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Unusual CT/MR features of putative ligamentum flavum ossification in a North African woman

Departments of ¹Neurosurgery and ²Radiology, Saint-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium

View larger version (115K): [in a new window]   Figure 1. Spiral CT work-up. (a) Mid-sagittal reformatted image at the T9–T10 level showing intracanalar protrusion of two supernumerary bone outgrowths originating from the posterior elements. Observe cortical/spongy differentiation of the abnormal "bones", and pseudoarthritic changes at their interface, with focal cortical thickening and "degenerative" geode filled with air at the caudal aspect of the "pseudoarthrosis" (arrow). (b) Axial transverse reformatted image through the T9 level showing perfect cortical/spongy differentiation of abnormal ossicles together with calcifications of the ligamenta flava from which they are originating. (c) Axial transverse reformatted image through the T10 level showing pseudoarthritic thickening of the inferior border of the "pseudoarthosis", and the same air-filled geode as in Figure 1a (arrow). (d) Frontal reformatted image, well disclosing the pseudoarthritic interface between the two supernumerary ossicles. Their origin from posterior elements is obvious.

View larger version (84K): [in a new window]   Figure 2. MR work-up. (a) Mid-sagittal T2 weighted image showing spinal cord compression at the T9–T10 level, with abnormal hyperintensity within cord parenchyma. (b) Mid-sagittal T1 weighted image showing hypointensity on the margins of the "pseudoarthrosis" due to reactive hyperostosis (arrowheads), and fatty bone marrow within central areas of the protruded ossicles (arrows). Normal epidural fat is present up and below the level of the intracanalar abnormalities (double ball-arrowheads). Compare similar slice location on CT image (Figure 1a).