The thoracic ligamentum flava connect adjacent thoracic laminae, forming the posterior spinal canal wall at each level. They are thicker and less elastic than cervical flavum, and are the primary site of thoracic ossification (OLF — ossification of the ligamentum flavum).
Restrain excessive thoracic flexion, maintain posterior canal dimensions, and assist recoil of the thoracic spine after flexion loading.
Thoracic ossification of the ligamentum flavum (OLF) is more common in East Asian populations and the lower thoracic spine, producing progressive myelopathy from posterior cord compression. Bilateral OLF at multiple levels can produce a "pincer" compression pattern combined with anterior spondylosis. Laminectomy with flavectomy or posterior instrumented fusion addresses OLF myelopathy.
Flavum ossification at multiple thoracic levels producing progressive spastic paraparesis, treated by thoracic laminectomy with flavectomy and stabilisation.
The characteristic distribution of thoracic OLF in Japanese and Korean patients at T9-T11 levels, producing conus medullaris syndrome with lower extremity and bladder dysfunction.
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