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Thoracic Myelopathy due to Extensive Calcification of the Posterior Longitudinal Ligament and Ligamentum Flavum Secondary to Hypophosphatemic Rickets 2014

Category General Spine Ann T. Packard
Carrie Carr
Felix E. Diehn
Patrick Luetmer, MD
Purpose A 29 year old man with a history of hypophosphatemic rickets diagnosed between the ages of 18 months and 3 years presented in early 2012 with increased back pain which had been present for 5 years. Symptoms then progressed rapidly, and by the end of 2012, patient had sustained a fall. This resulted in the development of leg numbness, weakness and urinary incontinence. He also described sensory loss below the level of the umbilicus and balance issues. During this time he began having to use a cane and, at the time of presentation, a wheeled walker. The patient was no longer on therapy for rickets and his phosphate level was low. Given the clinical presentation, a thoracic myelopathy was likely. The patient underwent CT and MRI of the spine revealing severe multilevel spinal canal stenosis in both the cervical and thoracic spine secondary to extensive calcification of the posterior longitudinal ligament and ligamentum flavum. This is a rare case of multilevel spinal stenosis and spinal cord compression in a patient with hypophosphatemic rickets secondary to extensive calcification of the posterior longitudinal ligament and ligamentum flavum. The pathophysiology of this condition as well as imaging findings of spinal involvement secondary to hypophosphatemic rickets will be reviewed. Materials & Methods N/A Results N/A Conclusion This case highlights the unique spinal imaging findings in a patient with untreated hypophosphatemic rickets. References 1. Kawaguchi A, Miyamoto K, Hosoe H, et al. Surgical treatment of multiple spinal canal stenoses associated with vitamin D- resistant rickets. Journal of Clinical Neuroscience: Case Reports. 2009. 16: 717-719. 2. Saito T, Shimizu Y, Hori M, et al. A patient with hypophosphatemic rickets and ossification of the posterior longitudinal ligament caused by a novel homozygous mutation in ENPP1 gene. Bone. 2011. 49: 913-916. 3. Burnstein M, Lawson J, Kottamasu SR. et al. The enthesopathic changes of hypophosphatemic osteomalacia in adults: radiologic findings. American Journal of Roentgenology. 1989. 153: 785-790.