OPLL pp 49-58 | Cite as

Pathology of Ossification of the Ligamentum Flavum

  • Munehito Yoshida
  • Tetsuya Tamaki


Ossification of the ligamentum flavum (OLF) is a pathological condition that causes myelopathy, radiculopathy, or both [1,2]. The etiology of hypertrophy and ossification of the ligamentum flavum is unknown. OLF can be diagnosed by lateral radiographs as ossification of the spinal foramen. On comparing the narrowing of the spinal canal as seen by computed tomography (CT) and by magnetic resonance imaging (MRI), the CT scan provides information superior to that of MRI because it shows precisely the protruded ossification from the posterior to anterior aspect of the spinal canal [3-6].


Spinal Canal Thoracic Spine Ligamentum Flavum Diffuse Idiopathic Skeletal Hyperostosis Spinal Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anzai N (1938) Four cases with radiculomyelopathy due to hypertrophic changes of the ligamentum flavum (in Japanese). J Jpn Orthop Assoc 13: 305–316Google Scholar
  2. 2.
    Yamaguchi H, Tamagake S, Fujita S (1960) A case of the ossification of the ligamentum flavum with spinal cord tumor symptoms (in Japanese). Seikei Geka (Orthop Surg) 11:951–956Google Scholar
  3. 3.
    Hattori A, Endoh H, Suzuki K, Kaneda M (1976) Ossification of the thoracic ligamentum flavum with compression of the spinal cord-a report of six cases. J Jpn Orthop Assoc 50: 1141–1146Google Scholar
  4. 4.
    Yonenobu K, Ebara S, Fujiwara K, Yamashita K, Ono K, Yamamoto T, Harada N, Ogino H, Ojima S (1987) Thoracic myelopathy secondary to ossification of the spinal ligament. J Neurosurg 66: 511–518PubMedCrossRefGoogle Scholar
  5. 5.
    Okada K, Oka S, Tohge K, Ono K, Yonenobu K, Hosoya T (1991) Thoracic myelopathy caused by ossification of the ligamentum flavum: clinicopathologic study and surgical treatment. Spine 16: 280–287PubMedCrossRefGoogle Scholar
  6. 6.
    Yoshizawa H, Ohiwa T, Iwata H, Nakamora H (1988) High thoracic myelopathy due to ossification of the ligamentum flavum. Neuro-Orthopedics 5: 36–44Google Scholar
  7. 7.
    Polgar F (1929) Uber interarkuelle Wirbelverkalkung. Fortschr Geburtshilfe Roentgenol 40: 292–298Google Scholar
  8. 8.
    Oppenheimer A (1942) Calcification and ossification of vertebral ligaments (spondilitis ossificans ligamentosa): roentgen study of pathogenesis and clinical significance. Radiology 38: 160–173Google Scholar
  9. 9.
    Koizumi M (1962) Three cases of spinal cord paralysis proved by ligamenta flava ossification (in Japanese). Rinsho Geka (J Clin Surg) 17: 1181–1188Google Scholar
  10. 10.
    Yanagi T, Kato H, Shiozawa Z (1972) Ossification of ligamenta flava of the thoracic spine: association with radiculomyelopathy. Clin Neurol 12: 562–570Google Scholar
  11. 11.
    Nagashima C (1975) Myelopathy due to ossification of the posterior longitudinal and the yellow ligament (in Japanese). Saigai Igaku 18: 671–683Google Scholar
  12. 12.
    Kaneda K, Sato E, Higuchi M, Nohara H, Koguma T, Honma S, Mituzaki A, Fujitani H (1981) Thoracic spinal canal stenosis due to ossification of the spinal canal ligaments (in Japanese). Rinsho Seikeigeka (Clm Orthop Surg) 16: 53–74Google Scholar
  13. 13.
    Saiki K, Hattori S, Kawai S (1981) The ossification of the yellow ligament in the thoracic spine (in Japanese). Seikei Geka (Orthop Surg) 24: 191–198Google Scholar
  14. 14.
    Govoni AF (1971) Developmental stenosis of a thoracic vertebra resulting in narrowing of the spinal canal. AJR (Am J Roentgenol) 112: 401–404CrossRefGoogle Scholar
  15. 15.
    Barnett GH, Hardy RW Jr, Little JR, Bay JW, Sypert GW (1987) Thoracic spinal canal stenosis. J Neurosurg 66: 338–344CrossRefGoogle Scholar
  16. 16.
