Lumbar ligamentum flavum hematoma at L3-4 treated with full-endoscopic laminectomy: a case report

Lumbar ligamentum flavum hematoma (LFH) is a rare cause of nerve root and/or cauda equina compression which is commonly treated using microsurgical laminectomy and posterior fixation. However, technological advances may allow for less invasive options to be used.

A 70-year-old female with lower back and right lower extremity radicular pain without relevant medical history. Muscle strength and tendon reflexes were normal. Lumbar computed tomography (CT) and magnetic resonance imaging (MRI) revealed a lumbar dural sac and nerve root compression due to lumbar canal stenosis and lumbar LFH at L3-4. Full-endoscopic laminectomy (FEL) was performed at L3-4 after conservative treatment failed to provide sufficient improvement. Intraoperative observation revealed the presence of a hematoma during removal of the lumbar ligamentum flavum. Postoperatively, the lower back and right lower extremity radicular pain resolved. Postoperative MRI and CT demonstrated tomography revealed decompression of the lumbar dural sac and nerve root. The patient was discharged without any perioperative complications. No recurrence was observed for at least 3 months postoperatively.

FEL appears to be an effective and minimally invasive approach for lumbar LFH, owing to its ability to visualize and drain the hematoma from the ligamentum flavum and perform dural sac and nerve root decompression.