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Symptomatic Hematoma of CervicalLigamentum Flavum: Case Report

Chen, Hsien-Chih, MD*; Hsu, Peng-Wei, MD*; Lin, Chin-Yew, MD; Tzaan, Wen-Ching, MD*

doi: 10.1097/01.brs.0000174282.71947.c7
Case Report

Study Design. A case of symptomatic hematoma of cervical ligamentum flavum.

Objective. To report the first ligamentum flavum hematoma in the cervical spine and review the reported cases.

Summary of Background Data. A herniated nucleus pulposis, spondylosis, epidural hematoma or abscess, neoplasm, or some pathology of the ligamentum flavum, such as hypertrophy, ossification, or calcification, are the most common causes of spinal cord and nerve root compression. A ligamentum flavum hematoma has also been reported as a cause of compression of the cauda equina and lumbar nerve roots but has never been found in the cervical spine.

Methods. A 72-year-old man presented with left upper arm pain and left hemiparesis following traditional massage therapy. Admission magnetic resonance images showed a posterior oval-shaped mass that was continuous with the ligamentum flavum at C3–C4 level.

Results. A C3–C4 laminectomy for decompression and resection of the lesion was performed. One year after surgery, the patient remained neurologically intact and symptom-free.

Conclusions. Hematoma of the ligamentum flavum occurring in the cervical spine has never been reported previously. Repeated trivial injury on a degenerative ligamentum flavum might be the leading predisposing factor. Spine surgeons should be aware of a hematoma in the ligamentum flavum as a possible cause of spinal cord or root compression, especially in the mobile cervical and lumbar spine.

The first case of ligamentum flavum hematoma in the cervical spine is reported. The authors review the previously reported 7 cases and analyze the possible pathophysiologic mechanism. The outcomes were all excellent after surgery.

From the Departments of *Neurosurgery and †Pathology, Chang Gung University and Chang Gung Memorial Hospital, Taiwan, Republic of China.

Acknowledgment date: January 26, 2005. First revision date: February 21, 2005. Acceptance date: February 22, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Hsien-Chih Chen, MD, Chang Gung Memorial Hospital, 222, Mai-Chin Road, Keelung 204, Taiwan, Republic of China; E-mail address:;

© 2005 Lippincott Williams & Wilkins, Inc.