Ligamentum flavum hematoma in the rigid thoracic spinal segments

✓ Ligamentum flavum hematoma, a rare cause of spinal nerve root and canal compression, typically occurs in the mobile lumbar spine segments. A thoracic ligamentum flavum hematoma is extremely rare—only one such case of a thoracolumbar (T11–12) lesion has been reported. The thoracolumbar region with its floating ribs, however, is structurally and biomechanically similar to the lumbar spine and its mobility is greater than the higher thoracic levels. To the best of their knowledge, the authors report the first case of a ligamentum flavum hematoma in the region of the rigid thoracic spinal segments with the contiguous rib cage. A symptomatic T9–10 ligamentum flavum hematoma is described in the case of a 66-year-old woman with compensatory thoracic lordosis secondary to the lumbar degenerative kyphosis. The hematoma was removed and the diagnosis was histologically confirmed. The authors speculate that thoracic lordosis might have contributed to the development of the hematoma because the ligamentum flavum and the facet joint were subjected to greater axial stress than in individuals with normal spinal alignment.

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Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine

Journal of Neurosurgery ◽

10.3171/jns.1990.72.3.0378 ◽

1990 ◽

Vol 72 (3) ◽

pp. 378-382 ◽

Cited By ~ 92

Author(s):

Joseph C. Maroon ◽

Thomas A. Kopitnik ◽

Larry A. Schulhof ◽

Adnan Abla ◽

James E. Wilberger

Keyword(s):

Facet Joint ◽

Lumbar Disc ◽

Spinal Nerve ◽

Magnetic Resonance Images ◽

Content Type ◽

Enhanced Ct ◽

Disc Herniations ◽

Microsurgical Approach ◽

Far Lateral ◽

Fine Print

✓ Lumbar-disc herniations that occur beneath or far lateral to the intervertebral facet joint are increasingly recognized as a cause of spinal nerve root compression syndromes at the upper lumbar levels. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the incorrect interspace. If these herniations are diagnosed, they often cannot be adequately exposed through the typical midline hemilaminectomy approach. Many authors have advocated a partial or complete unilateral facetectomy to expose these herniations, which can lead to vertebral instability or contribute to continued postoperative back pain. The authors present a series of 25 patients who were diagnosed as having far lateral lumbar disc herniations and underwent paramedian microsurgical lumbar-disc excision. Twelve of these were at the L4–5 level, six at the L5–S1 level, and seven at the L3–4 level. In these cases, myelography is uniformly normal and high-quality magnetic resonance images may not be helpful. High-resolution computerized tomography (CT) appears to be the best study, but even this may be negative unless enhanced by performing CT-discography. Discography with enhanced CT is ideally suited to precisely diagnose and localize these far-lateral herniations. The paramedian muscle splitting microsurgical approach was found to be the most direct and favorable anatomical route to herniations lateral to the neural foramen. With this approach, there is no facet destruction and postoperative pain is minimal. Patients were typically discharged on the 3rd or 4th postoperative day. The clinical and radiographic characteristics of far-lateral lumbar-disc herniations are reviewed and the paramedian microsurgical approach is discussed.

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Facet joint degeneration adversely affects ultrasound imaging of the lumbar spine

Medical Ultrasonography ◽

10.11152/mu-1699 ◽

2019 ◽

Vol 21 (2) ◽

pp. 131

Author(s):

Karthikeyan Srinivasan ◽

Hong Kuan Kok ◽

Mona Mubarak ◽

William Torregianni ◽

Robert Whitty

Keyword(s):

