Thoracic Ossification of the Ligamentum Flavum With Isolated Radiculopathy in a Teenage Baseball Pitcher: Possibly the Youngest Surgically Treated Case

TL;DR

A 19-year-old baseball pitcher had successful surgery for a rare spinal condition that caused severe pain and affected his performance.

Contribution

This is the youngest reported case of surgically treated thoracic ossification of the ligamentum flavum in a young athlete.

Findings

Surgical resection resolved symptoms and restored athletic performance in a teenage pitcher.

Thoracic OLF should be considered in the differential diagnosis for unilateral thoracic pain in young throwing athletes.

Conservative treatment failed to alleviate persistent pain in this case.

Abstract

Ossification of the ligamentum flavum (OLF) typically occurs in individuals aged >50 years, especially in East Asian men, and commonly presents with myelopathy. Cases in adolescents, especially athletes, are exceedingly rare. We report a case of thoracic OLF in a 19-year-old right-handed collegiate baseball pitcher who presented with isolated radiculopathy. The patient experienced sharp left dorsal pain (numerical rating scale 6-8/10) during the late cocking phase of pitching, which involves thoracic extension, rotation, and slight left lateral flexion. Despite one year of conservative treatment, including physical therapy and adjustments to pitching mechanics, his symptoms persisted, ultimately leading to a performance breakdown often referred to as the "yips". He subsequently underwent surgical resection of the ossified ligament at the T8-T9 level, resulting in rapid symptom resolution and a full return to competitive sports. To our knowledge, the current case represents the youngest patient with surgically treated thoracic OLF to date. This case underscores the importance of considering thoracic OLF in the differential diagnosis of unilateral thoracic pain in young throwing athletes and illustrates the role of surgery when pain impairs athletic function.

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