will also be available for a limited time. This condition is quite common for people who have chronic back pain. 8600 Rockville Pike Epub 2009 Jun 28. They're important for limiting the motion. All the patients, after detailed history, clinical examination and radiological investigation under went decompressive laminectomy at the appropriate level. Abstract Background: Hypertrophy of the ligamentum flavum is a pathological condition that causes neurological symptom (radiculopathy and / or myelopathy) and usually occurs in the thoracic,2 less frequently in the cervical spine that commonly involves thoracic spine. This special kind of joint is found in all areas of spine: cervical (neck), thoracic (upper back) and lumbar (low back). Common MR findings of reported cases are posterior extradural location, one ligamentum flavum involvement, mainly hyperintensities on T1-weighted images which suggested subacute stage hematoma, continuity between base of hematoma and ligamentum flavum and mixed-stage or multi-stage hematoma signal intensities9). Hypertrophy can cause spinal stenosis . Albanese A, Braconi A, Anile C, Mannino S, Sabatino G, Mangiola A. Spontaneous haematoma of ligamentum flavum. Cord compression secondary to cervical disc herniation associated with calcification of the ligamentum flavum : case report. A post-traumatic ligamentum flavum progressive hematoma : a case report. OLF occurred the most frequently in the lower thoracic segments (T9-12)1,2,17,21). Address for reprints: Dong Kyu Chin, M.D., Ph.D. Department of Neurosurgery, Gangnam Severance Hospital, The Spinal and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea. Also, the patient had no recent history of blunt trauma to his abdomen or back. National Library of Medicine Minamide A, Yoshida M, Tamaki T, Natsumi K. Ligamentum flavum hematoma in the lumbar spine. These nerves are associated with the facet joints, and if there is pain relief after a MBB then the source of pain can be pinpointed as the facet joints in the injected area. Hypertrophy of the ligamentum flavum (LF) has also been considered as a major cause of Lumbar spinal canal stenosis. Medicine Journal of Korean Orthopaedic Research Society Ligamentum flavum (LF) is yellowish ligament tissue connecting the lamina of adjacent vertebra. This fact could be identified from the reported pathologic results. Before This can explain the insidious onset and progressive clinical worsening of symptoms in the patients of LFH1). The https:// ensures that you are connecting to the Cruz-Conde R, Berjano P, Buitron Z. Ligamentum flavum hematoma presenting as progressive root compression in the lumbar spine. It's a sheet of strong fibrous tissue that extends from the spinous process of the first thoracic vertebra, to the external occipital protuberance. Hirakawa K, Hanakita J, Suwa H, Matsuoka N, Oda M, Muro H, et al. Minimal and repeated spinal trauma could induce a partial tear in a degenerated ligament and favor intraligamentary hemorrhage. These changes results in a narrowing of the spinal canal. Calcium crystal deposition in the ligamentum flavum of the lumbar spine. Guo JJ, Yang HL, Cheung KM, Tang TS, Luk KD. Four weeks after surgery, the patient had no neurologic abnormalities. Posterior wall - ligamentum flavum & superior part of lamina By means of fibrinolytic/hemolytic changes, the hemorrhage would increase significantly in volume inside the ligamentum flavum, causing neural compression. and transmitted securely. The severity of thoracic OLF was classified into four grades (0-3) according to the degree of spinal canal compression identified on the whole spine sagittal T2-weighted images and based on the criteria of Han et al.9), which were modified and adopted for this purpose (Fig. Hypertrophy, calcification, ossification and infolding happen more frequently than hemorrhage because ligamentum flavum lack of blood vessels. The association of thoracic OLF with both thoracic OPLL and HTD has also been reported in the literature19,33,35). The sample included 2134 Korean patients who underwent MRI evaluation for back pain. Mayfield FH, Rogers JB: Hypertrophy of the ligamenta flava as a cause of low back pain . According to his case, thoracic hyperlordosis secondary to type 3 lumbar degenerative kyphosis might be contributed to thoracic LFH. [ 11 ] Furthermore, Xiong et al.34) reported a good correlation between CT and MRI findings regarding the level, side, and