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At least 19 recordsLinked to original sources
PubMed2002

Thoracic cord compression due to ossified hypertrophied ligamentum flavum.

Ossified ligamentum flavum is increasingly appreciated as an important cause of thoracic myeloradiculopathy. Fifteen patients with age ranging from 30-61 years were studied. Fourteen presented with spastic paraparesis, and radiculopathy was the only complaint in one patient. Routine skiagrams and myelograms showed non-specific changes. Baseline CT and CT myelogram, however, documented the ossification of ligamentum flavum comprehensively. MRI was done in three patients. Multiple levels of the disease were seen in two cases. Four patients had ossified posterior longitudinal ligament. Thickened ligamentum flavum should be considered as an important cause of thoracic cord compression.

Adult↗
PubMed1993

[Ossification and calcification of the cervical ligamentum flavum--case reports].

Ossification of ligamentum flavum was reported usually lower thoracic and lumbar region, and rarely seen in the cervical region. Calcification of cervical ligamentum flavum is also relatively rare. We report a case of ossification and another of calcification of cervical ligamentum flavum, and discussed the difference of the clinical and radiological features in these conditions. Case 1: A 55-year-old man presented with numbness of the left shoulder and urinary dysfunction. Neurological examination revealed weakness, muscle atrophy and elevated deep tendon reflexes of the left extremities. CT showed ossified mass protruding into the right side of the canal and compressing the spinal cord at C 3/4 and C 4/5. MRI showed low intensity mass both on T1- and T2-weighted images and severe compression of the spinal cord. Left side partial hemilaminectomy with foraminotomy, so called "key hole" foraminotomy, satisfactorily decompressed the cord with clinical improvement. Case 2: A 70-year-old woman complained numbness of both hands for two years. She had sensory disturbance of both hands and spastic gait disturbance. Cervical X-ray films showed calcified nodules on the inner surface of lamina at C4/5. Axial CT demonstrated calcification in the ligamentum flavum at the C4/5 and C5/6 levels. MRI showed posterior spinal cord compression at the C4/5 and C5/6 levels. Osteoplastic laminotomy and removal of the affected ligamentum flavum were performed with successful result. Only 8 cases ossification of cervical ligamentum flavum above C6/7 have been so far reported. All are Japanese; four male and four female cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

Morphological changes of the ligamentum flavum as a cause of nerve root compression.

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.

Aged↗
PubMed2005

Symptomatic hematoma of cervical ligamentum flavum: case report.

STUDY DESIGN: A case of symptomatic hematoma of cervical ligamentum flavum. OBJECTIVE: To report the first ligamentum flavum hematoma in the cervical spine and review the reported cases. SUMMARY OF BACKGROUND DATA: A herniated nucleus pulposis, spondylosis, epidural hematoma or abscess, neoplasm, or some pathology of the ligamentum flavum, such as hypertrophy, ossification, or calcification, are the most common causes of spinal cord and nerve root compression. A ligamentum flavum hematoma has also been reported as a cause of compression of the cauda equina and lumbar nerve roots but has never been found in the cervical spine. METHODS: A 72-year-old man presented with left upper arm pain and left hemiparesis following traditional massage therapy. Admission magnetic resonance images showed a posterior oval-shaped mass that was continuous with the ligamentum flavum at C3-C4 level. RESULTS: A C3-C4 laminectomy for decompression and resection of the lesion was performed. One year after surgery, the patient remained neurologically intact and symptom-free. CONCLUSIONS: Hematoma of the ligamentum flavum occurring in the cervical spine has never been reported previously. Repeated trivial injury on a degenerative ligamentum flavum might be the leading predisposing factor. Spine surgeons should be aware of a hematoma in the ligamentum flavum as a possible cause of spinal cord or root compression, especially in the mobile cervical and lumbar spine.

Aged↗
PubMed1993

Calcification inhibitors in human ligamentum flavum.

To examine the presence of substances which inhibit calcification in human ligamentum flavum, the inhibitory effect of an Na2HPO4 extract of the flavum was determined in terms of the in vitro calcium uptake of the ligamentum flavum matrix. Additionally, grafts of extracted and non-extracted dry ligamentum flavum matrices were transplanted into the dorsal muscles of rats, and calcification in the grafts was examined radiologically and histochemically. In order to determine if component cells of human ligamentum flavum produce calcification inhibitors, ligamentum flavum cells were cultured, and the crystal inhibitor activity of the culture medium was measured by a seed test which used hydroxyapatite as the nucleus of precipitation. The calcification reaction system demonstrated that the ligamentum flavum extract contains an inhibitory factor for calcium uptake by the ligamentum flavum matrix. The seed test revealed that human ligamentum flavum cells produce calcification inhibitor activity.

