Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Report
  • Published:

A patient with cervical ligamentum flavum haematoma: case report

Spinal Cord Series and Cases volume 10, Article number: 65 (2024) Cite this article

Subjects

Abstract

Introduction

Ligamentum flavum haematoma (LFH) is an extremely rare entity, found mostly in the lumbar and thoracic ligamentum flavum and seldom in the cervical ligamentum flavum. Cervical LFH can cause paralysis in patients. We describe a case of LFH in the cervical spine that accepted surgical treatment.

Case presentation

A 70-year-old man with incomplete spinal cord injury presented with sudden paralysis of his left limbs for 10 days and hemi-hypaesthesia below the level of the right clavicle. Magnetic resonance imaging (MRI) showed a space-occupying lesion in the left ligamentum flavum between the C4 and C5 laminae. The preliminary diagnoses were concluded to be incomplete spinal cord injury, spinal epidural lesions, and cervical spinal stenosis. After a posterior C3–C6 laminectomy with lateral mass screw instrumentation, the muscle strength and sensation recovered partially. The lesion was greyish black and located in the ligamentum flavum. A pathological examination identified it as a haematoma of the ligamentum flavum. The patient was discharged 15 days after the operation and commenced rehabilitation.

Discussion

The LFH was mainly caused by slight trauma during gentle activities and contributed by many factors. MRI is an essential tool but pathological diagnosis is the gold standard. Most LFH patients can be treated surgically.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: CT images of ligamentum flavum (LF) hematoma.
Fig. 2: MRI images of ligamentum flavum (LF) hematoma.
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The dataset of this study is available from the corresponding author (YC).

References

  1. Shimada Y, Kasukawa Y, Miyakoshi N, Hongo M, Ando S, Itoi E. Chronic subdural hematoma coexisting with ligamentum flavum hematoma in the lumbar spine: a case report. Tohoku J Exp Med. 2006;210:83–9. https://doi.org/10.1620/tjem.210.83.

    Article  PubMed  Google Scholar 

  2. Hirakawa K, Hanakita J, Suwa H, Matsuoka N, Oda M, Muro H, et al. A post-traumatic ligamentum flavum progressive hematoma: a case report. Spine. 2000;25:1182–4. https://doi.org/10.1097/00007632-200005010-00021.

    Article  CAS  PubMed  Google Scholar 

  3. Sweasey TA, Coester HC, Rawal H, Blaivas M, McGillicuddy JE. Ligamentum flavum hematoma. Report of two cases. J Neurosurg. 1992;76:534–7. https://doi.org/10.3171/jns.1992.76.3.0534.

    Article  CAS  PubMed  Google Scholar 

  4. Chen HC, Hsu PW, Lin CY, Tzaan WC. Symptomatic hematoma of cervical ligamentum flavum: case report. Spine. 2005;30:E489–491. https://doi.org/10.1097/01.brs.0000174282.71947.c7.

    Article  PubMed  Google Scholar 

  5. Salehpour F, Mirzaei F, Rezakhah A, Aeinfar K, Kazemzadeh M, Alavi SAN. Ligamentum flavum hematoma presented with low back pain: a case report and review of the literature. Int J Spine Surg. 2018;12:337–41. https://doi.org/10.14444/5039.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cruz-Conde R, Berjano P, Buitron Z. Ligamentum flavum hematoma presenting as progressive root compression in the lumbar spine. Spine. 1995;20:1506–9. https://doi.org/10.1097/00007632-199507000-00012.

    Article  CAS  PubMed  Google Scholar 

  7. Wild F, Tuettenberg J, Grau A, Weis J, Krauss JK. Ligamentum flavum hematomas of the cervical and thoracic spine. Clin Neurol Neurosurg. 2014;116:24–7. https://doi.org/10.1016/j.clineuro.2013.11.008.

    Article  PubMed  Google Scholar 

  8. Kanat A, Yazar U, Ozdemir B, Kazdal H, Balik MS. Neglected knowledge: asymmetric features of lumbar disc disease. Asian J Neurosurg. 2017;12:199–202. https://doi.org/10.4103/1793-5482.145573.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Minamide A, Yoshida M, Tamaki T, Natsumi K. Ligamentum flavum hematoma in the lumbar spine. J Orthop Sci Off J Jpn Orthop Assoc. 1999;4:376–9. https://doi.org/10.1007/s007760050119.

    Article  CAS  Google Scholar 

  10. Yüceer N, Başkaya MK, Smith P, Willis BK. Hematoma of the ligamentum flavum in the lumbar spine: case report. Surg Neurol. 2000;53:598–600. https://doi.org/10.1016/s0090-3019(00)00187-7.

