Symptomatic Tuberculous Ligamentum Flavum Cyst Treated by Full Endoscopic Resection: Review with Technical Notes

Endoscopic treatment of lumbar ligamentum flavum cyst by interlaminar approach: a minimally invasive and effective alternative to open surgery

BACKGROUND AND OBJECTIVES

Lumbar ligamentum flavum cyst is a rare spinal condition that can cause significant morbidity and neurological deficits. Traditional surgical treatment involves open surgery, which can be associated with prolonged recovery time and significant morbidity. In recent years, endoscopic treatment of lumbar ligamentum flavum cyst has emerged as a minimally invasive and effective alternative to open surgery, but only a few cases have been reported in the literature. This paper describes our experience with endoscopic resection of an L4/5 ligamentum flavum cyst through an interlaminar approach and reviews the literature on the treatment of lumbar ligamentum flavum cyst.

METHODS

An 87-year-old man presented with lameness in the left leg, and magnetic resonance imaging (MRI) showed nerve compression by a ligamentum flavum cyst at the L4/5 intervertebral plane. The patient underwent endoscopic resection of the ligamentum flavum cyst through a left interlaminar approach with the facet joint preserved. The present study was approved by the Ethics Committee of our hospital. The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Text regarding patient consent is not applicable for this case.

RESULTS

Postoperative clinical results improved significantly, and postoperative MRI showed complete cyst resection.

CONCLUSION

Total endoscopic resection via an interlaminar approach provides a new minimally invasive approach for the surgical treatment of lumbar ligamentum flavum cyst, which can be used as a reference by clinicians.

Ligamentum Flavum Cyst With Acute Onset Motor Deficit: A Literature Review and Case Series

BACKGROUND

Ligamentum flavum cysts have been rarely described in the literature and are one of the rare causes of neural compression and canal stenosis. Very few cases of their association with neurologic deficits are reported to date, and association with acute onset weakness is even rarer.

CLINICAL PRESENTATION

We report our experience with 3 cases of ligamentum flavum cyst that presented with acute onset weakness and also present a comprehensive literature review on lumbar ligamentum flavum cysts reported to date. All 3 patients had symptoms of severe neurogenic claudication and presented to us with acute onset of motor weakness in lower limbs. Ligamentum flavum cyst was located in the midline in 2 cases and laterally in 1 case. We performed excision of the cyst and decompression with fusion in 2 cases and decompression alone in 1 case. All 3 cases had significant improvement in their neurologic status postoperatively. Histopathological examination confirmed ligamentum flavum cyst in all 3 cases. We performed a PUBMED and EMBASE database search using the MeSH (Medical Subject Headings) terms "ligamentum flavum" and "cysts" for articles published to April 2019. We could identify 7 studies describing 20 cases of lumbar ligamentum flavum cysts with motor weakness in the literature. Only 1 case had been described with an acute onset of weakness.

CONCLUSIONS

Ligamentum flavum cysts should remain in the differential diagnosis of a patient who has symptoms of lumbar canal stenosis and presents with acute onset of neurological deficits. Such patients have a good improvement with surgery.