Adolescent↗
PubMed2002

Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique.

BACKGROUND: The ligamentum flavum is the anatomic plane between the epidural and laminar-extralaminar spaces, which should be meticulously preserved for a possible reoperation. Preservation of the ligamentum flavum together with other epidural anatomic structures, such as epidural fat tissue and venous plexuses, and limited removal of the lamina are important components in preventing epidural fibrosis that may be the cause of failed back surgery syndrome. METHODS: One thousand five hundred patients underwent microdiskectomy with preservation of the ligamentum flavum over an 8-year period. This technique was performed with a small incision using an 18 mm-width mini Taylor retractor. The ligamentum flavum was released and preserved as a 3-sided flap. The disk content was totally removed and a pediculated fat graft was used to cover the root at the end. Four hundred patients operated on with the ligamentum flavum preserving technique were randomly selected for this study (Group 1). Their results were compared with those of 200 patients who were operated on with the standard microdiskectomy (Group 2). Standard microdiskectomy technique was performed with fenestration and foraminotomy and the ligamentum flavum was partially or totally excised. Early clinical outcome was classified as excellent, good, fair, poor, or failure. The clinical mean follow-up period in Group 1 was 36.8 months and in Group 2 it was 32.4 months. One hundred patients from each group had computed tomographic scans with contrast administration performed at least one year after the operation to examine late epidural fibrosis. A questionnaire was given to all patients at least 3 times during the late follow-up period. The questionnaire required patients to describe their relief of pain, job performance, and abstinence from narcotic analgesic use. RESULTS: Early clinical outcome (fourth postoperative week) in Group 1 was satisfactory in 96.75% of the patients, whereas it was satisfactory in only 81.5% in Group 2 (p < 0.001). The radiological examinations revealed fibrosis in 18% of the patients in Group 1 and 37% in Group 2 (p < 0.001). None of the patients in Group 1 were readmitted because of fibrosis-related symptoms. The reoperation rate in Group 1 was 4.5%. The recurrence rate was 1.75% and disc at another level was 2.5%. One patient was reoperated because of a suture granuloma. In Group 2, the reoperation rate was 9% (p < 0.05). The recurrence rate was 4.5%, disc at another level was 3.5% and extensive epidural fibrosis was 1%. Two patients who underwent surgery for epidural fibrosis in this group had disappointing outcomes. Overall success rate based on the questionnaire was 91% in Group 1 and 76% in Group 2 (p < 0.001). CONCLUSIONS: The ligamentum flavum preserving technique is useful in achieving a favorable long-term outcome, and reoperation, if necessary, is easier and safer.

Adult↗
PubMed2006

Case reports: a rare cause of radicular complaints: ligamentum flavum hematoma.

Hematomas in the lumbar ligamentum flavum are rare and may generate signs and symptoms of lumbar nerve root compression or neurogenic claudication similar to the far more common degenerative diseases. The pathogenesis of these hematomas is unclear. Ruptured irregular vessels of the degenerated and hypertrophic ligamentum flavum were assumed. We diagnosed three patients with a flavum hematoma intraoperatively leading to radicular complaints and spinal claudication. One occurred as a complication of local infiltration therapy, and the other two patients reported minor trauma as the releasing factor. Using spinal magnetic resonance imaging, a preoperative diagnosis is possible but the differentiation to synovial cysts is difficult. Surgical resection of the ligamentum flavum, including the hematoma, provided adequate treatment in these patients.

Diagnosis, Differential↗
PubMed2004

The pathology of ligamentum flavum in degenerative lumbar disease.

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.

Aged↗
PubMed1996

The anatomy of the human lumbar ligamentum flavum. New observations and their surgical importance.

