Compressive myelopathy due to ossified yellow ligament among South Asians: analysis of surgical outcome.

BACKGROUND

Ossified yellow ligament (OYL) is a rare, disabling cause of extradural compressive radiculomyelopathy, responding poorly to surgical intervention.

METHODS

From January 1999 to December 2008, 16 patients (male/female, 11/5; mean age, 45.7 years; median, 44.5 years) harbouring symptomatic OYL were managed at our center. Radiological investigations including computerised tomography and magnetic resonance imaging scans were performed before undertaking surgical intervention. High-speed drills and operating microscope were put to use in excising these pathological ligaments.

RESULTS

At median follow-up of 16.5 months, all patients had improved to better clinical status. The spasticity was the most resistant to recovery, while motor power improved in 13 cases. Intra-operatively, dural ossification was noted in 50% of the cases, requiring repair or prophylactic cerebrospinal fluid drainage.

CONCLUSIONS

The surgical technique of drilling and yellow ligament excision needs precision. Patients with poor neurological status may also benefit from surgical decompression and should be offered the option of surgery.