A post-traumatic ligamentum flavum progressive hematoma - A case report

Study Design. A case report. Objectives. To understand a rare case of ligamentum flavum progressive hematoma. Summary of Background Data. Previously there were only two reports about ligamentum flavum hematoma. Methods. A patient was surgically treated for ligamentum flavum hematoma causing progressive L5 radiculopathy. Clinical and neuroradiologic features were reported, and the literature was reviewed. Results. The etiology of this case could not be defined except by minor back injury. In spite of conservative therapy, the symptoms were progressive for 7 months. Magnetic resonance imaging demonstrated the epidural mass lesion at L4-L5 that was continuous with the ligamentum flavum. The mass was hypointense in T1-weighted images and central hyperintense and marginal hypointense in T2-weighted images. The margin was well enhanced by Gd-DTPA administration. After removal of the mass lesion, the patient's symptoms completely resolved. Before surgery, accurate diagnosis was difficult even based on magnetic resonance imaging and was achieved after histologic examinations. Conclusions. Surgery could be a choice of the treatment modality to resolve symptoms in ligamentum flavum hematoma.