Lumbar ligamentum flavum hematoma treated with endoscopy.

The research focused on a hematoma in the ligamentum flavum, treated for the first time using endoscopic decompression rather than traditional surgical methods. The patient fully recovered after the procedure, indicating the potential of this approach for future cases of the same condition.

Introduction and Purpose of the Study

• A hematoma in the ligamentum flavum, which causes neural compression, is a rare condition typically treated through open surgical procedures, either total laminectomy or bilateral partial laminectomy.
• The study aims to explore a novel treatment approach. It documents the first case of a microscope-assisted endoscopic decompression used to remove a hematoma from the ligamentum flavum.

Case Presentation

• The patient was a 52-year-old male who came in presenting symptoms of back and leg pain and had difficulty starting to urinate.
• An MRI scan revealed an epidural mass at the L5/S1 level, which was continuous with the facet joint.
• During the surgical procedure, the doctors saw a reddish tan-brown solid mass located beneath the ligamentum flavum via an endoscope. Using the endoscope, they successfully decompressed the cauda equine and nerve roots.
• The patient’s leg pain decreased and bladder function improved shortly after the decompression.
• A histological examination of the ligamentum flavum later revealed that the mass was a consolidated hematoma with granulomatous change.

Discussion and Literature Review

• The researchers conducted a review of the English literature and found 29 cases of hematoma in the lumbar ligamentum flavum.
• Prior surgical decompression in these patients was accomplished through standard open methods including hemilaminectomy (in 11 cases), total laminectomy (in 10 cases), or laminectomy followed by posterior fixation (in 3 cases).
• There were no recorded incidents of the hematoma in the lumbar ligamentum flavum being treated endoscopically.

Conclusion and Implications

• This case study could influence the future management of the same condition. The successful implementation of endoscopic decompression in treating a hematoma in the ligamentum flavum may lead to the expansion of the use of endoscopes in spine surgeries and potentially replace the traditional open surgical methods.