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Background and Importance: Acute spinal cord injury without an apparent spinal fracture/ dislocation in an asymptomatic subject with silent thoracic ossification of the ligamentum flavum (TOLF) is extremely rare with only seven fully documented examples of this specific scenario in the literature. Case Presentation: A previously healthy middle-aged woman with a documented magnetic resonance imaging (MRI) history of silent TOLF presented severe lower extremity weakness immediately after a minor fall. Repeat MRI revealed the appearance of myelopathy at the silent T10-T11 ossification of the ligamentum flavum (OLF) site. Laminectomy and excision of the OLF result in complete recovery within 6 months. Conclusion: We believe that our asymptomatic patient should have undergone prophylactic surgical intervention before this catastrophic event. In a survey of medical literature, we found that the presented case is the first example of a documented MRI of TOLF in its silence period. [ABSTRACT FROM AUTHOR]

Background and Importance: The development of C5 root palsy is a well-known potential complication of cervical spine surgeries for the correction of cervical spondylotic myelopathy. It typically occurs unilaterally, but on extremely rare occasions, bilaterally. The value of intraoperative neurophysiologic monitoring in detecting iatrogenic acute versus delayed onset C5 palsy, the rarity of bilateral C5 palsy, and its optimal management require further discussion. Case Presantation: A 49-year-old woman with quadriparesis due to cervical spondylotic myelopathy is presented. She underwent circumferential 360° cervical spine surgery. This operation was subsequently complicated by a delayed bilateral C5 palsy, despite normal transcranial Motor Evoked Potentials (MEPs). With the utilization of conservative treatment, the complete resolution of this complication took roughly eight months. Conclusion: Bilateral C5 palsy is an infrequent consequence of multilevel cervical spine surgeries. Although intraoperative monitoring of transcranial electrical stimulation-induced MEPs has high sensitivity and specificity in foreseeing the acute-onset C5 palsy, it cannot predict delayed-onset palsy. Including the current case, only seven cases have been reported in the medical literature. Overall, conservative management in adherence to rigorous physical therapy may be an acceptable treatment. [ABSTRACT FROM AUTHOR]

Background: Ossification of the ligamentum flavum (OLF) occurs mostly in adult males, typically in the thoracolumbar spine where it may contribute to neurological deficits. Here we reviewed 68 cases of cervical OLF resulting in progressive quadriparesis. Methods: The literature on cervical OLF was reviewed between 1962 and 2018 along with the case of an 81-year-old male with progressive quadriparesis attributed to cervical OLF. Results: Most patients with cervical OLF are Asian, with Caucasians constituting the second most frequently impacted population. Conclusions: Cervical OLF is typically reported in the Asian, followed by the Caucasian population, and is most often found in the thoracolumbar spine. Here we presented an 81-year-old male with cervical OLF contributing to quadriparesis. [ABSTRACT FROM AUTHOR]