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Ossification of the ligamentum flavum demonstrated by Tc-99m MDP SPECT imaging of the thoracic spine.

A 72-year-old white woman with untreated locally advanced carcinoma of the right breast was examined for bilateral leg weakness and dysasthesia below the waist. Positive findings on physical examination were 4–5 power of hip flexion, reduced sensation to light touch and pinprick below the T11 dermatome level, and absent patellar tendon reflexes. No spinal cord compression was evident on a magnetic resonance scan. A bone scan showed increased tracer uptake bilaterally in the spine at the T9 vertebral level. SPECT images revealed increased uptake localized to the lateral neural arch at T9-T10. A computed tomographic scan of this site showed ossification of the ligamentum flavum with indentation of the thecal sac. In the absence of spinal cord compression, the final diagnosis was paraneoplastic paraparesis.