Case reports: a rare cause of radicular complaints: ligamentum flavum hematoma

Ligamentum flavum hematoma in the lumbar spine mimicking spinal tumor: A case report and review of the literature

Liagmentum flavum hematoma (LFH) is a rare cause of radiculopathy and low back pain, sharing similar symptomatology with disc herniation. It predominantly affects the lumbar thoracic spine. The underlying mechanism of LFH remains unclear; however, surgical removal of the hematoma has consistently demonstrated excellent outcomes. The objective of this case report is to emphasize the significance of diagnosing LFH. We present a surgically confirmed lumbar LFH case that mimicked a lumbar tumor, highlighting the challenges encountered during diagnosis and subsequent management.

Ligamentum flavum hematoma following a traffic accident: A case report

BACKGROUND

Ligamentum flavum hematoma (LFH) can cause compression of the spinal cord or nerve root, which results in neurological symptoms. We report a case of lumbar radicular pain due to LFH following a traffic accident.

CASE SUMMARY

A 59-year-old man complained of left buttock and lateral thigh pain that was dull in nature after a traffic accident 18 d prior to presentation. Magnetic resonance imaging (MRI), taken 17 d after the traffic accident, revealed a mass lesion at the L4-5 Level. These MRI findings suggested subacute LFH. The patient's pain was not alleviated with conservative treatment, including oral medication and epidural steroid injection. After a partial-hemilaminectomy and removal of LFH, the patient's pain completely disappeared.

CONCLUSION

Because early operation for decompression is important for a good outcome, clinicians should be able to determine LFH from MRI results and be aware of the possibility of LFH, especially in patients with a history of trauma.

A Succession of MRI Scans Supports the Diagnosis of Lumbar Ligamentum Flavum Hematoma: A Case Report and Review of the Literature

Ligamentum flavum hematoma (LFH) is a rare cause of spinal nerve compression. This condition remains challenging to diagnose using MRI due to the changing intensity of the hematoma on imaging. The aim of this study was to describe the patient with LFH who had a succession of MRI scans carried out. We report on a 71-year-old woman with a mass at L4/5 and decompression surgery was performed for her left leg symptom. She had MRI carried out in a previous hospital and also had MRI again in our hospital. In a 2^nd MRI of the same area, after a 2-week interval, a newly isointense mass was present within the anterior part of the previously identified lesion on T1-weighted image and the hyperintense area in the lesion was a little extended on T2-weighted imaging. Her symptoms were resolved immediately after decompression surgery. Following a review of previous cases, we suggest that consecutive MRI scanning may support the diagnostic process for LFH.

Ligamentum flavum hematomas: Why does it mostly occur in old Asian males? Interesting point of reported cases: Review and case report

Hematoma of the ligamentum flavum (LF) is a rare cause of neural compression and sciatica. Currently, the etiology and epidemiological characteristics of ligamentum flavum hematoma (LFH) are unknown and epidemiological investigations using rewieving of reported cases have not been performed. We report the case of a 63-year-old man with a LFH compressing the spinal canal at the left L2-L3 level, rewieved relevant literature. In Medline research, wefound a total of 50 reported cases with LFHs, and the interesting point of these cases were analyzed. Many of cases were old males. Interestingly, 39 of the 50 cases were reported from Asian countries. The ages of 42 patients could be verified. The youngest age was 45 years, oldest age was 81 years, and mean age was 66.07 years. Thirty-three out of these 42 patients (78.53%) were older than 60 years. An important aspect of the present review is to bring attention for occurrence in older Asian males. With an increasing number of elderly people in the general population, there is a need to investigate risk factors such as sexual gender, age, and geographic location for LFH.

The Mechanism of Ligamentum Flavum Hypertrophy: Introducing Angiogenesis as a Critical Link That Couples Mechanical Stress and Hypertrophy

BACKGROUND

Biochemical alterations associated with mechanical stress have been explored as an initiating step in the pathological progression of ligamentum flavum hypertrophy (LFH); however, this mechanism remains poorly understood. Recently, the inflammation induced after mechanical stress and the subsequent response of ligamentum flavum (LF) cells have been implicated in LFH pathology.

OBJECTIVE

To investigate the hypothesis that angiogenesis may be a critical link between hypertrophy and a series of stimulating events, including mechanical stress.

METHODS

LF from 20 lumbar spinal canal stenosis (LSCS) patients and 16 non-LSCS patients (control group) were collected during surgery. Patient demographic and radiographic data were obtained. The levels of angiogenic factors (vascular endothelial growth factor [VEGF], angiopoietin-1, vascular cell adhesion molecule, and basic fibroblast growth factor) in the LF were investigated by using an enzyme-linked immunosorbent assay. Angiogenesis was also quantified by immunohistochemical detection of CD34-positive capillaries. The correlations among clinical factors, including radiographic factors, angiogenic factors, and angiogenesis, were statistically analyzed.