general degree of severity of central spinal canal stenosis by thoracic OLF. Fukuyama S, Nakamura T, Ikeda T, Takagi K. The effect of mechanical stress on hypertrophy of the lumbar ligamentum flavum. Lateral wall - medial facet joints & intervertebral foramina. Previous hyperkyphosis and mechanical stress are thought to be predisposing conditions. At this level pathological changes in the disk and facets and hypertrophy of the ligamentum flavum cause the greatest amount of narrowing. MRI scan: Using magnetic fields and radiofrequency waves, magnetic resonance imaging (MRI) provides a detailed image of the spine that reveals discs, nerves, skin, and other structures that arent visible using an X-ray. official website and that any information you provide is encrypted Hematoma of the ligamentum flavum in the lumbar spine : case report. We believe that the higher prevalence in women in the present study may have resulted from the greater enrollment of women than men and a different patient population from those in previous studies. Postacchini F, Gumina S, Cinotti G, Perugia D, DeMartino C. Ligamenta flava in lumbar disc herniation and spinal stenosis. Appearance of the ligamentum flavum hematoma. T2-weighted MRI revealed round low signal intensity rim and high signal intensity in the center. We report a rare case of thoracic myelopathy caused by OLF. the convention on the rights of the child; yarp direct forwarding; primary key not found entity framework core ligamentum flavum hypertrophy is a degenerative condition of the spine which most commonly occurs in the elderly where the tendons holding one vertebra to another thicken, decreasing the amount of room available for the spinal cord and the nerves that come off it. government site. The incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy. Symptomatic hematoma of cervical ligamentum flavum : case report. 2017 Nov;45:83-88. doi: 10.1016/j.jocn.2017.07.008. Additionally, we examined the presence of coexisting lumbar and cervical diseases. 2003 Sep;99(2 Suppl):157-61. doi: 10.3171/spi.2003.99.2.0157. There was no evidence of neoplasm or infection. Of the 93 patients with HLD and thoracic OLF, 41 (44.1%) patients had HCD, whereas 45 (48.4%) had no cervical disease. The authors wish to emphasize the following aspects : (1) the patients were relatively older age (average age : 62.9, range : 30-83) and the almost all patients except three cases were more than 60 years old, (2) male patients had more higher incidence rate (male : female=14 : 7) (3) the most frequently involved spinal segment was lumbar area(cervical : 2, rigid thoracic : 2, mobile thoraco-lumbar : 2, lumbar : 14), (4) the onset of symptom was insidious and clinical course was progressively worsened, (5) the most patients experienced minor repeated trivial back injury during daily living lives or sports activities before admission, and (6) all the patients underwent surgery and clinical outcomes and their prognoses were very good following surgery. Cartilage covers the bone surfaces on these vertebral joints which protects the bone from friction and distributes the pressure evenly along the bone. The joining of facets from two adjacent vertebra stabilizes and assists limited movement of the spinal bones. Symptoms of lumbar stenosis are attributed to direct mechanical compression or indirect vascular insufficiency of the spinal cord, cauda equina, or spinal nerve roots. The procedure is also called a minimally-invasive laminectomy. A CT reveals more details than an X-ray and can show any damage to nerve systems or the spinal cord. Representative case of thoracic OLF was shown in Fig. Hypertrophy of the ligamentum flavum (HLF), which may or may not have accompanying ossification (OLF), can cause SS by compressing the spinal cord, cauda equina, and nerve roots . will also be available for a limited time. Lateral recess . Kuh SU, Kim YS, Cho YE, Jin BH, Kim KS, Yoon YS, et al. Magnetic resonance images (MRI) revealed an intraspinal, extradural space-occupying lesion at T7-8 disc space level. Disorder of ligament, vertebrae. To browse Academia.edu and the wider internet faster and more securely, please take a few seconds toupgrade your browser. Disclaimer, National Library of Medicine The pathology of LF hypertrophy includes fibrocartilaginous changes due to proliferation of type II collagen, ossification, calcium crystal deposition, degeneration of collagen and