Korean J Neurotrauma.  2018 Apr;14(1):43-46. 10.13004/kjnt.2018.14.1.43.

Thickening Ligamentum Flavum Mimicking Tumor in the Epidural Space of the Cervical Spine

• Bae SH
• Son DW
• Kwon OI
• Lee SH
• Lee JS
• Song GS

• KMID: 2410922
• DOI: http://doi.org/10.13004/kjnt.2018.14.1.43

Abstract

In patients with tumors and spinal cord lesions, inflammation and tissue infection can result in mass effect detection on imaging. As a result, surgical biopsy procedures are often performed on the lesions. We report a rare case in which the thickening ligamentum flavum (LF) appeared to be a tumor in the epidural space of the cervical spine based on imaging findings. A 52-year-old man visited our outpatient clinic with severe shoulder pain and radicular pain in his right arm that had developed gradually after a traffic accident two months earlier. Magnetic resonance imaging of the cervical spine revealed an extradural mass at the cervicothoracic junction level. Suspecting a tumor, spinal decompression surgery was performed and a biopsy of the mass was obtained. At the time of surgery, the LF was thick and compressed the spinal cord. After successful removal of the LF, the spinal cord appeared normal. Histopathological examination confirmed the mass as the LF. The patient was discharged without pain or weakness two weeks postoperatively. This case demonstrated that when the LF of the cervicothoracic junction is thickened, it may be misdiagnosed as a cervical spine tumor compressing the spinal cord.

Keyword

Cervical vertebrae; Ligamentum flavum; Radiculopathy; Spinal cord compression

MeSH Terms

Accidents, Traffic
Ambulatory Care Facilities
Arm
Biopsy
Cervical Vertebrae
Decompression
Epidural Space*
Female
Humans
Inflammation
Ligamentum Flavum*
Magnetic Resonance Imaging
Middle Aged
Radiculopathy
Shoulder Pain
Spinal Cord
Spinal Cord Compression
Spine*

Figure

• 

  FIGURE 1 Preoperative T2-weighted magnetic resonance images (MRIs): (A) sagittal and (B) axial views. T1-weighted MRIs with gadolinium: (C) sagittal and (D) axial views. The images revealed an extradural mass at the right epidural space of the C7-T1 level.

• 

  FIGURE 2 (A) Intraoperative photograph showing the hard and stiff epidural mass (arrow) compressed the spinal cord. (B) After careful removal of the epidural mass using a dissector and punch, the spinal cord appeared normal.

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  FIGURE 3 Postoperative T2-weighted magnetic resonance images (MRIs): (A) sagittal and (B) axial views. T1-weighted MRIs with gadolinium: (C) sagittal and (D) axial views. The images revealed remarkable resolution of the mass after right hemilaminectomy.

• 

  FIGURE 4 Microscopic photograph of the section from the resected mass compressing the spinal cord, original magnification ×100. The resected mass was a ligamentum flavum, containing elastic fibers with irregular arrangement, reduced elastic components, and increased collagen tissue.

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