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Akio Minami - One of the best experts on this subject based on the ideXlab platform.
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Spinal cord compression by hematoma in the cervical Ligamentum flavum: a case report
The spine journal : official journal of the North American Spine Society, 2012Co-Authors: Yoshihisa Kotani, Hideki Sudo, Kuniyoshi Abumi, Manabu Ito, Shinji Matsubara, Akio MinamiAbstract:Abstract Background context There 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. Purpose We describe another case of the Ligamentum flavum hematoma in the cervical spine with a different feature of occurrence that required surgical treatment. Study design Case report. Patient sample Patient with Ligamentum flavum hematoma in the cervical spine. Outcome measures Preoperative magnetic resonance imaging and pathologic finding from operative specimen confirmed the diagnosis. Methods A 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. Results Histopathologic 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. Conclusions We 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.
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Spinal cord compression by Ligamentum flavum hematoma in the thoracic spine.
Spine, 2009Co-Authors: Hideki Sudo, Kuniyoshi Abumi, Manabu Ito, Yoshihisa Kotani, Masahiko Takahata, Yoshihiro Hojo, Masatoshi Sanda, Akio MinamiAbstract:Study Design. Case report. Objective. To report an extremely rare case of hematoma derived from the Ligamentum flavum within the thoracic spine. Summary of Background Data. Only one previous case has been reported of a hematoma derived from the Ligamentum flavum in the thoracic spine. Methods. A 61-year-old man presented with gait disturbance and numbness below the navel. Magnetic resonance imaging on the 16th day after the onset of the symptoms showed spinal cord compression at the T10–T11 level caused by a round mass. This intraspinal, extradural space occupying lesion, continuous with Ligamentum flavum was centrally hypointense and marginal hyperintense on a T1-weighted image and central heterogeneous and marginal hypointense on a T2-weighted image. The wall of the lesion was slightly enhanced after use of a contrast medium. Results. The patient underwent a T10 laminectomy and the mass was carefully resected from the dura mater. Histologic examination showed that the wall of the mass comprised fibrous connective tissue that contained elastic fibers derived from a degenerative Ligamentum flavum tear. It also revealed that evidence of previous hemorrhagic events within the mass. There was no evidence of neoplastic nor synovial tissue. After surgery, the patient’s numbness and gait disturbance disappeared. Conclusion. This report identifies an extremely rare case of spinal cord compression by a hematoma from the Ligamentum flavum within the thoracic spine.
Hirofumi Jono - One of the best experts on this subject based on the ideXlab platform.
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amyloid deposits derived from transthyretin in the Ligamentum flavum as related to lumbar spinal canal stenosis
Modern Pathology, 2015Co-Authors: Akihiro Yanagisawa, Mitsuharu Ueda, Masayoshi Tasaki, Yohei Misumi, Takanao Sueyoshi, Tatsuya Okada, Toru Fujimoto, Keisuke Kitagawa, Toshinori Oshima, Hirofumi JonoAbstract:Amyloidosis is a protein conformational disorder with the distinctive feature of extracellular accumulation of amyloid fibrils that come from different proteins. In the Ligamentum flavum of the lumbar spine, amyloid deposits were frequently found in elderly patients with lumbar spinal canal stenosis and were at least partially formed by wild-type transthyretin. However, how amyloid deposits in the Ligamentum flavum affect lumbar spinal canal stenosis has remained unclear. In this study, we analyzed clinical, pathologic, and radiologic findings of patients with lumbar spinal canal stenosis who had amyloid deposits in the Ligamentum flavum. We studied 95 Ligamentum flavum specimens obtained from 56 patients with lumbar spinal canal stenosis and 21 Ligamentum flavum specimens obtained from 19 patients with lumbar disk herniation. We evaluated histopathologic findings and clinicoradiologic manifestations, such as thickness of the Ligamentum flavum and lumbar spinal segmental instability. We found that all 95 Ligamentum flavum specimens resected from patients with lumbar spinal canal stenosis had amyloid deposits, which we classified into two types, transthyretin-positive and transthyretin-negative, and that transthyretin amyloid formation in the Ligamentum flavum of patients with lumbar spinal canal stenosis was an age-associated phenomenon. The amount of amyloid in the Ligamentum flavum was related to clinical manifestations of lumbar spinal canal stenosis, such as thickness of the Ligamentum flavum and lumbar spinal segmental instability, in the patients with lumbar spinal canal stenosis with transthyretin-positive amyloid deposits. To our knowledge, this report is the first to show clinicopathologic correlations in transthyretin amyloid deposits of the Ligamentum flavum. In conclusion, transthyretin amyloid deposits in the Ligamentum flavum may be related to the pathogenesis of lumbar spinal canal stenosis in elderly patients.