Lumbar Spine ◽

Ligamentum Flavum ◽

Facet Joint ◽

Posterior Longitudinal Ligament ◽

Joint Degeneration ◽

Neuraxial Block ◽

Interspinous Space ◽

Facet Joint Degeneration ◽

Experienced Operator ◽

Magnetic Resonance Imaging Mri

Aim: Ultrasound of neuraxis can be used to identify the best possible inter-spinous space to perform neuraxial block. The aim of this study was to assess the anatomical correlation between neuraxial ultrasound and magnetic resonance imaging (MRI).Material and method: Twenty-one patients who underwent MRI of the lumbar spine had ultrasound of lumbar neuraxis performed by an experienced operator. Each lumbar interspinous space was graded on ultrasound as good [posteriorcomplex (ligamentum flavum and duramater) and anterior complex (posterior longitudinal ligament) visible], intermediate (either anterior complex or posterior complex visible) or poor (both anterior complex and posterior complex not visible) in both the transverse median (TM) and paramedian sagittal oblique (PSO) plane. Pre-determined MRI parameters were measured by a radiologist blinded to sonographic findings at each inter-spinal level.Results: Seventy-eight lumbar interspinous spaces were evaluated. There was a significant association (p<0.004) between the facet joint degeneration on MRI and the poor ultrasound view in the transverse median (TM) group. The odds of obtaining a poor view in TM plane was 7 times higher (95% CI 1.7-28.9, p=0.007) in the presence of facet joint degeneration. None of the other variables had a significant association with a poor neuraxial view in the TM plane. Poor views in the parasagittal oblique (PSO) plane did not correlate with any of the variables measured on MRI.Conclusion: Facet joint degeneration is a major contributing factor to poor neuraxial ultrasound views in the TM plane.

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Facet Cyst Haematoma in the Lumbar Spine: A Report of Four Cases

Journal of Orthopaedic Surgery ◽

10.1177/230949900901700118 ◽

2009 ◽

Vol 17 (1) ◽

pp. 80-84 ◽

Cited By ~ 8

Author(s):

N Miyatake ◽

T Aizawa ◽

H Hyodo ◽

H Sasaki ◽

T Kusakabe ◽

...

Keyword(s):

Lumbar Spine ◽

Ligamentum Flavum ◽

Facet Joint ◽

Cauda Equina ◽

High Signal ◽

Resonance Imaging ◽

Synovial Lining ◽

En Bloc ◽

Synovial Lining Cells ◽

History Of

We present 4 cases of facet cyst haematoma in the ligamentum flavum of the lumbar spine. All patients presented with a one-to-3-month history of back pain or numbness in the legs, and sudden neurological deterioration. One also developed cauda equina syndrome and another developed radiculopathy. In all cases, magnetic resonance imaging showed a mass with high signal intensity on both T1- and T2-weighted images. Facet arthrography and computed tomography revealed communication between the mass and the neighbouring facet joint. The haematomas were removed en bloc with the ligamentum flavum. They were surrounded by the ligament and contained degenerated and lacerated elastic fibres but no synovial lining cells. Facet cyst haematoma is so-named because of bleeding from tissue adjacent to the facet joint into a pre-existing facet cyst.

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Upper thoracic spinal cord herniation after traumatic nerve root avulsion

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.99.3.0306 ◽

2003 ◽

Vol 99 (3) ◽

pp. 306-309 ◽

Cited By ~ 7

Author(s):

Victor R. Dasilva ◽

Mubarak Al-Gahtany ◽

Rajiv Midha ◽

Dipanka Sarma ◽

Perry Cooper

Keyword(s):

Spinal Cord ◽

Nerve Root ◽

Root Avulsion ◽

Thoracic Spinal Cord ◽

Content Type ◽

First Case ◽

Thoracic Spinal ◽

Spinal Cord Herniation ◽

Nerve Root Avulsion ◽

Upper Thoracic

✓ Transdural herniation of the spinal cord, a rare but well-documented entity, has been reported sporadically for more than 25 years as a possible cause for various neurological signs and symptoms ranging from isolated sensory or motor findings to myelopathy and Brown—Séquard syndrome. The authors report, to the best of their knowledge, the first case of upper thoracic spinal cord herniation occurring after traumatic nerve root avulsion.

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A posttraumatic lumbar spinal synovial cyst

Journal of Neurosurgery ◽

10.3171/jns.1987.66.2.0293 ◽

1987 ◽

Vol 66 (2) ◽

pp. 293-296 ◽

Cited By ~ 55

Author(s):

Joel I. Franck ◽

Robert B. King ◽

George R. Petro ◽

Michael D. Kanzer

Keyword(s):

Preoperative Diagnosis ◽

Ligamentum Flavum ◽

Facet Joint ◽

Synovial Cyst ◽

Content Type ◽

Lumbar Spinal ◽

Fine Print

✓ A patient with posttraumatic lumbar radicular paresthesias is presented. The preoperative diagnosis of an epidural synovial cyst was considered. At surgery, an epidural synovial microcystic mass was found emanating from a distracted L4-5 facet joint and dissecting into the layers of the ligamentum flavum. A brief review of the condition is presented.

