Ossifiye Ligamentum Flavuma Sekonder Gelişen Siringomiyeli: Tek Taraflı Yaklaşımla İki Taraflı Dekompresyon Uygulanan Bir Olgu Sunumu

Abstract

Siringomiyeli en sık Chiari malformasyonu, tümörler, travma veya araknoidit ile ilişkilidir; ancak ligamentum flavum ossifikasyonuna ikincil olarak ortaya çıkması son derece nadirdir. Elli bir yaşındaki kadın hasta uzun süredir devam eden sırt ağrısı, sağ bacak ağrısı, kas spazmları ve uylukta uyuşma şikayetleriyle başvurdu. Nörolojik muayenede T10 dermatomunda ağrı ve ısı duyusunda azalma ile alt ekstremitelerde hafif spastisite saptandı. Manyetik rezonans görüntülemede T10–T11 seviyesinde bilateral OLF’ye bağlı spinal kanal darlığı ve 73 mm uzunluğunda kraniokaudal uzanım gösteren siringomiyeli görüldü. Bilgisayarlı tomografi, Sato sınıflamasına göre füzyon tipi ligamentum flavum ossifikasyonunu ve anteroposterior kanal çapında %49,3 oranında daralmayı doğruladı. Hastaya T9–T10 ve T10–T11 seviyelerinde unilateral yaklaşımla bilateral dekompresyon uygulandı. Ameliyat sonrası klinik bulgular belirgin şekilde düzeldi ve kontrol görüntülemelerinde siringomiyelinin gerilediği ve kanal boyutlarının normale döndüğü gözlendi. Bu olgu, torakal ligamentum flavum ossifikasyonunun nadiren de olsa siringomiyeliye yol açabileceğini göstermektedir. Erken cerrahi dekompresyon, özellikle unilateral yaklaşımla bilateral dekompresyon, hem semptomatik iyileşme hem de siringomiyelide radyolojik gerileme sağlayabilir.

Keywords

• Ossifiye ligamentum flavum
• Siringomiyeli
• Tek taraflı yaklaşım ve iki taraflı dekompresyon
• Torasik miyelopati

Syringomyelia Secondary to Ossified Ligamentum Flavum Treated with Unilateral Approach and Bilateral Decompression: A Case Report

Abstract

Syringomyelia is most commonly associated with Chiari malformation, tumors, trauma, or arachnoiditis; however, its occurrence secondary to ossification of the ligamentum flavum is extremely rare. A 51 year old woman presented with long-standing back pain, right leg pain, muscle spasms, and numbness in the thigh. Neurological examination revealed decreased pain and temperature sensation in the T10 dermatome and mild spasticity in the lower extremities. Magnetic resonance imaging demonstrated bilateral OLF at the T10–T11 level causing spinal canal stenosis and associated syringomyelia extending 73 mm longitudinally. Computed tomography confirmed fused type ossification of the ligamentum flavum according to the Sato classification, with a 49.3% reduction in anteroposterior canal diameter. The patient underwent a unilateral approach with bilateral decompression at T9–T10 and T10–T11. Postoperatively, clinical symptoms improved markedly, and follow-up imaging demonstrated regression of the syrinx and restoration of canal dimensions. This case highlights that thoracic ossification of the ligamentum flavum can rarely cause syringomyelia. Early surgical decompression, particularly unilateral approach with bilateral decompression, may result in both symptomatic improvement and radiological regression of the syrinx.

Keywords

• Bilateral decompression
• Ossified ligamentum flavum
• Syringomyelia
• Thoracic myelopathy
• Unilateral approach

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