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Lumbar ligamentum flavum hematoma masquerading as multilevel lumbar spinal stenosis: A case report
Hiroaki Matsumoto1, Yasunori Yoshida1, Akihiro Okada1
1Department of Neurosurgery, Cerebrovascular Research Institute, Yoshida Hospital, Kobe, Japan.
Background:
Ligamentum flavum hematoma (LFH) is a rare cause of acute or subacute neurological deterioration. Preoperative diagnosis is often difficult because magnetic resonance imaging (MRI) findings vary with the stage of hemorrhage and may mimic other epidural lesions. Diagnostic challenges increase further when LFH is masked by multilevel lumbar degenerative changes.
Case Description:
A 79-year-old female with known lumbar spinal stenosis developed sudden worsening of low back pain, bilateral buttock pain, and right L5 radiculopathy. The MRI revealed multilevel lumbar canal/foraminal stenosis with uniformly low T2 signal intensity within the ligamentum flavum (LF) at all levels. The computed tomography demonstrated calcification at the right L2/3 facet joint, but no findings suggestive of hematoma. At surgery, the LF at L2/3 appeared brownish and degenerated. Incision into the LF produced the immediate release of non-coagulated dark-red blood consistent with LFH. In addition, the LF demonstrated marked inflammatory changes, marked hypertrophy, and strong adhesions to the underlying dura. Postoperatively, the patient's symptoms rapidly improved. The histopathology was consistent with a hematoma (i.e., LFH-hemosiderin deposition and inflammatory infiltration).
Conclusion:
Patients with magnetic resonance studies demonstrating uniform low T2 signal intensity within dorsolaterally hypertrophied LF and severe multilevel lumbar stenosis may have LFH.
