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Case Reports in Surgery
Volume 2016, Article ID 2318759, 5 pages
Case Report

Iatrogenic Spinal Cord Injury during Removal of the Inferior Articular Process in the Presence of Ossification of the Ligamentum Flavum

1Department of Neurosurgery, Tufts Medical Center, Boston, MA 02111, USA
2Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA

Received 18 June 2015; Accepted 16 November 2015

Academic Editor: Christoph Schmitz

Copyright © 2016 Shane M. Burke et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Ossified ligamentum flavum (OLF) is a condition of heterotopic lamellar bone formation within the yellow ligament. Some patients with OLF can be asymptomatic. However, asymptomatic OLF may not be obvious on preoperative MRI and could increase the risk of iatrogenic injury during treatments for unrelated spinal conditions. This report describes a case of spinal cord injury caused by the indirect transmission of force from an osteotome to an asymptomatic OLF during the resection of a thoracic inferior articular process (IAP). To prevent this outcome, we urge careful review of CT imaging in the preoperative setting and advocate the use of a high-speed drill instead of an osteotome during bone removal in the setting of an adjacent area of OLF.