorada; ressonância magnética cervical e torácica imediata mostrou flambagem de LF, que causou estenose do canal e compressão severa. Urgente laminectomia posterior e descompressão do canal com fusão óssea foram agendadas em o mesmo dia. O paciente foi submetido a fisioterapia e recuperou força dos membros superiores e inferiores e sua capacidade de andar.

Keywords

anterior cervical discectomy - corpectomy - ligamentum flavum - cervical spondylotic myelopathy - case report

Palavras-chave

discectomia cervical anterior - corpectomia - ligamento amarelo - mielopatia espondilótica cervical - relato de caso

Patient Consent

The patient signed a consent form after being informed of all the details.


Authors Contribution

O. J.: designed the study, collected data, critically revised the draft, and read and approved the final manuscript.


S. J.: managed the literature searches and completed the final draft, besides reading and approving the final manuscript.


H. A.: managed the literature searches and data collection and wrote the first draft of the manuscript, besides reading and approving the final manuscript.


S. S.: managed the literature searches, wrote the first draft of the manuscript, read, and approved the final manuscript.




Publication History

Received: 16 July 2021

Accepted: 30 July 2021

Article published online:
26 November 2021

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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