Nozomu Inoue - One of the best experts on this subject based on the ideXlab platform.
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Ligamentum flavum thickness measurements
2018Co-Authors: Gunnar B J Andersson, Justin J Munns, Joe Y B Lee, Nozomu Inoue, Alejandro Espinoza Orias, Ryota TakatoriAbstract:This data file contains the data used in the manuscript "Ligamentum flavum Hypertrophy in Asymptomatic and Chronic Low Back Pain Subjects" by Munns et al. Currently only identified as PONE-D-14-5081
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Ligamentum flavum hypertrophy in asymptomatic and chronic low back pain subjects
PLOS ONE, 2015Co-Authors: Justin J Munns, Joe Y B Lee, Alejandro Espinoza A Orias, Ryota Takatori, Gunnar B J Andersson, Nozomu InoueAbstract:Purpose To examine Ligamentum flavum thickness using magnetic resonance (MR) images to evaluate its association with low back pain symptoms, age, gender, lumbar level, and disc characteristics. Materials and Methods Sixty-three individuals were part of this IRB-approved study: twenty-seven with chronic low back pain, and thirty-six as asymptomatic. All patients underwent MR imaging and computed tomography (CT) of the lumbar spine. The MR images at the mid-disc level were captured and enlarged 800% using a bilinear interpolation size conversion algorithm that allowed for enhanced image quality. Ligamentum flavum thickness was assessed using bilateral medial and lateral measurements. Disc height at each level was measured by the least-distance measurement method in three-dimensional models created by CT images taken of the same subject. Analysis of variance and t-tests were carried out to evaluate the relationship between Ligamentum flavum thickness and patient variables. Results Ligamentum flavum thickness was found to significantly increase with older age, lower lumbar level, and chronic low back pain (p < 0.03). No difference in Ligamentum flavum thickness was observed between right and left sided measurements, or between male and female subjects. Disc height and both Ligamentum flavum thickness measurements showed low to moderate correlations that reached significance (p < 0.01). Additionally, a moderate and significant correlation between disc degeneration grade and Ligamentum flavum thickness does exist (p <0.001). Conclusion By measuring Ligamentum flavum thickness on MR images at two different sites and comparing degrees of disc degeneration, we found that Ligamentum flavum thickness may be closely related to the pathogenesis of pain processes in the spine.
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Ligamentum flavum hypertrophy in asymptomatic and chronic low back pain subjects.
PloS one, 2015Co-Authors: Justin J Munns, Joe Y B Lee, Alejandro Espinoza A Orias, Ryota Takatori, Gunnar B J Andersson, Nozomu InoueAbstract:Purpose To examine Ligamentum flavum thickness using magnetic resonance (MR) images to evaluate its association with low back pain symptoms, age, gender, lumbar level, and disc characteristics. Materials and Methods Sixty-three individuals were part of this IRB-approved study: twenty-seven with chronic low back pain, and thirty-six as asymptomatic. All patients underwent MR imaging and computed tomography (CT) of the lumbar spine. The MR images at the mid-disc level were captured and enlarged 800% using a bilinear interpolation size conversion algorithm that allowed for enhanced image quality. Ligamentum flavum thickness was assessed using bilateral medial and lateral measurements. Disc height at each level was measured by the least-distance measurement method in three-dimensional models created by CT images taken of the same subject. Analysis of variance and t-tests were carried out to evaluate the relationship between Ligamentum flavum thickness and patient variables. Results Ligamentum flavum thickness was found to significantly increase with older age, lower lumbar level, and chronic low back pain (p < 0.03). No difference in Ligamentum flavum thickness was observed between right and left sided measurements, or between male and female subjects. Disc height and both Ligamentum flavum thickness measurements showed low to moderate correlations that reached significance (p < 0.01). Additionally, a moderate and significant correlation between disc degeneration grade and Ligamentum flavum thickness does exist (p
Mitsuo Ochi - One of the best experts on this subject based on the ideXlab platform.