STUDY DESIGN: An anatomic study was performed to investigate the ligamentum flavum of the human lumbar spine. OBJECTIVES: To describe accurately the interlaminar portion of ligamentum flavum, and to determine if there is an insertion onto the anterosuperior surface of the caudal lamina. SUMMARY OF BACKGROUND DATA: The insertions of the ligamentum flavum onto its adjacent laminas were classically described by Naffzinger. His description has been recounted by others. It has been the authors' observation that there is a slip of inferior ligamentum flavum that inserts onto the anterosuperior surface of the caudal lamina. Review of the literature revealed only anecdotal observations that support the authors' finding. A clear anatomic description of this structure is important to the surgeon who frequently enters the spinal canal at this anatomic site. METHODS: Thirty human lumbar ligamenta flava from six fresh frozen lumbar spines were studied macroscopically, with particular attention paid to the insertions onto the adjacent laminas. RESULTS: The ligamentum flavum consists of a superficial and a deep component. It is continuous in the midline. The superficial ligamentum flavum inserts onto the superior edge and posterosuperior surface of the caudal lamina. The deep ligamentum flavum inserts for a variable distance onto the anterosuperior surface of the caudal lamina. CONCLUSIONS: There is an inferoventral slip of the ligamentum flavum that attaches to the anterosuperior surface of the caudal lamina. This slip is the inferior portion of the deep ligamentum flavum. When the ligamentum flavum's superficial layer is selectively released, the inferoventral slip of the ligamentum flavum's deep layer remains attached to the anterosuperior surface of the caudal lamina and remains between the surgeon and the dura.

Anatomy, Cross-Sectional↗
PubMed2005

Hypertrophy of ligamentum flavum in lumbar spinal stenosis associated with increased proteinase inhibitor concentration.

BACKGROUND: It is well known that age-related fibrosis, or decreases in the elastin-to-collagen ratio of the ligamentum flavum, along with hypertrophy of the ligamentum flavum, are associated with lumbar spinal stenosis. However, the molecular mechanism by which this fibrosis and hypertrophy develop is unknown. Tissue inhibitors of matrix metalloproteinase (TIMPs) are proteinase inhibitors that suppress extracellular matrix degradation. Elevated TIMP-1 and TIMP-2 expression has been implicated in various fibrotic diseases of the liver, kidney, lung, and heart. These TIMPs can also induce cellular proliferation and inhibit apoptosis in a wide range of cell types. These findings led us to postulate that TIMP-1 and TIMP-2 might also be associated with hypertrophy and fibrosis of the ligamentum flavum in lumbar spinal stenosis. METHODS: We quantified and localized TIMP expression in ligamentum flavum tissues that had been obtained during surgery from thirty patients with spinal stenosis and from thirty gender-matched control patients with disc herniation. The thickness of the ligamentum flavum at the level of the facet joint was measured on axial T1-weighted magnetic resonance images. In addition, we examined ligamentum flavum tissues for the expression of markers of cellular proliferation and apoptosis. RESULTS: The ligamentum flavum was significantly thicker in the patients with spinal stenosis (mean, 5.68 mm) than in the patients with disc herniation (mean, 2.70 mm) (p < 0.001). The concentration of TIMP-2 in the ligamentum flavum was significantly higher in the patients with spinal stenosis (mean, 12.62 ng/mL) than in those with disc herniation (mean, 8.85 ng/mL) (p = 0.028). TIMP-1 and TIMP-2 were detected in the cytoplasm of ligamentum flavum fibroblasts. TIMP-1 and TIMP-2 concentrations were associated with hypertrophy of the ligamentum flavum (p = 0.015 and p = 0.003, respectively). None of the samples from the patients with stenosis had evidence of proliferation of ligamentum flavum fibroblasts. The expression of markers for apoptosis was significantly higher in the patients with spinal stenosis (58.8%) than in those with disc herniation (26.6%) (p < 0.001). CONCLUSIONS: Increased TIMP expression has been implicated in fibrosis and hypertrophy of the extracellular matrix of several organs. Our results suggest that increased expression of TIMP-2 in ligamentum flavum fibroblasts is associated with fibrosis and hypertrophy of the ligamentum flavum in patients with spinal stenosis.

Aged↗
PubMed2005

Ligamentum flavum hematoma in the rigid thoracic spinal segments: case report.

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.

Aged↗
PubMed1994

[Histological investigation of the ligamentum flavum].

The micro- and ultrastructures of the human ligamentum flavum were investigated. It was found that the ligamentum flavum is made of chiefly of elastic fibers. This kind of structure provides a basis for the important physiological functions of the ligamentum flavum. So the load is transmitted between the vertebrae and spinal stability is maintained by means of this ligament. Then clinical relevance was discussed.

Adult↗
PubMedDate not supplied

Lumbar spinal stenosis and spondylosis associated with amyloid deposition in the ligamentum flavum.

Thickening (hypertrophy) of the ligamentum flavium is one of the many anatomical abnormalities associated with lumbar stenosis and spondylosis. In twelve of 97 patients who had decompression laminectomy the thickened ligamentum flavum contained abundant amyloid in both light and electronmicroscopic preparations. Since the cases were collected over a period of two years from the practice of a single neurosurgeon, its appears to be a common finding, and is age related. In all cases CT and MR scans showed a prominent ligamentum flavum. Nevertheless, there was not a well-defined clinicopathological correlation. The pathogenesis is not clear.