    Miyasaka K, Kaneda K, Ito T, Takei H, Sugimoto S, Tsuru M (1982) Ossification of spinal ligaments causing thoracic radiculomyelopathy. Radiology 143: 463–468Google Scholar
  17. 17.
    Omojola MF, Cardoso ER, Fox AJ, Fox AJ, Drake CG, Durward QJ (1982) Thoracic myelopathy secondary to ossified ligamentum flavum. J Neurosurg 56: 448–450PubMedCrossRefGoogle Scholar
  18. 18.
    Yamamoto I, Matsumae M, Ikeda A, Shibuya N, Sato O, Nakamura K (1988) Thoracic spinal stenosis: experience with seven cases. J Neurosurg 68: 37–40PubMedCrossRefGoogle Scholar
  19. 19.
    Williams DM, Gabrielsen TO, Latack JT (1982) Ossification in the caudal attachments of the ligamentum flavum. Radiology 45: 693–697Google Scholar
  20. 20.
    Otani K, Yoshida M, Fujii E, Nakai S, Shibasaki K (1988) Thoracic disc herniation: surgical treatment in 23 patients. Spine 13: 1262–1267PubMedCrossRefGoogle Scholar
  21. 21.
    Marzluff JM, Hungerford GD, Kempe LG, Rawe SE, Trevor R, Perot PL (1979) Thoracic myelopathy caused by osteophytes of the articular processes: thoracic spondylosis. J Neurosurg 50: 779–783PubMedCrossRefGoogle Scholar
  22. 22.
    Ungersbock K, Perneczky A, Korn A (1987) Thoracic vertebrostenosis combined with thoracic disc herniation: case report and review of the literature. Spine 12: 612–615PubMedCrossRefGoogle Scholar
  23. 23.
    Johnsson KE, Petersson H, Wollheim FA (1983) Diffuse idiopathic skeletal hyperostosis ( DISH) causing spinal stenosis and sudden paraplegia. J Rheumatol 10: 784–789PubMedGoogle Scholar
  24. 24.
    Smith DE, Godersky JC (1987) Thoracic spondylosis: an unusual cause of myelopathy. Neurosurgery (Baltimore) 20: 569–593Google Scholar
  25. 25.
    Machida H, Kurokawa T, Tanaka H, Kobayashi M, Nakamura K, Iizuka T, Hoshino Y, Tsuyama N (1981) The relationship between ossification of posterior longitudinal ligament and ossification of thoracic yellow ligament (in Japanese). Seikei Saigaigeka (Orthop Surg Trauma) 16: 185–189Google Scholar
  26. 26.
    Sakou T, Morizono Y, Yoshinaga K, Yone K, Wakimaru K (1985) Results of surgical treatment for the ossification of yellow ligament and posterior longitudinal ligament; thoracic and thoracolumbar spine (in Japanese). Seikei Geka (Orthop Surg) 36: 1367–1375Google Scholar
  27. 27.
    Ohtsuka K, Yanaguhara M (1987) Epidemiologic and statistical study on the ossification of the spinal ligament (in Japanese). Seikei Geka (Orthop Surg) 50: 12–15 (Ossification of the spinal ligament)Google Scholar
  28. 28.
    Sakou T, Tomimura K, Maehara T (1977) Pathophysiological study of the ossification of the ligamentum flavum (in Japanese). Rinsho Seikei Geka (Clin Orthop Surg) 12: 368–376Google Scholar
  29. 29.
    Yanai T, Naito A, Yashuda T, Hashizume, Y, Omori K (1985) CT scan and pathological study of the ossification of the ligamentum flavum (in Japanese). In: Investigation commitee on ossification of spinal ligament. Japanese Ministry of Public Health and Welfare, Tokyo, pp 126–134Google Scholar
  30. 30.
    Ono K, Okada K, Touge K, Yonenobu K (1980) Pathological study on the ossification of the ligamentum flavum (in Japanese). In: Investigation commitee on ossification of spinal ligament. Japanese Ministry of Public Health and Welfare, Tokyo, pp 131–139Google Scholar
  31. 31.
    Nakatani S, Kimura H, Kataoka O (1982) Investigation of the ossification of the spinal ligament: fourth report (in Japanese). In: Investigation comittee on ossification of spinal ligament. Japanese Ministry of Public Health and Welfare, Tokyo, pp 81–87Google Scholar
  32. 32.
    Hotta Y (1985) Anatomical study of the yellow ligament of the spine with special reference to its ossification. J Jpn Orthop Assoc 59: 311–325Google Scholar
  33. 33.
