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Case Reports
, 7 (Suppl 3), S61-3

Conservative Management of a Cervical Ligamentum Flavum Hematoma: Case Report

Case Reports

Conservative Management of a Cervical Ligamentum Flavum Hematoma: Case Report

Hanna Algattas et al. Surg Neurol Int.


Background: Spontaneous epidural hematoma arising from the ligamentum flavum is a rare cause of acute spinal cord compression. There are only four reports in the cervical spine literature, and all were managed with surgery. Here, we describe an acute case of a spontaneous epidural hematoma arising from the ligamentum flavum in the cervical spine successfully managed without surgery.

Case description: A 69-year-old woman with a cervical spine epidural hematoma contained within the ligamentum flavum presented with paroxysmal neck pain and stiffness without a history of trauma. The magnetic resonance imaging (MRI) revealed a posterolateral epidural hematoma contained within the ligamentum flavum. As the patient was intact, she was managed conservatively with cervical orthosis. Three months later, she was symptom-free, and the hematoma resolved on the follow-up MRI study.

Conclusion: Spontaneous epidural hematoma arising from ligamentum flavum is a rare cause of spinal cord compression. Previous reports have described success with surgical decompression. However, initial observation and conservative management may be successful as illustrated in this case.

Keywords: Cervical spine; epidural hematoma; ligamentum flavum.


Figure 1
Figure 1
Computed tomography neck: Sagittal, axial, coronal views: CT neck demonstrating right posterolateral hyperdense mass. Left: Sagittal, Middle: Axial, Right: Coronal
Figure 2
Figure 2
MRI Cervical Spine with Contrast: MRI cervical spine revealing right posterolateral epidural mass contained within ligamentum flavum and extending from C2-C5 vertebral levels. Mass appears as isointense lesion on T1-weighted images and heterogeneous isointense to hyperintense lesion on T2-weighted images. The addition of Gd-DTPA contrast enhanced the outer border of the ligament on T1-weighted images. (a) Sagittal T2- Weighted MRI, (b) Sagittal T1-Weighted MRI, (c) Axial T2-Weighted MRI, (d) Axial T1-Weighted MRI with contrast
Figure 3
Figure 3
Follow-up MRI Cervical Spine with Contrast: Three month follow-up MRI (T1 and T2-weighted) of cervical spine demonstrating complete resolution of hematoma with moderate stenosis from pre-existing osteophyte complexes emanating from the vertebral bodies of C2-C4. (a) Follow-up Sagittal T2-Weighted MRI, (b) Follow-up Sagittal T1-Weighted MRI

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