Spinal cord compression by hematoma in the cervical ligamentum flavum: a case report

Background contextThere have been some reports describing hematoma in the thoracic and lumbar ligamentum flavum, but there have been only three reports of hematoma in the cervical ligamentum flavum.PurposeWe describe another case of the ligamentum flavum hematoma in the cervical spine with a different feature of occurrence that required surgical treatment.Study designCase report.Patient samplePatient with ligamentum flavum hematoma in the cervical spine.Outcome measuresPreoperative magnetic resonance imaging and pathologic finding from operative specimen confirmed the diagnosis.MethodsA 69-year-old man insidiously presented with pain in his left upper arm and difficulty in left shoulder abduction. Neurologic examination demonstrated a cervical myelopathy with diffuse muscle weakness of left upper extremity and sensory disturbance. Imaging studies revealed a mass of high intense on T1-weighted images and isointense on T2-weighted images posterior to the dura at C4 lower end level. The patient underwent C4–C5 hemilaminectomy and the removal of the mass. The mass existed within the ligamentum flavum and was connected toward the pedicle like the beads of a rosary.ResultsHistopathologic examination of the surgical specimen showed that the hematoma was present within the ligamentum flavum and contained macrophages that had phagocytosed red blood cells and hemosiderin. After surgery, the patients' symptoms immediately improved, and no recurrence was observed at 2 years postoperatively.ConclusionsWe reported a very rare case of hematoma in the ligamentum flavum of the cervical spine that required surgery. Because the patient was without the history of trauma, it was suggested that the use of antiplatelet drugs was responsible for the occurrence of the disease.