Bilateral lower limb dysfunction due to acute hematoma in the lumbar ligamentum flavum: A case report and literature review.
Bingyi Yang, Huoliang Zheng, Qizhu Chen et al.
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Case in brief
A 71-year-old man developed sudden lower back pain without an identifiable trigger, followed by worsening pain, numbness, and weakness in both legs. MRI on day 8 showed severe L4/5 canal stenosis and cauda equina compression from a posterior mass with mixed signal characteristics. Histopathology and immunohistochemistry identified a ligamentum flavum hematoma with recent angiogenesis and hemorrhage in degenerated tissue. The mass was resected with L4/5 decompression and fusion. Bilateral leg dysfunction improved immediately; at two weeks, strength was grade 5 and symptoms had not recurred.
What made this case unusual
The hematoma was acute and arose without an identifiable trigger, whereas the report notes that most previously described lumbar ligamentum flavum hematomas were chronic.
Diagnostic / clinical pearl
In sudden bilateral leg deficits, consider acute ligamentum flavum hematoma even without trauma. MRI can reveal a compressive posterior mass, while histopathology can confirm the diagnosis.