Dorsal Myelopathy Due to Ossified Ligamentum Flavum: Institutional Experience of 47 Patients

Background: Thoracic myelopathy due to ossified ligamentum flavum (OLF) is a rare cause of spinal cord compression, accounting for less than 2% of spinal disorders. Patients typically present with progressive sensorimotor dysfunction and gait disturbances, with surgical decompression being the primary treatment. Objective: To present our institutional experience in the clinical profile, imaging, surgical management, and outcomes of dorsal OLF. Materials and Methods: We retrospectively analyzed 47 patients (36 males, 11 females; age 35–65 years) who underwent surgery for thoracic OLF between 2001 and 2023. Clinical presentation, radiological characteristics, surgical techniques, and postoperative outcomes were evaluated. Results: Sensory disturbances and gait impairment were the most common symptoms. The mean duration of symptoms was 19 months. Imaging showed continuous (50%), isolated (30%), and non-continuous (20%) OLF, most frequently at D10–11. Surgical procedures included laminectomy with or without facetectomy and fusion. At ≥3 months follow-up, most patients showed improved motor function and gait. Complications occurred in 8.5%, including CSF leak and transient neurological worsening. Conclusion: Thoracic OLF is an uncommon but important cause of myelopathy. Early recognition and timely surgical decompression are crucial for favorable outcomes, whereas delayed diagnosis, acute deterioration, and co-morbidities adversely affect prognosis.