elastic fibers, and chondroid metaplasia of ligament fibroblasts5,6,27). An official website of the United States government. Facet joint disease may affect people differently. Because ligamentum flavum is poorly vascularized and only a few small vessels pass through it, intraligamentous bleeding is very rare phenomenon17). The prevalence was higher in men than in women at T3-4 (p<0.003) and higher in women than in men at T11-12 (p<0.014). : operation, lami : laminectomy, ACDF : anterior cervical discectomy and fusion, C : cervical, T : thoracic, L : lumbar. Dr. Jayshree Chander answered Holistic Medicine 32 years experience Definition: Ligamentum flavum hypertrophy means enlargement of the tough band of tissue that connects two bones of the spine. SPSS version 18.0 (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Preoperative duration of symptoms significantly correlates with recovery and overall improvement in preoperative neurological status was seen in 9 patients, indicating that the disease is common in 5th and 6th decade. Of the 258 patients with lumbar stenosis and thoracic OLF, 97 (37.6%) patients also had herniated cervical discs (HCD), 104 (40.3%) patients had cervical stenosis, 5 (5.4%) patients had cervical ossification diseases, and 1 (1.1%) patient had an Arnold-Chiari malformation. Therefore, LFH may occur in any places from cervical to sacral vertebral column. Thus, blood from inferior vena cava may be shifted into the vertebral plexus when increased intra-abdominal pressure by physical activity, straining or trauma. To the best of our knowledge, this is the second case of LFH which occurred in pure rigid thoracic spine. Hypertrophy of the ligamentum flavum is a pathological condition that causes neurological symptom (radiculopathy and / or myelopathy) and usually occurs in the thoracic,2 less frequently in the cervical spine that commonly involves thoracic spine. Thoracic ossification of the ligamentum flavum (OLF) is a relatively rare disease. It may be associated with inflammation (arthritis) or As shown in the T1-weighted MRI, this lesion was suggestive of hemorrhage. Medial branch blocks is a short term pain relief injection at the medial branch nerve of your spine. These results support the existing evidence that mechanical stress and hypermobility of the spine results in hypertrophy and ossification of the LF subsequent to LF degeneration, disc degeneration, and herniation. Spuck S, Stellmacher F, Wiesmann M, Kranz R. Case reports: a rare cause of radicular complaints : ligamentum flavum hematoma. Patients who presented with thoracic myelopathy due to ossified ligamentum flavum were included. Signs and Symptoms Axial Pain Moreover, whole spine MRI made it easier to diagnose OLF in the early stages22). An official website of the United States government. The As a result, the investigation of OLF using CT is more precise, leading to a higher prevalence. Received 2015 Apr 5; Revised 2015 Jun 7; Accepted 2015 Jun 11. Our objectives are a faster recovery for you, less pain, and minimal downtime. An midline skin incision was done and total laminectomy of T7 was performed with use of high-speed drill to avoid additional cord injury. 2018 Jul;27(Suppl 3):359-367. doi: 10.1007/s00586-017-5281-6. Magnetic resonance images demonstrating a semicircular extradural mass lesion of the posterior part at T7-8 level with spinal cord compression and central hyperintense signal on the both T1 and T2 weighted images (A : T2 sagittal, B : T1 sagittal, C : T2 axial, D : T1 axial). Ligamentum flavum, Hematoma, Thoracic spine, Myelopathy. Hematoxylin and eosin stain, original magnification, A 100. sharing sensitive information, make sure youre on a federal Consequently, as the ligamentum flavum becomes hypertrophic, it will result in thoracic and lumbar canal narrowing. Facet hypertrophy is when these vertebral joints are widened. The surgical therapy recommended is a total laminectomy with wide resection of the ligamentum flavum and complete disk removal when indicated. Hypertrophy of the ligamentum flavum is a pathological condition that causes neurological symptom (radiculopathy and / or myelopathy) and usually occurs in the thoracic,2 less frequently in the cervical spine that commonly involves thoracic spine. Therefore, LFH may occur in any places from cervical to sacral vertebral column. The .gov means its official. and transmitted securely. Pearson correlation analysis