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

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...

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Autores principales:	Omar F. Jbarah, Sultan Jarrar, Hassan M. Abushukair, Sebawe S. Syaj
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Revinter Publicações Ltda. 2021
Materias:	anterior cervical discectomy corpectomy ligamentum flavum cervical spondylotic myelopathy case report Medicine R Surgery RD1-811
Acceso en línea:	https://doaj.org/article/32e62829c05346edaba09611864465ae
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spelling	oai:doaj.org-article:32e62829c05346edaba09611864465ae2021-11-27T00:19:21ZBuckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report0103-53552359-592210.1055/s-0041-1739276https://doaj.org/article/32e62829c05346edaba09611864465ae2021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1739276https://doaj.org/toc/0103-5355https://doaj.org/toc/2359-5922Introduction 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.Omar F. JbarahSultan JarrarHassan M. AbushukairSebawe S. SyajThieme Revinter Publicações Ltda.articleanterior cervical discectomycorpectomyligamentum flavumcervical spondylotic myelopathycase reportMedicineRSurgeryRD1-811ENBrazilian Neurosurgery, Vol 40, Iss 04, Pp e399-e403 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anterior cervical discectomy corpectomy ligamentum flavum cervical spondylotic myelopathy case report Medicine R Surgery RD1-811
spellingShingle	anterior cervical discectomy corpectomy ligamentum flavum cervical spondylotic myelopathy case report Medicine R Surgery RD1-811 Omar F. Jbarah Sultan Jarrar Hassan M. Abushukair Sebawe S. Syaj Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report
description	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.
format	article
author	Omar F. Jbarah Sultan Jarrar Hassan M. Abushukair Sebawe S. Syaj
author_facet	Omar F. Jbarah Sultan Jarrar Hassan M. Abushukair Sebawe S. Syaj
author_sort	Omar F. Jbarah
title	Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report
title_short	Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report
title_full	Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report
title_fullStr	Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report
title_full_unstemmed	Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report
title_sort	buckling of the ligamentum flavum as a rare complication of anterior cervical corpectomy and fusion: a case report
publisher	Thieme Revinter Publicações Ltda.
publishDate	2021
url	https://doaj.org/article/32e62829c05346edaba09611864465ae
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Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

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