RESULTS

The LSCS group was older and exhibited a longer symptom duration, wider segmental motion, and thicker LF than the control group. The LSCS group showed significantly higher tissue concentrations of VEGF (P < .001) that positively correlated with LF thickness (r = 0.557, P < .001) and segmental motion (r = 0.586, P < .001). The LSCS group showed significantly more CD34-positive capillaries than the control group (P = .004).

CONCLUSION

The LSCS group showed greater segmental motion, higher VEGF concentrations, and more CD34-positive capillaries than the control group. These data indicate that VEGF-mediated angiogenesis following mechanical stress may be a critical step within the series of pathological events in LFH.

Ligamentum flavum hematomas of the cervical and thoracic spine

OBJECTIVE

To report extremely rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Only six cases of thoracic ligamentum flavum hematomas and three cases of cervical ligamentum flavum hematomas have been reported so far.

METHODS

Two patients presented with tetraparesis and one patient presented with radicular pain and paresthesias in the T3 dermatome. MRI was performed in two patients, which showed a posterior intraspinal mass, continuous with the ligamentum flavum. The mass was moderately hypointense on T2-weighted images and hyperintense on T1-weighted images with no contrast enhancement. The third patient underwent cervical myelography because of a cardiac pacemaker. The myelography showed an intraspinal posterior mass with compression of the dural sac at C3/C4.

RESULTS

All patients underwent a hemilaminectomy to resect the ligamentum flavum hematoma and recovered completely afterwords, and did not experience a recurrence during follow-up of at least 2 years.

CONCLUSION

This case series shows rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Surgery achieved complete recovery of the preoperative symptoms in all patients within days.

Ligamentum flavum hematoma: a case report and literature review

The aim is to present a rare case of ligamentum flavum hematoma in the lumbar region, discuss its physiopathology and treatment and review the literature. A woman aged 68 presented with neurogenic claudication due to degenerative lumbar spondylolisthesis that evolved into a sudden worsening with cauda equina syndrome. The magnetic resonance imagining (MRI) showed signs of degeneration of the lumbar spine, with a narrow spinal canal from L2 to S1, anterolisthesis L4 L5 and an expansive lesion hyperintense on T1-weighted and hypointense on T2-weighted images considered compatible with hematoma in the topography of the yellow ligament in L1-L2. The patient underwent laminectomy and lumbar fixation. Her evolution was good in the postoperative period and at 18 months of follow-up hse walked alone, despite the pain that is controlled with simple medications. Even though rare, it seems that ligamentum flavum hematoma has a relationship with the degeneration and rupture of small vessels associated with micro trauma to the spine. Its physiopathology is not well defined and treatment is similar to other spine compression processes.

Lumbar ligamentum flavum hematoma treated with endoscopy

Hematoma of the ligamentum flavum is a rare cause of neural compression, for which treatment has consisted of excising the hematoma via open surgical approaches, including total laminectomy or bilateral partial laminectomy. This article presents the first report of a microscope-assisted endoscopic decompression to resect a hematoma of the ligamentum flavum.A 52-year-old man presented with back and leg pain, as well as difficulty initiating micturation. Magnetic resonance imaging demonstrated an epidural mass at L5/S1 that was continuous with the facet joint. Visualization was obtained via an endoscope, and a reddish tan-brown solid mass was found beneath the ligamentum flavum. Thorough decompression of the cauda equine and nerve roots was undertaken. The patient's radicular leg pain and bladder function improved soon after the decompression. Histological examination of the ligamentum flavum revealed a consolidated hematoma with granulomatous change.A review of the English literature revealed 29 cases of hematoma in the lumbar ligamentum flavum. Surgical decompression in these patients was accomplished with a standard open approach through hemilaminectomy (n=11), total laminectomy (n=10), or laminectomy followed by posterior fixation (n=3). The literature review did not identify any case of hematoma of the lumbar ligamentum flavum that was treated endoscopically. We expect our case may expand the indications for the endoscope in spine surgery.

Spinal cord compression by ligamentum flavum hematoma in the thoracic spine

STUDY DESIGN

Case report.

OBJECTIVE

To report an extremely rare case of hematoma derived from the ligamentum flavum within the thoracic spine.

SUMMARY OF BACKGROUND DATA

Only one previous case has been reported of a hematoma derived from the ligamentum flavum in the thoracic spine. METHODS.: A 61-year-old man presented with gait disturbance and numbness below the navel. Magnetic resonance imaging on the 16th day after the onset of the symptoms showed spinal cord compression at the T10-T11 level caused by a round mass. This intraspinal, extradural space occupying lesion, continuous with ligamentum flavum was centrally hypointense and marginal hyperintense on a T1-weighted image and central heterogeneous and marginal hypointense on a T2-weighted image. The wall of the lesion was slightly enhanced after use of a contrast medium.

