Cervical Ligamentum Flavum Research Articles

Hematoma in the cervical ligamentum flavum. Report of a case and review of the literature

Hematoma of the cervical ligamentum flavum is very rare, and its pathogenesis is unknown. We describe a case of ligamentum flavum hematoma in the cervical spine causing severe myelopathy. Postoperative histological examination suggested it was the result of the rupture of a hemangioma or of an arteriovenous malformation in the ligamentum flavum. After removal of the lesion, the patient's condition immediately improved. Review of all three reported cases, including this one, showed that complete resection of the mass resulted in immediate relief of symptoms of incomplete paraplegia. The findings of magnetic resonance imaging (MRI) of the hematoma may vary with time, and they may show no characteristic intensity. However, MRI of this case revealed that the tissues surrounding the mass were enhanced with gadolinium diethylene triamine penta-acetic acid, and an area of homogeneous iso-intensity was clearly surrounded by a low-intensity area (flavum) on T2-weighed short-tau inversion recovery images. These findings could be characteristic of the ligamentum flavum hematoma and might help in the differentiation from a cervical epidural hematoma.

Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy

High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure. Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2–3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3–6 spondylotic changes. A decompressive laminectomy using “posterior floating and enbloc resection” brought significant relief in myelopathy. Histopathology showed mature bony trabeculae, bone marrow and ligament tissue. The coexisting mobile cervical vertebral segment above and congenitally fused or spondylotic rigid segment below the level of LF may have led to abnormal strain patterns within resulting in its unilateral ossification. In dealing with cervical OLF, carefully preserving facets during laminectomy or laminoplasty helps in maintaining normal cervical spinal curvature.

Comparison of Methods to Confirm the Cervical Epidural Space

Background: The loss of resistance (LOR) method is most commonly used to identify the epidural space. This method is thought to rely on the penetration of the ligamentum flavum. Unfortunately the exact morphology of the ligamentum flavum is variable at different vertebral lev els. Especially, it has been pointed out that the lower cervical ligamentum flavum may be discontinuous in the mi dline in up to 50% of patients. Thus, the LOR method may be inaccurate to confirm the cervical epidural space . The aim of this study is to determine which method is the safest and most exact for confirming the cervical epidural space. Methods: 100 adult, chronic renal failure patients who were undergoing an arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. During the cervical epidural puncture, we identified the cervical epidural space by subjectively feeling the resistance with using a finger just through the ligamentum flavum, and we also used the drip infusion method, the loss of resistance method using air, and the hanging drop method. By using 5 grades, we classified the extent of whether or not the techniques were effective. Results: Using the drip infusion method, we identify the epidural space in all the patients as ＋/＋＋ grade. The catheter insertion method was also successful in identifying those epidural spaces over a ± grade. The pseudo LOR was over ± grade in 47 patients. Conclusions: The combined LOR/hanging drop with drip infusion method is useful for confirming the cervical epidural space. (Korean J Pain 2009; 22: 158-162)

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease in the Cervical Ligamentum Flavum - A Case Report -

Calcium pyrophosphate dihydrate deposition disease (CPPD) is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. The cervical ligamentum flavum is a rare location of CPPD deposition. A 65-year-old woman was admitted with complaints of neck pain and a tingling sensation and numbness below the xiphoid process for 2 months. Magnetic resonance (MR) imaging and computed tomography (CT) revealed compression of the spinal cord due to a nodular calcified mass in or attached to the ligamentum flavum at the C4-5, C5-6, or C6-7 level. The patient underwent a laminectomy at C4-5, C5-6, and C6-7, and resectioning of calcified extradural nodules that impinged on the cervical cord. The operation resulted in a resolution of neck pain and hypoesthesia, except in the feet. Histopathological examination of the excised specimen revealed rectangular CPPD crystals. Here, we report a case of compressive cervical spine due to CPPD deposition disease of the cervical spine and describe the literature relevant to CPPD deposition disease of the cervical spine.

Calcification du ligament jaune du rachis cervical: À propos d’un cas et revue de la littérature

Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved. Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

Acute Quadriparesis Caused by Calcification of the Entire Cervical Ligamentum Flavum in a White Female—Report of An Unusual Case And A Brief Review of the Literature

Case report. To describe an extremely unusual case of acute quadriparesis in a white female caused by calcification of the ligamentum flavum (LF) from C1 to T2, and to review briefly the pertinent literature. Diseases characterized by abnormal calcium deposition on the spinal ligaments have an unclear etiology. The overwhelming majority of these cases has been reported in people of Asian descent and has a predilection for the thoracic spine. Multilevel involvement of the cervical LF in white patients is exceptionally rare. To our knowledge, complete calcification of the entire cervical LF has not been previously reported in the literature. The history, physical examination, and radiographic studies of a 64-year-old white female with a history of scleroderma are described. The patient presented with neck pain and acute quadriparesis caused by spinal cord impingement by calcified cervical LF from C1 to T2. The patient underwent emergent C3-C7 laminectomy and C2-C7 posterior spinal fusion. Operative intervention resulted in marked neurologic improvement and relief from neck pain. Histopathologic examination of the calcified LF showed that the deposits consisted of hydroxyapatite crystals exclusively with no heterotopic bone. However, kyphosis did develop in the patient after laminectomy. To our knowledge, this unusual case of complete calcification of the entire cervical LF has not previously been described. Multilevel laminectomy and fusion can improve neurologic function but may result in kyphosis.