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Morphological changes of the Ligamentum flavum as a cause of nerve root compression
European Spine Journal, 2005Co-Authors: Teruaki Okuda, Yoshinori Fujimoto, Nobuhiro Tanaka, Osamu Ishida, Itsushi Baba, Mitsuo OchiAbstract:The Ligamentum flavum is considered to be one of the important causes of radiculopathy in lumbar degenerative disease. Although there have been several reports anatomically examining the positional relationship between the Ligamentum flavum and nerve root, there are few reports on ventral observation. The purpose of this study is to clarify the shape of the Ligamentum flavum seen ventrally, and to obtain anatomic findings related to nerve root compression. The subjects were 18 adult embalmed cadavers, with an average age of 78 years at the time of death. The ventral shapes of the Ligamentum flavum were observed. The relationships between the morphological change of the Ligamentum flavum and nerve root compression or radiographic findings were statistically evaluated. Among the shapes of the Ligamentum flavum, bulging of the ligament was most frequently observed. Proximal bulging indicates the type with the cranial portion bulging from the subarticular zone to the foraminal zone of the Ligamentum flavum. In this type associated with a decrease in disc height, nerve root compression was frequently observed. Thus, we could more realistically grasp the relationship between bulging morphology of the Ligamentum flavum and nerve root compression.
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The Pathology of Ligamentum flavum in Degenerative Lumbar Disease
Spine, 2004Co-Authors: Teruaki Okuda, Yoshinori Fujimoto, Nobuhiro Tanaka, Itsushi Baba, Tadayoshi Sumida, Hideki Manabe, Yuzo Hayashi, Mitsuo OchiAbstract:Study design A pathologic study of the Ligamentum flavum in degenerative lumbar disease. Objectives To elucidate the clinical significance of each pathologic finding of the Ligamentum flavum. Summary of background data In many reports, researchers observed the Ligamentum flavum removed partially during surgery and did not evaluate the whole image of the Ligamentum flavum. In addition, there are only a few reports that examined the possible association between various histologic findings and clinical findings. And, thus, there are many unclear points in the clinical significance indicated by each pathologic finding. Methods The study participants were 50 patients with degenerative lumbar diseases who underwent surgical decompression with removal of the Ligamentum flavum of the affected spinal level. Tissue specimens of the removed Ligamentum flavum in cross section were prepared, and changes in the elastic fibers and collagen fibers were evaluated in three grades to evaluate the whole image. In addition, we observed the presence or absence of any focal lesions and statistically analyzed the possible association between these histologic findings and clinical symptoms or image findings. Results In regard to the association between histologic findings and clinical symptoms or image findings, calcification was observed in significantly older patients, who tended to have low scores in preoperative JOA score, and was frequently observed in patients with cauda equina symptoms. Patients with ossification had a significantly greater % slip, and chondroid cells were frequently observed in patients with spondylolisthesis. Conclusion Various pathologic findings provided important foundations for discussing the pathogenesis of lesions in Ligamentum flavum. Calcification was frequently observed in elderly patients and those with cauda equina symptoms, and these patients tended to have severer preoperative symptoms. Chondroid cells were frequently observed in patients with spondylolisthesis, and patients with ossification had a greater % slip, suggesting involvement of mechanical load in ossification of ligaments. The pathologic findings were significantly related to the clinical features, and these findings will be profitable for understanding the pathogenesis of degenerative lumbar disease.
Takeo Fukushima - One of the best experts on this subject based on the ideXlab platform.
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A post-traumatic Ligamentum flavum progressive hematoma: a case report.
Spine, 2000Co-Authors: Katsuyuki Hirakawa, Junya Hanakita, Hideyuki Suwa, Norihiro Matsuoka, Masashi Oda, Hiroyuki Muro, Takeo FukushimaAbstract: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.