RESULTS

The patient underwent a T10 laminectomy and the mass was carefully resected from the dura mater. Histologic examination showed that the wall of the mass comprised fibrous connective tissue that contained elastic fibers derived from a degenerative ligamentum flavum tear. It also revealed that evidence of previous hemorrhagic events within the mass. There was no evidence of neoplastic nor synovial tissue. After surgery, the patient's numbness and gait disturbance disappeared.

CONCLUSION

This report identifies an extremely rare case of spinal cord compression by a hematoma from the ligamentum flavum within the thoracic spine.

Facet cyst haematoma in the lumbar spine: a report of four cases

We present 4 cases of facet cyst haematoma in the ligamentum flavum of the lumbar spine. All patients presented with a one-to-3-month history of back pain or numbness in the legs, and sudden neurological deterioration. One also developed cauda equina syndrome and another developed radiculopathy. In all cases, magnetic resonance imaging showed a mass with high signal intensity on both T1- and T2-weighted images. Facet arthrography and computed tomography revealed communication between the mass and the neighbouring facet joint. The haematomas were removed en bloc with the ligamentum flavum. They were surrounded by the ligament and contained degenerated and lacerated elastic fibres but no synovial lining cells. Facet cyst haematoma is so-named because of bleeding from tissue adjacent to the facet joint into a pre-existing facet cyst.

Thoracic disk herniation with hematoma--case report

A 54-year-old man presented with an extremely rare case of intervertebral disk herniation with hematoma in the thoracic spine, manifesting as acute progressive numbness and muscle weakness in the bilateral lower extremities. He had been treated with anticoagulants. Magnetic resonance imaging of the thoracic spine showed intervertebral disk herniation and severe compression of the spinal cord at T9-10, appearing as hyperintense on T(1)- and hypointense on T(2)-weighted imaging suggestive of concomitant hematoma. His symptoms completely resolved after resection of the brownish herniated disk material. Old hemorrhage was also aspirated from the intervertebral disk space. Hemosiderin deposition was found in the cartilaginous tissue of the resected disk. Intervertebral disk herniation with hematoma is extremely rare, but may occur in patients with bleeding diathesis.

Spontaneous ligamentum flavum hematoma in the rigid thoracic spine : a case report and review of the literature

Ligamentum flavum hematoma is a rare condition. Twenty cases including present case have been reported in English-language literature. Among them, only one case reported in pure thoracic spine. A 72-year-old man presented with thoracic myelopathy without precedent cause. Magnetic resonance images revealed a posterior semicircular mass which was located in T7 and T8 level compressing the spinal cord dorsally. T7-8 total laminectomy and extirpation of the mass was performed. One month later following surgery, the patient fully recovered to normal state. Pathologic result was confirmed as ligamentum flavum hematoma. Ligamentum flavum hematoma of rigid thoracic spine is a very rare disease entity. Most reported cases were confined to mobile cervical and lumbar spine. Surgeons should be aware that there seems to be another different pathogenesis other than previously reported cases of mobile cervical and lumbar spine.

Foot drop of sudden onset caused by acute hematoma in the lumbar ligamentum flavum: a case report and review of the literature

STUDY DESIGN

A case report.

OBJECTIVE

To describe an unusual case of acute hematoma in the lumbar ligamentum flavum causing foot drop.

SUMMARY OF BACKGROUND DATA

There have been several reports of hematoma in the lumbar ligamentum flavum causing compression of the cauda equina and/or nerve root. However, the majority of these cases were chronic hematomas, based on clinical history and histologic findings.

METHODS

A 64-year-old man presented with right foot drop of sudden onset and severe sciatica. Magnetic resonance imaging (MRI) on the 10th day after the onset of symptoms revealed spinal stenosis at L4/5 caused by a posterior mass that was isointense on T1-weighted images and hyperintense on T2-weighted images, but was hyperintense on T1-weighted images and hypointense on T2-weighted images 5 days later. Because of these neurologic findings, surgical exploration and excision of the intraspinal mass were performed on the 18th day after onset.

RESULTS

Surgical treatment was uneventful, and the severe sciatica improved immediately after surgical treatment. Histologic examination revealed recent extravasation of blood in the degenerated ligamentum flavum. These findings were supported by the 2 consecutive preoperative MRI examinations. At 1 year after surgery, manual muscle testing of the tibialis anterior on the affected side had recovered to grade 4.

CONCLUSION

Consecutive MRI examinations performed 5 days apart in the early stage after the onset of symptoms clearly demonstrated intensity change, indicating acute hematoma of ligamentum flavum as a cause of foot drop of sudden onset.