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Intraspinal cervical degenerative cyst

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.95.1.0139 ◽

2001 ◽

Vol 95 (1) ◽

pp. 139-142 ◽

Cited By ~ 9

Author(s):

Ossama Hatem ◽

Gérard Bedou ◽

Christian Négre ◽

Jean Luis Bertrand ◽

Jean Camo

Keyword(s):

Cyst Wall ◽

Ligamentum Flavum ◽

Facet Joint ◽

The Other ◽

Content Type ◽

Fine Print

✓ The authors report three cases of cervical degenerative cysts causing medullary or radiculomedullary compression. Anatomicopathological examination confirmed the fibrous nature of the cyst wall and the absence of a synovial layer. One of the cysts was embedded in the ligamentum flavum, whereas the other two were most lateral and adherent to the facet joint. The physiopathogenesis of these cysts is discussed.

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Intraosseous glomus tumor of the spine

Journal of Neurosurgery ◽

10.3171/jns.1996.85.2.0344 ◽

1996 ◽

Vol 85 (2) ◽

pp. 344-347 ◽

Cited By ~ 12

Author(s):

James C. Robinson ◽

Scott E. Kilpatrick ◽

David L. Kelly

Keyword(s):

Back Pain ◽

Case Report ◽

Lumbar Spine ◽

Glomus Tumor ◽

Radiographic Findings ◽

Content Type ◽

Glomus Tumors ◽

First Case ◽

Fine Print

✓ The authors report a case of glomus tumor originating within the lumbar spine. Glomus tumors of intraosseous origin are rare, with the only case reported in the spine arising in the sacrum. The patient presented with the solitary complaint of radiating back pain that resolved postoperatively. The histopathological and radiographic findings are reviewed. To the authors' knowledge, this represents the first case report of a glomus tumor of the spine originating above the sacrum.

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Vertebral synovial chondromatosis

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.1.2.0211 ◽

2004 ◽

Vol 1 (2) ◽

pp. 211-218 ◽

Cited By ~ 22

Author(s):

Gary L. Gallia ◽

Nirit Weiss ◽

James N. Campbell ◽

Edward F. McCarthy ◽

Anthony P. Tufaro ◽

...

Keyword(s):

Posterior Approach ◽

Facet Joint ◽

Histopathological Examination ◽

Tumor Resection ◽

Synovial Chondromatosis ◽

Low Grade ◽

Radiographic Findings ◽

Content Type ◽

First Case ◽

Fine Print

✓ Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules within the synovium, most commonly affecting large joints. Its involvement with the spine is rare; only six cases have been reported. The authors describe two patients with synovial chondromatosis involving the cervical spine. In the first case, synovial chondromatosis arose from the left C1–2 facet joint. This patient underwent a two-stage procedure including a posterior approach for tumor resection and occipitocervical fusion as well as a transmandibular circumglossal approach to the anterior craniocervical junction to complete the tumor removal. Interestingly, on histopathological examination, scattered foci of low-grade chondrosarcoma were intermixed within the synovial chondromatosis. To the authors' knowledge, this is the first report of secondary low-grade chondrosarcoma arising in vertebral synovial chondromatosis. In the second case, synovial chondromatosis involved the left C4–5 facet joint. Tumor resection and cervical fusion were performed via a posterior approach. In this report, the authors describe the clinical presentation, radiographic findings, operative details, histopathological features, and clinicoradiological follow-up data obtained in these two patients and review the literature pertaining to this rare entity.

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Thoracic dorsal ramus entrapment

Journal of Neurosurgery ◽

10.3171/jns.1989.70.1.0124 ◽

1989 ◽

Vol 70 (1) ◽

pp. 124-125 ◽

Cited By ~ 3

Author(s):

José M. González-Darder

Keyword(s):

Back Pain ◽

Chronic Back Pain ◽

Transverse Process ◽

Spinal Nerve ◽

Sensory Disturbance ◽

Content Type ◽

Thoracic Spinal ◽

Dorsal Rami ◽

Fine Print

✓ Entrapment of the dorsal ramus of a thoracic spinal nerve is described in a patient with chronic back pain and sensory disturbance in the cutaneous territory served by the T3–5 dorsal rami. The dorsal ramus of the T-4 nerve was found to be compressed by a bone spur involving the inferior T-4 apophyseal facet. The point of entrapment was a tunnel bounded by the transverse process, apophyseal joint, rib, and superior costotransverse ligament.

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