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report

A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patient's myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. Association between degenerative intraspinal cysts and listhesis is discussed. To our knowledge, this is the first case of cyst of the ligamentum flavum associated with cervical subluxation.

Cervical and High Thoracic Ligamentum Flavum Frequently Fails to Fuse in the Midline

Cervical and High Thoracic Ligamentum Flavum Frequently Fails to Fuse in the Midline

Six cases of cervical ligamentum flavum calcification in Blacks in the French West Indies

Objective. Calcification of the ligamentum flavum at the cervical spine is an uncommon condition reported mainly in Japanese patients. We describe the clinical manifestations, imaging study findings, and outcomes in six cases seen in the French West Indies. Material and methods. We retrospectively reviewed the medical charts of six patients admitted to an orthopedics department for spinal cord compression shown upon computed tomography to be caused by calcification of the ligamentum flavum. There were five women and one man, mean age at admission was 71.7 years (range, 64–79 years), and all six patients were Black. Results. Five patients had cervical myelopathy and one was asymptomatic. All five symptomatic patients had cervical spinal stenosis, explaining the rapid symptom onset (within six and a half months) and severe motor loss. Computed tomography reconstruction in the sagittal plane ruled out ossification of the ligamentum flavum. Magnetic resonance imaging of the neck failed to demonstrate the calcifications but was useful in evaluating the severity of the spinal cord compression. One patient had articular chondrocalcinosis in both knees and another had calcifications in the basal ganglia. Surgical decompression by the posterior route was performed in two patients and was effective in both, whereas two of the three symptomatic patients who did not have surgery experienced worsening neurological loss. Analysis of the operative specimens from the two surgically treated patients showed a mixture of calcium pyrophosphate dihydrate crystals and apatite microcrystals. Conclusion. Calcification of the ligamentum flavum is probably underrecognized in blacks. This condition causes severe neurological loss. Imaging studies provide the diagnosis. The pathogenesis remains unclear.

Clinical study of calcification of the cervical ligamentum flavum

Clinical study of calcification of the cervical ligamentum flavum

Ossification of the cervical ligamentum flavum

A case of a 61-year-old man with ossification of the cervical ligamentum flavum is reported. The ossification was located on the left side of C3-4. The symptoms improved with laminectomy and resection. Ossification of the ligamentum flavum usually occurs in the lower thoracic spine, and is rare in the cervical region. Including the present one, only eight cases have been reported to our knowledge. The clinical features and pathogenesis are discussed.

Myeloradiculopathy Secondary to Pseudogout in the Cervical Ligamentum Flavum: Case Report

Abstract A case of cervical myeloradiculopathy secondary to deposits of calcium pyrophosphate dihydrate (Ca2P2O7 2H2O) (CPPD) crystals in the degenerating ligamentum flavum, with marked granulomatous inflammation, is presented. This uncommon clinical presentation of pseudogout (CPPD deposition disease) was confirmed after surgical removal of a compressive cervical ligamentum flavum. The diagnosis of CPPD crystal deposition was determined by polarized light microscopy and energy-dispersive x-ray microanalysis in frozen sections of the biopsy specimen. A review of seven previously reported cases along with the present case failed to reveal trauma as a causative factor.

Symptomatic Calcification and Ossification of the Cervical Ligamentum Flavum: Clinical, radiological and pathological features

Four surgical cases of symptomatic calcification or ossification of the cervical ligamentum flavum are reported. Both of these conditions occurred in the lower cervical spine of older women, and are best demonstrated on axial computerized tomography (CT) scan. All of our patients showed marked improvement after surgical decompression.

Ultrastructural study of calcification process in the ligamentum flavum of the cervical spine.

The ultrastructure of the formation of calcified nodules in three cases of symptomatic calcification of the cervical ligamentum flavum were studied. In some areas of the ligament, extracellular plasma membrane-invested matrix vesicles and thick wall-bound matrix giant bodies with or without mineralized deposits were present. These calcified vesicles and bodies were also encountered in the wide mineralized areas among the collagen and elastic fibers in the ligament. The mineralization process of the calcified nodules in the ligamentum flavum implies that matrix vesicles and matrix giant bodies acquire mineralized precipitates; then some gather in clusters. Calcified deposits may spread to collagen and elastic fibers contiguous with the calcified vesicles and bodies, and some eventually coalesce to make a calcified nodule.