Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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September 23, 2013
Spinal Cord Compression Secondary to Ossification of Ligamentum Flavum and Epidural Lipomatosis
- Ligamentum Flavum Ossification:
- Occurs mainly in Japanese and North African populations, with a predilection for the lower thoracic spine
- Often an incidental finding, but may result in myelopathy
- There is no association between ossification of ligamentum flavum and epidural lipomatosis.
- Epidural lipomatosis can be seen in obese patients, patients on steroids or anti-HIV medications, and in Cushing's syndrome.
- Key Diagnostic Features: Ossification of ligamentum flavum (usually bilateral)—better seen on CT. Myelopathy if present—better seen on MRI as increased signal on T2WI. Epidural lipomatosis: increased epidural fat.
- DDx: Meningioma, hypertrophied facet joints
- Rx: Conservative if asymptomatic; surgical decompression if symptomatic
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