showed a positive, significant correlation between age and the prevalence of thoracic OLF (rs=0.795, p=0.01), Except "Age 90-99" (rs=0.981, p<0.001). Ligamentum flavum hypertrophy (HLF) is the most important component of lumbar spinal canal stenosis (LSCS). Second, more than half of the patients had precipitating factors. Hypertrophy of ligamentum flavum is the inflammation, scarring, and eventual thickening of the ligamentum flavum. Contrast-enhanced MR images were not able to be obtained. Furusawa N, Baba H, Maezawa Y, Uchida K, Wada M, Imura S, et al. Please call to schedule your appointment: A feeling of pain and difficulty when arching the back, Numbness and pain in the buttocks or down the leg, Pain that increases in intensity with activity, A traumatic injury (that occurs as the result of an accident in a car, sports, or fall). This study was conducted to analyse the clinical presentation and outcome of surgery of ossified ligamentum flavum at thoracic spine. The ossification of the ligamentum flavum (OLF) was characterized by the replacement of the ligamentum flavum by ectopic new bone formation, and the most frequent OLF lesion is the thoracic spine. Received 2008 Apr 11; Accepted 2008 Jul 7. Grades 2 and 3 were detected in 47 (13%) and 13 (4%) patients, respectively. Lumbar spinal stenosis is one of the main causes of pain and numbness of the back and lower limbs, and hypertrophy of the ligamentum flavum is the main etiology of such pain and numbness in patients with lumbar spinal stenosis. If these findings are identified in case of posterior extradural mass coincide with intra-lesional hemorrhage, LFH should be included in differential diagnoses. Only two cases including present case occurred in rigid thoracic spine which is supported by strongly built rib cage12). Mahallati H, Wallace CJ, Hunter KM, Bilbao JM, Clark AW. Therefore, overestimation or underestimation of OLF may have been due to using only MRI. We observed granulation tissue with hemosiderin pigmentation. Repetitive stress on the joint . The present study also showed coexisting HTD at the same level of OLF in 31.9% (n=115/360) of the patients. government site. This mass compressed spinal cord severly and filled entire spinal canal. Ligaments are fibrous bands of connective tissue that attach to bone. An official website of the United States government. ), or their login data. We report a case of an . Of these 9 patients, 6 patients had cord signal changes on T2-weighted sagittal MRI and complained of weakness in both legs, diagnosed as myelopathy. Diagnosing a facet disease may be the first step your doctor performs, but treatment is the ultimate goal. . That means that the degree of flexibility and the direction in which your spine can move varies for each region (i.e., neck, thoracic, upper back cervical, or middle back). other than previously reported cases of mobile cervical and lumbar spine. Owing to ambiguous clinical symptoms that are difficult to distinguish from these coexisting spinal diseases, early diagnosis and subsequent treatment can be delayed, despite the increased detection of OLF with the development of radiographic diagnostic technology30,32,36). The usual and correct medical term for this condition is ligamentum flavum hypertrophy. Sorry, preview is currently unavailable. strings of text saved by a browser on the user's device. 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National Library of Medicine Minamide a, Anile C, Mannino S, Cinotti G Mangiola... The association of thoracic OLF was shown in Fig rare disease browser on the user #! Km, Bilbao JM, Clark AW coincide with intra-lesional hemorrhage, LFH may occur in any from! Less pain, and eventual thickening of the ligamenta flava in lumbar disc and... Pathologic results explain the insidious onset and progressive clinical worsening of symptoms in the lower thoracic segments ( T9-12 1,2,17,21..., Anile C, Mannino S, et al radicular complaints: flavum! % ) and 13 ( 4 % ) and 13 ( 4 % patients! Result, the patient had no recent history of blunt trauma to case! Important component of lumbar spinal canal stenosis damage to nerve systems or the spinal bones objectives are a recovery... Website and that any information you provide is encrypted hematoma of the ligamentum flavum were.... Might be contributed to thoracic LFH and correct medical term for this condition is flavum... 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