Symptomatic ganglion cyst of ligamentum flavum as a late complication of lumbar fixation (original) (raw)
Related papers
Lumbar Ligamentum Flavum Cyst: Case Report
Istanbul Medical Journal
The term ligamentum flavum cyst is defined as a cystic formation arising from ligamentum flavum that is not lined with synovial epithelium (1). Ligamentum flavum cyst is a rare cause of spinal cord and nerve compression (2). It was first defined by Moiel et al. (3) in 1967. It occurs most frequently in the lower lumbar region (4). It may cause neurological complaints due to spinal canal stenosis or lumbar root compression (5). These cysts accompany degenerative changes in the spine. It can be distinguished from synovial and other degenerative spinal cysts based on localization and histopathological features (6). We aimed to present two cases of ligamentum flavum cysts that we diagnosed based on original magnetic resonance imaging (MRI) findings and confirmed one histopathologically. Case Reports Case 1 A lumbar MRI was requested for a 54-year-old male patient with low back pain, slow-developing gait disturbance, hip, and right leg pain. Neurological examination revealed normal motor functions, but sensory impairment in the right L4 dermatome. The patient's medical history included hypertension and diabetes. No pathology was observed in laboratory tests. Degenerative changes were observed on the direct X-ray of the lumbosacral vertebra. Multilevel facet arthropathy, more prominent in L3-L4, was observed in lumbar MRI. A 17x5.5 mm ligamentum flavum cyst, which was hypointense on T1-weighted images (T1WI) and hyperintense on T2-WI, was found at L3-L4 level. The cyst caused right lateral recess stenosis by compressing thecal sac and spinal
Midline Ligamentum Flavum Cyst of Lumbar Spine
World Neurosurgery, 2018
Background: Ligamentum flavum cysts are thought to develop due to facet joint hypermobility however the etiology of these lesions is not completely elucidated. These cysts may lead to compressive pathologies of the spine requiring surgical intervention. Case Report: We report the case of a 63-year-old male with chronic back pain and progressive neurogenic claudication for 6 months. He was found to have a ligamentum flavum cyst situated along the dorsal midline of the lumbar spinal canal contributing to spinal stenosis. The patient underwent a decompressive L4 laminectomy and en bloc excision of the ligamentum flavum cyst with complete resolution of his symptoms post-operatively. Conclusions: We suggest that chronic mechanical stress leads to degeneration of the ligamentum flavum and contributes directly to cyst formation.
Journal of Orthopaedic Surgery and Research, 2010
Three Chinese patients suffered from severe lumbar spinal stenosis with debilitating symptoms due to a rare condition of ligamentum flavum cysts in the midline of the lumbar spine. This disease is distinct from synovial cyst of the facet joints or ganglion cysts, both intraoperatively and histopathologically. Magnetic Resonance imaging features of the ligamentum flavum cyst are also demonstrated. We share our surgical experiences of identification of the ligamentum flavum cysts, decompression and excision for two of the patients with demonstrably good recovery. This disease should be considered in the differential diagnosis of an extradural instraspinal mass in patients with lumbar spinal stenosis.
Journal of Minimally Invasive Spine Surgery and Technique, 2021
Lumbar spinal stenosis is most common entity coming to spine outpatient department which may present with complaint of back pain with lower limbs neurogenic claudication, caused by degenerative disc conditions or to facet joint hypertrophy or ligamentum flavum thickening. We represent a case report of a patient suffering from low back pain with worsening neurogenic claudication. Imaging showing a cystic lesion at L3-4 spinal level with no lysthesis pinching the traversing nerve root who undervent minimal invasive tubular transforaminal lumbar interbody fusion. Intraoperatively, a cystic mass originating from ligament flavum with yellow jelly fluid adherent to dura and no communication with subarachnoid space or facet joint was found. Histologically, these cysts represent a distinct entity different from synovial cysts in terms of devoid of epethelial lining. To differentiate in cyst outlines and origin is very helpful in preoperative planning as even complete removal of ligamentum flavum cyst does not damage the facet joint and no fixation is required in these cases as compared to facetal cyst which represents instability and fixation is mandatory.
Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report
European Spine Journal, 2005
Cysts of the ligamentum flavum are rare lesions that are most frequently located in the lumbar spine [1 -4, 21, 23], the cervical localization is unusual . Most of the intraspinal degenerative cysts are juxta-articular (synovial and ganglion) cysts, and have a similar radiologic appearance . We report the unique neuroimaging and pathological findings obtained in a patient with a cyst of the ligamentum flavum in the cervical region associated with a C7-T1 subluxation. This report, to our information, is the first of its kind.
Report of a Rare Case: Ligamentum Flavum Cyst
MGM Journal of Medical Sciences, 2015
A rare case of ligamentum flavum cyst of the lumbar spine in an elderly male is reported. The patient presented with low backache and features of bilateral radiculopathy of a sudden onset. The cyst was lying in the extradural space. After surgery, the patient reported complete relief of symptoms.
2020
Background: Ligamentum flavum cysts have been rarely described in the literature and are one of the rare causes of neural compression and canal stenosis. Very few cases of their association with neurologic deficits are reported to date, and association with acute onset weakness is even rarer. Clinical Presentation: We report our experience with 3 cases of ligamentum flavum cyst that presented with acute onset weakness and also present a comprehensive literature review on lumbar ligamentum flavum cysts reported to date. All 3 patients had symptoms of severe neurogenic claudication and presented to us with acute onset of motor weakness in lower limbs. Ligamentum flavum cyst was located in the midline in 2 cases and laterally in 1 case. We performed excision of the cyst and decompression with fusion in 2 cases and decompression alone in 1 case. All 3 cases had significant improvement in their neurologic status postoperatively. Histopathological examination confirmed ligamentum flavum c...
Journal of Medical Case Reports, 2012
We report on a very rare case of a cervical ligamentum flavum cyst, which presented with progressive myelopathy and radiculopathy. The cyst was radically extirpated and our patient showed significant recovery. A review of the relevant literature yielded seven cases. Case presentation: An 82-year-old Greek woman presented with progressive bilateral weakness of her upper extremities and causalgia, cervical pain, episodes of upper extremity numbness and significant walking difficulties. Her neurological examination showed diffusely decreased motor strength in both her upper and lower extremities. Magnetic resonance imaging of her cervical spine demonstrated a large, well-demarcated cystic lesion on the dorsal aspect of her spinal cord at the C3 to C4 level, significantly compressing the spinal cord at this level, in close proximity to the yellow ligament and the C3 left lamina. The largest diameter of this lesion was 1.4 cm, and there was no lesion enhancement after the intravenous administration of a paramagnetic contrast. The lesion was surgically removed after a bilateral C3 laminectomy. The thick cystic wall was yellow and fibro-elastic in consistency, while its content was gelatinous and yellow-brownish. A postoperative cervical-spine magnetic resonance image was obtained before her discharge, demonstrating decompression of her spinal cord and dural expansion. Her six-month follow-up evaluation revealed complete resolution of her walking difficulties, improvement in the muscle strength of her arms (4+/5 in all the affected muscle groups), no causalgia and a significant decrease in her preoperative upper extremity numbness. Conclusion: Cervical ligamentum flavum cysts are rare benign lesions, which should be included in the list of differential diagnosis of spinal cystic lesions. They can be differentiated from other intracanalicular lesions by their hypointense appearance on T 1 -weighted and hyperintense appearance on T 2 -weighted magnetic resonance images, with contrast enhancement of the cystic wall. Surgical extirpation of the cyst is required for symptom alleviation and decompression of the spinal cord. The outcome of these cysts is excellent with no risk of recurrence.