    Article  PubMed  Google Scholar 

  11. Ozdemir B, Kanat A, Batcik OE, Gucer H, Yolas C. Ligamentum flavum hematomas: Why does it mostly occur in old Asian males? Interesting point of reported cases: Review and case report. J Craniovertebral Junction Spine. 2016;7:7–12. https://doi.org/10.4103/0974-8237.176605.

    Article  Google Scholar 

  12. Miller JA, Schmatz C, Schultz AB. Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine. 1988;13:173–8.

    Article  CAS  PubMed  Google Scholar 

  13. Takahashi H, Wada A, Yokoyama Y, Fukushi S, Sakurai T, Shibuya K, et al. Ligamentum flavum haematoma: a report of two cases. J Orthop Surg Hong Kong. 2009;17:212–5. https://doi.org/10.1177/230949900901700219.

    Article  PubMed  Google Scholar 

  14. Chi TWC, Li KT, Chieng PU. Post-traumatic ligamentum flavum hematoma: a case report. Kaohsiung J Med Sci. 2004;20:41–4. https://doi.org/10.1016/S1607-551X(09)70083-X.

    Article  PubMed  Google Scholar 

  15. Liu HP, Chen CL, Chen NF, Liao CY, Ou CY. Ligamentum flavum hematoma due to stretching exercise. Am J Emerg Med. 2016;34:2058.e3–2058. https://doi.org/10.1016/j.ajem.2016.03.042. e6.

    Article  PubMed  Google Scholar 

  16. Kaneko T, Oshima Y, Inoue H, Iwai H, Takano Y, Inanami H, et al. Successful treatment of lumbar ligamentum flavum hematoma using a spinal full-endoscopic system. J Spine Surg Hong Kong. 2018;4:744–9. https://doi.org/10.21037/jss.2018.09.09.

    Article  Google Scholar 

  17. Algattas H, Kimmell KT, Petraglia AL, Maurer PK. Conservative management of a cervical ligamentum flavum hematoma: case report. Surg Neurol Int. 2016;7:S61–63. https://doi.org/10.4103/2152-7806.174887.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Miyakoshi N, Shimada Y, Kasukawa Y, Ando S. Ligamentum flavum hematoma in the cervical spine - case report. Neurol Med Chir (Tokyo). 2006;46:556–8. https://doi.org/10.2176/nmc.46.556.

    Article  PubMed  Google Scholar 

  19. Tamura T, Sakai T, Sairyo K, Takao S, Kagawa S, Katoh S, et al. Hematoma in the cervical ligamentum flavum. Report of a case and review of the literature. Skeletal Radiol. 2010;39:289–93. https://doi.org/10.1007/s00256-009-0805-8.

    Article  PubMed  Google Scholar 

  20. Kotani Y, Sudo H, Abumi K, Ito M, Matsubara S, Minami A. Spinal cord compression by hematoma in the cervical ligamentum flavum: a case report. Spine J. 2012;12:e18–21. https://doi.org/10.1016/j.spinee.2012.03.029.

    Article  PubMed  Google Scholar 

  21. Haghnegahdar A, Sedighi M, Rahmanian A, Baghban F. Cervical Ligamentum Flavum Hematoma: A Case Report. Spine J. 2016;6:e30–34. https://doi.org/10.1055/s-0035-1550342.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the patients who participated in the study.

Author information

Author notes

  1. These authors contributed equally: Nixi Xu, Chang Jiang.

Authors and Affiliations

  1. Department of Orthopedics, Zhongshan Hospital Fudan University, Shanghai, 200032, China

    Nixi Xu, Chang Jiang, Zixian Chen, Zhenzhou Feng, Chun Jiang & Yuanwu Cao

Authors
  1. Nixi Xu
    View author publications

    Search author on:PubMed Google Scholar

  2. Chang Jiang
    View author publications

    Search author on:PubMed Google Scholar

  3. Zixian Chen
    View author publications

    Search author on:PubMed Google Scholar

  4. Zhenzhou Feng
    View author publications

    Search author on:PubMed Google Scholar

  5. Chun Jiang
    View author publications

    Search author on:PubMed Google Scholar

  6. Yuanwu Cao
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Nixi Xu and Chang Jiang contributed equally to this article as co-first authors. Nixi Xu wrote the main manuscript text. Chang Jiang, Zixian Chen, Zhenzhou Feng, Chun Jiang and Yuanwu Cao reviewed the manuscript.

Corresponding author

Correspondence to Yuanwu Cao.

Ethics declarations

Competing interests

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, N., Jiang, C., Chen, Z. et al. A patient with cervical ligamentum flavum haematoma: case report. Spinal Cord Ser Cases 10, 65 (2024). https://doi.org/10.1038/s41394-024-00679-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41394-024-00679-6

Search

Advanced search

Quick links