Treatment of posttraumatic lumbar interspinous ligament calcification with partial resection of spinous processes and calcified interspinous ligaments: case report

Abstract

The authors report on the first surgical treatment for traumatic interspinous ligament calcification, with significant radiographic and symptomatic improvements at long-term follow-up. Heterotopic ossification occurs following traumatic injury but does not typically affect the interspinous ligaments. While these ligaments can calcify with age, this is rarely seen in patients younger than 50 years of age. The authors present the unusual case of a 31-year-old man who suffered traumatic fractures of thoracic and lumbar spinous processes. He developed progressive low-back pain that failed to respond to conservative treatments. At presentation, he was neurologically intact. CT scanning demonstrated partial calcification of the interspinous ligaments at L2–3, L3–4, and L4–5 with significant hypertrophy of the spinous processes at those levels. He did not have significant disc pathology, and his symptoms were attributed to the limited range of motion caused by the enlarged spinous processes. Partial resection of the spinous processes and calcified interspinous ligaments was performed to remove the heterotopic bone. The patient was seen in follow-up at 5 months postoperatively for imaging, and he was interviewed at 1 and 2 years postoperatively. He is doing well with significant pain relief and an improved range of motion. His Oswestry Disability Index improved from 25 preoperatively to 18 at 2 years postoperatively.