WITHDRAWN: Bilateral lower limb dysfunction due to acute hematoma in the lumbar ligamentum flavum: Case report and literature review

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Study design Case report and literature review. Objective To describe an unusual case of acute hematoma in the lumbar ligamentum flavum causing bilateral lower limb dysfunction. Summary of Background Data: There have been several reports of lumbar yellow ligament hematomas leading to cauda equina and/or nerve root compression. However, based on clinical history and histological findings, most of these cases involve chronic hematomas. Acute lumbar yellow ligament hematomas causing nerve compression are relatively rare. Methods A 71-year-old male presented with sudden onset of low back pain and worsening bilateral lower limb dysfunction. Magnetic resonance imaging (MRI) on the 8th day after the onset of symptoms revealed severe stenosis of the L4/5 spinal canal and cauda equina compression caused by a posterior mass, which appeared as a high signal on T1-weighted images and a low signal with nodular and ring-like high signals on T2-weighted images. Due to these neurological findings, surgical exploration and resection of the intradural mass were performed on the 9th day after symptom onset. Results The surgical treatment was successful, and the severe bilateral lower limb dysfunction improved immediately after the surgery. Histological and immunohistochemical examination showed recent angiogenesis and hemorrhage in the degenerated yellow ligament. These findings were supported by the preoperative MRI. Two weeks after surgery, the patient had a follow-up, with muscle strength restored to grade 5 and no recurrence of symptoms. Conclusion The patient developed symptoms without any obvious trigger, and the MRI clearly showed changes in signal intensity, indicating that the acute hematoma in the yellow ligament was the cause of the sudden onset of bilateral lower limb dysfunction. Mini Abstract The ligamentum flavum may undergo various pathologic changes, including hypertrophy, calcification, ossification and cyst formation. Therefore, ligamentum flavum hematoma is an exceptionally rare spinal epidural compressive lesion and usually occurs in the lumbar spine. We report a 71-year-old man who developed bilateral lower limb dysfunction due to LFH, with MRI showing typical lesion intensity characteristics.

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