Aged↗
PubMed2004

The incidence of lumbar ligamentum flavum midline gaps.

UNLABELLED: Lumbar epidural anesthesia and analgesia has gained increasing importance in perioperative pain therapy for abdominal and lower limb surgery. The loss-of-resistance technique, used to identify the epidural space, is thought to rely on the penetration of the ligamentum flavum. However, the exact morphology of the ligamentum flavum at different vertebral levels remains controversial. Therefore, in this study, we directly investigated the incidence of lumbar ligamentum flavum midline gaps in embalmed cadavers. Vertebral column specimens were obtained from 45 human cadavers. On each dissected level, ligamentum flavum midline gaps were recorded. The incidence of midline gaps per number of viable specimens at the following levels was: L1-2 = 10 of 45 (22.2%), L2-3 = 5 of 44 (11.4%), L3-4 = 5 of 45 (11.1%), L4-5 = 4 of 43 (9.3%), L5/S1 = 0 of 33 (0%). In conclusion, the present study determined the frequency of lumbar ligamentum flavum midline gaps. Gaps in the lumbar ligamentum flavum are most frequent between L1 and L2 but are more rare below this level. When using the midline approach, the ligamentum flavum may not impede entering the epidural space in all patients. IMPLICATIONS: The ligamentum flavum is a crucial anatomical landmark for the safe performance of epidural anesthesia. However, the present study demonstrates some failure of the lumbar ligamentum flavum as a landmark. This may mean that, using a midline approach, one cannot always rely on the ligamentum flavum as a perceptible barrier to epidural needle advancement.

Cadaver↗
PubMed2001

Quantitative analysis of transforming growth factor-beta 1 in ligamentum flavum of lumbar spinal stenosis and disc herniation.

STUDY DESIGN: The concentration of transforming growth factor-beta 1 (TGF-beta1) was examined in the ligamentum flavum of lumbar spinal stenosis and disc herniation. OBJECTIVE: To investigate the role of TGF-beta1 on hypertrophy of the ligamentum flavum in lumbar spinal stenosis compared with that of lumbar disc herniation. SUMMARY OF BACKGROUND DATA: The hypertrophy of the ligamentum flavum is known to be related to degenerative changes that are secondary to the aging process or mechanical instability. However, there has been no study to investigate the effect of biochemical factors, such as growth factors, associated with hypertrophy of the ligamentum flavum. METHODS: The concentrations of TGF-beta1 were analyzed in the surgically obtained ligamentum flavum specimens from lumbar spinal stenosis (n = 10; mean age 62.8 years) and disc herniation (n = 10; mean age 35.6 years) by enzyme-linked immunosorbent assay. The localization of TGF-beta1 within the ligamentum flavum was determined using immunohistochemical study. The thickness of the ligamentum flavum was measured with axial T1-weighted magnetic resonance imaging. The biochemical and radiologic results were compared for these two conditions. RESULTS: The mean concentration of TGF-beta1 was 123.78 pg/100 microg protein (range 11-374 pg/100 microg protein) in lumbar spinal stenosis and 38.56 pg/100 microg protein (range 0-155 pg/100 microg protein) in lumbar disc herniation; the difference between lumbar spinal stenosis and disc herniation was statistically significant (P = 0.029). The mean thickness of the ligamentum flavum was 4.44 mm (range 3.4-5.4 mm) in lumbar spinal stenosis and 2.44 mm (range 1.8-4.0 mm) in lumbar disc herniation; the difference between lumbar spinal stenosis and disc herniation was statistically significant (P = 0.001). On immunohistochemical study TGF-beta1 was positively stained on the fibroblasts within the ligamentum flavum specimens. CONCLUSION: The current results suggest that higher expression of TGF-beta1 by fibroblasts might be related to the development of hypertrophy of the ligamentum flavum in lumbar spinal stenosis.

Aged↗
PubMed2005

Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments.