    Naffziger HC, Inman V, Saunders JBCM (1938) Lesions of the intervertebral disc and ligamenta Hava: clinical and anatomical studies. Surg Gynecol Obstet 66: 288–299Google Scholar
  34. 34.
    Hiraoka S (1955) The ossification of the ligamentum flavum of the spinal foramena (in Japanese). Geka no Ryoiki (Surg area) 3: 6–11Google Scholar
  35. 35.
    Yong-Hing K, Reilly J, Kirkaldy-Willis WH (1976) The ligamentum flavum. Spine 1: 226–234CrossRefGoogle Scholar
  36. 36.
    Yoshida M, Oura H, Shima K, Iwahashi T, Natsumi K, Oshima A (1990) Immunohistochemical study on the enthesis of the ligamentum flavum in the thoracic spine (in Japanese). Bessatsu Seikeigeka (Orthop Surg) 18: 75–80Google Scholar
  37. 37.
    Niepel GA, Sitdj S (1979) Enthesopathy. Clin Rheum Dis 5: 857–871Google Scholar
  38. 38.
    Resnick D, et al (1983) Entheses and enthesopathy. Radiology 146: 1–9PubMedGoogle Scholar
  39. 39.
    Ono K, Ota H, Tada K (1977) Ossified posterior longitudinal ligament: a clinicopathological study. Spine 2: 126–138Google Scholar
  40. 40.
    Yoshida M, Tamaki T, Iwahashi T, Natsumi K, Ohshima A (1989) Immunohistochemical localization of collagens of the ossified ligamentum flavum in the thoracic spine (in Japanese). Cent Jpn J Orthop Surg Traumatol 32: 124126Google Scholar
  41. 41.
    Yoshida M, Shima K, Taniguti Y, Tamaki T, Tanaka T (1992) Hypertrophied ligamentum flavum in lumbar spinal canal stenosis—pathogenesis and morphologic and immunohistochemical observation. Spine 17: 1353–1360Google Scholar
  42. 42.
    Miyamoto S, Yonenobu K, Fujiwara K, Ono K (1991) Pathologic study of ossification of the ligamentum flavum (in Japanese). Spine Spinal Cord 4: 523–526Google Scholar
  43. 43.
    Resnik D, Niwayama G (1976) Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperosteosis ( DISH ). Radiology 119: 559–566Google Scholar
  44. 44.
    Yamaoka K, Igata T, Yonezawa M (1982) Roentgenographic study of dynamic factor in the thoracic myelopathy with OYL. Cen Jpn J Orthop Surg Traumatol 25: 961–963Google Scholar
  45. 45.
    Kurakami C, Kaneda K, Abumi K, Hashimoto T, Shirato O, Takahashi H, Takeda N, Fujitani M (1988) Study on pathology of ossification of the ligamentum flavum of the thoracolumbar spine (in Japanese). Rinsho Seikeigeka (Clin Orthop Surg) 23:441–448Google Scholar
  46. 46.
    Yamazaki A, Homma T, Uchiyama S, Takahashi H (1995) Ossification of the ligamentum flavum and disc degeneration. In: Spinal disorders in growth and aging. Springer Tokyo, pp 249–253Google Scholar
  47. 47.
    Otani K, Aihara T, Tanaka A, Shibasaki K (1986) Ossification of the ligamentum flavum of the thoracic spine. Int Orthop 10: 135–139PubMedCrossRefGoogle Scholar
  48. 48.
    Stoltmann HF, Blackwood W (1964) The role of ligamenta flava in the pathogenesis of myelopathy in cervical spondylosis. Brain 86: 45–54CrossRefGoogle Scholar
  49. 49.
    Herzog W (1950) Zur Morphologie und Pathologie des Ligamentum Flavum. Frankf Z Pathol 61: 250–267Google Scholar
  50. 50.
    White AA (1978) The basic kinematics of the human spine. Spine 3: 12–20PubMedCrossRefGoogle Scholar
  51. 51.
    Kawaguti H, Takahide K, Matsumoto T (1993) Immunohistochemical demonstration of bone morphogenic protein-2 and transforming growth factor-(3 in the OPLL of the spine. Seikei Geka (Orthop Surg) 44: 1041–1047Google Scholar
  52. 52.
    Miyamoto S, Yonenobu K, Ono K (1993) Immunohistochemical demonstration of transforming growth factor-ß, fibronectin and alkaline phosphatase in the ossified spinal ligaments. Seikei Geka (Orthop Surg) 44: 1048–1055Google Scholar

Copyright information

© Springer Japan 1997

Authors and Affiliations

  • Munehito Yoshida
    • 1
  • Tetsuya Tamaki
    • 1
  1. 1.Department of Orthopaedic SurgeryWakayama Medical CollegeWakayama 640 Japan

Personalised recommendations