gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Ligamentum flavum hematomas of the thoracic and the cervical spine

Meeting Abstract

  • F. Wild - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
  • J. Tüttenberg - Klinik für Neurochirurgie, Universität Heidelberg, Mannheim
  • A. Grau - Klinik für Neurologie, Klinikum Ludwigshafen, Ludwigshafen
  • J. Weis - Institut für Neuropathologie, Universitätsklinikum Aachen, Aachen
  • J.K. Krauss - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 013

DOI: 10.3205/12dgnc400, URN: urn:nbn:de:0183-12dgnc4005

Published: June 4, 2012

© 2012 Wild et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Progressive myelopathy due to hemorrhage into cysts of the ligamentum flavum has received only very little attention. We report our experiences in a series of 3 patients with ligamentum flavum hematomas in the cervical spine or in thoracic spine seen within a period of 10 years.

Methods: Three patients (age 55–69) presented with delayed onset of neurological symptoms due to acute hemorrhage into ligamentum flavum cysts. Two hematomas were localized in the cervical spine at level C3/C4, and one was localized in the thoracic spine at level T3. All patients underwent hemilaminectomy at the according level to decompress the mass lesion.

Results: The postoperative course of all patients was uneventful. Preoperative symptoms regressed within days. Follow-up examinations up to 2 years postoperatively were unremarkable. There was no recurrence of hematoma or new cyst formation. Histological examination showed the typical features of a ligamentum flavum cyst with hemorrhage.

Conclusions: Ligamentum flavum hematoma is a very rare cause of myelopathy. It appears to occur much less frequently than hemorrhage into synovial cysts or bleeding in the subdural or epidural spine. It has to be considered in the differential diagnosis in patients presenting first with mild symptoms which slowly progress to paraparesis or other symptoms of spinal mass lesion. MRI is confirmatory of the diagnosis. Prompt surgical resection of ligamentum flavum cyst hematomas resulted in excellent outcome. There was no further need for stabilization procedures.