STUDY DESIGN: A multidisciplinary study involving clinical, histologic, biomechanical, biologic, and immunohistologic approaches. OBJECTIVE.: To clarify the pathomechanism of hypertrophy of the ligamentum flavum. SUMMARY OF BACKGROUND DATA: The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain, and paresis. Canal narrowing, in part, results from hypertrophy of the ligamentum flavum. Although histologic and biologic literature on this topic is available, the pathomechanism of ligamentum flavum hypertrophy is still unknown. METHODS: The thickness of 308 ligamenta flava at L2/3, L3/4, L4/5, and L5/S1 levels of 77 patients was measured using magnetic resonance imaging. The relationships between thickness, age, and level were evaluated. Histologic evaluation was performed on 20 ligamentum flavum samples, which were collected during surgery. Trichrome and Verhoeff-van Gieson elastic stains were performed for each ligamentum flavum to understand the degree of fibrosis and elastic fiber status, respectively. To understand the mechanical stresses in various layers of ligamentum flavum, a 3-dimensional finite element model was used. Von Mises stresses were computed, and values between dural and dorsal layers were compared. There were 10 ligamenta flava collected for biologic assessment. Using real-time reverse transcriptase polymerase chain reaction, transforming growth factor (TGF)-beta messenger ribonucleic acid expression was quantitatively measured. The cellular location of TGF-beta was also confirmed from 18 ligamenta flava using immunohistologic techniques. RESULTS: The ligamentum flavum thickness increased with age, however, the increment at L4/5 and L3/4 levels was larger than at L2/3 and L5/S1 levels. Histology showed that as the ligamentum flavum thickness increased, fibrosis increased and elastic fibers decreased. This tendency was more predominant along the dorsal side. Von Misses stresses revealed that the dorsal fibers of ligamentum flavum were subjected to higher stress than the dural fibers. This was most remarkably observed at L4/5. The largest increase in ratio observed between the dorsal and dural layer was approximately 5-fold in flexion at L4/5 in flexion. Expression of TGF-beta was observed in all ligamenta flava, however, the expression decreased as the ligamentum flavum thickness increased. Immunohistochemistry showed that TGF-beta was released by the endothelial cells, not by fibroblasts. CONCLUSIONS: Fibrosis is the main cause of ligamentum flavum hypertrophy, and fibrosis is caused by the accumulation of mechanical stress with the aging process, especially along the dorsal aspect of the ligamentum flavum. TGF-beta released by the endothelial cells may stimulate fibrosis, especially during the early phase of hypertrophy.

Adolescent↗
PubMed2001

Thoracic myelopathy secondary to ossified ligamentum flavum.

BACKGROUND: Focal ossification of the ligamentum flavum (OLF) forms one of the rare causes of thoracic myelopathy. The lower thoracic spine is most frequently affected and the patients present with initial posterior column disturbances followed by progressively increasing spastic paraparesis. The pathogenesis of OLF has not been conclusively established. METHOD: Five patients with thoracic myelopathy due to OLF underwent decompressive laminectomy and excision of the ligamentum flavum. Their MRI delineated a linear or beak like excrescence, uniformly hypo-intense on T1 and T2 weighted images, situated posterior to the thecal sac. A comparison between the preoperative neurological status and the status at follow-up was done using Harsh's myelopathic grading. FINDING: Decompressive laminectomy followed by the drilling of the OLF and its excision, occasionally along with the adherent outer layer of the dura, resulted in significant improvement in motor weakness and tingling sensations. However, at the last available follow-up, none of the patients had retained their ability to run briskly (grade I) and all of them had residual spasticity. INTERPRETATION: OLF may significantly contribute to a spatial reduction of the thoracic spinal canal resulting in paraparesis. The T2 weighted sagittal image of the magnetic resonance imaging (MRI) is the modality of choice for screening of the longitudinal extent of the OLF. A rapid neurological improvement occurs following decompressive laminectomy and excision of the OLF. However, the persistence of residual spasticity at follow-up may be due to irreversible changes within the cord by the significant thecal compression and the delay between the onset of initial symptoms and signs and surgical decompression.

Adult↗
PubMed1988

Ligamentum flavum: appearance on sagittal and coronal MR images.

The appearance of the ligamentum flavum on sagittal and coronal magnetic resonance (MR) images has not been described in detail in the radiologic literature. The authors reviewed correlative MR images and anatomic sections obtained with a cryomicrotome in 20 cadavers in order to analyze anatomic relationships, variations, and progressive degenerative changes of the ligamentum flavum in the lumbar region. MR imaging showed the ligamentum flavum as an intermediate-signal-intensity structure on images obtained with short and long repetition times (TRs). Sagittal short TR images were effective for evaluating relationships between the ligamentum flavum, spinal canal, and nerve roots. Degenerative changes in the ligamentum flavum appeared as changes in shape or thickness of the ligaments on MR images. Calcification and fat infiltration, which were well depicted on anatomic sections, were not visualized on MR images.

Cadaver↗