Medical Analysis Report

I. Imaging Findings

From the provided CT images, a high-density lesion can be noted in the posterior aspect of the thoracic spinal canal near the lamina, appearing round or “V”-shaped protrusion and located behind the lamina. This high-density lesion is closely related to the adjacent lamina, causing a local narrowing of the spinal canal that may exert some degree of pressure on the spinal cord. Multi-planar reconstruction shows that this high-density area protrudes from the ligament position into the spinal canal, suggesting ligament calcification or ossification.

The patient’s symptoms mainly include lower limb weakness, instability, and sensory abnormalities, consistent with the degree of spinal cord compression observed on imaging. Overall, CT clearly demonstrates the extent and shape of the bone (or ligament) ossification/calcification and the resulting impact on the spinal cord, providing crucial information for further treatment decisions.

II. Potential Diagnoses

1. Ossification of the Ligamentum Flavum (OLF)
   Rationale:
   • On CT, the posterior ligament area often shows an irregular high-density lesion consistent with ossification (or calcification).
   • Clinically common in middle-aged or older patients, it can lead to thoracic spinal canal stenosis causing spinal cord compression.
   • Matches the patient’s symptoms (bilateral lower limb weakness, sensory deficit, ataxia, etc.).
2. Ossification of the Posterior Longitudinal Ligament (OPLL)
   Rationale:
   • Similar in tissue structure to OLF but located closer to the posterior edge of the vertebral body, protruding into the spinal canal.
   • Patients can also present with similar spinal cord compression symptoms, but in this case, the radiologic findings appear more posterior, so OPLL is relatively less likely.
3. Other compressive lesions in the spinal canal (e.g., epidural tumor or epidural hematoma, excessive proliferation of the lamina or facet joint capsule, etc.)
   Rationale:
   • Epidural tumors typically show local bone destruction or a soft tissue mass, not restricted to the ligament area.
   • An epidural hematoma usually presents acutely, with a clear history of trauma or surgery.
   • The current findings lean more towards localized ligament ossification, making other lesions less likely.

III. Final Diagnosis

Considering the patient’s age, four weeks of progressive bilateral lower limb weakness and sensory impairment, and CT findings showing a distinct high-density ossified ligament in the posterior canal, the most likely diagnosis is Ossification of the Thoracic Ligamentum Flavum (OLF).

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy Overview

• Conservative Treatment:
  If symptoms are mild, short-term use of anti-inflammatory analgesics or neuroprotective agents can be considered, supplemented by physical therapy (such as heat application or acupuncture) to relieve pain and muscle spasms. However, when significant gait difficulty and spinal cord compression symptoms are present, conservative treatment alone often fails to provide relief.
• Surgical Treatment:
  In cases of marked spinal cord compression accompanied by progressive neurological deterioration, surgical decompression is the mainstay. Common procedures include laminectomy or laminoplasty to remove the ossified ligamentum flavum, alleviating the pressure on the spinal cord. Postoperative outcomes can partially improve symptoms, but due to the long-standing condition, there may be limitations in the degree of neurological recovery, necessitating a thorough assessment.

2. Rehabilitation/Exercise Prescription Recommendations (FITT-VP Principle)

During the acute phase or early postoperative period, avoid strenuous activities to prevent further spinal cord compression or injury. As symptoms ease and under the guidance of a physician or rehabilitation therapist, gradual progression of training is advised:

• Frequency (F): It is recommended to perform rehabilitation exercises 3-5 times per week, adjusting based on individual tolerance.
• Intensity (I): Begin with low-intensity activities (such as slow walks on level ground or seated stretching exercises), then gradually increase intensity by monitoring heart rate and fatigue levels.
• Time (T): Start with 10-15 minutes per session and gradually extend to about 30 minutes. This can be divided into intervals, for example, 5-10 minutes each time, for 2-3 sets.
• Type (T):
  • Range of motion exercises: Passive or active lower limb stretching exercises to improve limb flexibility.
  • Muscle strength training: During the postoperative or remission phase, perform low-resistance exercises to strengthen lower limb muscles (e.g., using resistance bands or wall-sit exercises).
  • Balance and coordination training: Tools such as a balance board, or seated/assisted standing training can help patients maintain correct posture for standing and balance.
• Progression (P): As symptoms improve and fitness increases, gradually increase the difficulty and load of training, for instance by increasing resistance band tension or extending walking distance. If new pain or neurological symptoms appear, evaluation should be done promptly, and progression should be paused.

Because the patient is older and already exhibits spinal cord compression, it is crucial to protect lower limb muscle strength and balance ability during exercise. Movements should be performed slowly and in a controlled manner, avoiding sudden loading or excessive twisting.

Disclaimer

This report is based on the available imaging data and clinical background. The content provided is for reference only and cannot replace an in-person consultation or the actual diagnosis and treatment advice of a professional physician. It is recommended that patients, in combination with their own circumstances, develop and implement treatment and rehabilitation plans under the guidance of a specialist or rehabilitation therapist.