Non-traumatic rupture of the ligamentum flavum with symptomatic spontaneous lumbar epidural hematoma: A case report

Ashwin G. Ramayya, MD, PhD; Alejandro Carrasquilla, BS; Frederick L. Hitti, MD, PhD; Peter J. Madsen, MD; Jayesh P. Thawani, MD; Kimberly Imbesi, MD; Michael Trotter, MD; David K. Kung, MD; James Schuster, MD, PhD

Interdisciplinary Neurosurgery (Jun 2019)

Non-traumatic rupture of the ligamentum flavum with symptomatic spontaneous lumbar epidural hematoma: A case report

Ashwin G. Ramayya, MD, PhD,
Alejandro Carrasquilla, BS,
Frederick L. Hitti, MD, PhD,
Peter J. Madsen, MD,
Jayesh P. Thawani, MD,
Kimberly Imbesi, MD,
Michael Trotter, MD,
David K. Kung, MD,
James Schuster, MD, PhD

Affiliations

Ashwin G. Ramayya, MD, PhD: Department of Neurosurgery, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States; Corresponding author at: 3400 Spruce St., Philadelphia, PA 19103, USA
Alejandro Carrasquilla, BS: Perelman School of Medicine, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States
Frederick L. Hitti, MD, PhD: Department of Neurosurgery, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States
Peter J. Madsen, MD: Department of Neurosurgery, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States
Jayesh P. Thawani, MD: Department of Neurosurgery, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States
Kimberly Imbesi, MD: Department of Emergency Medicine, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States
Michael Trotter, MD: Department of Emergency Medicine, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States
David K. Kung, MD: Department of Neurosurgery, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States
James Schuster, MD, PhD: Department of Neurosurgery, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, United States

Journal volume & issue: Vol. 16
pp. 51 – 53

Abstract

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We present a case of a healthy 31 year-old male plumber who presented to the emergency room with acute onset back pain that acutely developed after simply bending over. He developed radiculopathy and cauda equina syndrome over a period of hours. An MRI demonstrated an acute lumbar epidural hematoma and a disruption of the ligamentum flavum, suggesting that he may have torn the ligament with lumbar flexion. The patient was taken to the operating room for an emergent lumbar decompression and recovered full neurological function post-operatively. To our knowledge, this is the first report of a spontaneous symptomatic lumbar epidural hematoma resulting from a non-traumatic ligamentum flavum rupture. Keywords: Ligamentum flavum rupture, Epidural hematoma, Cauda equina syndrome, Back pain

Published in Interdisciplinary Neurosurgery

ISSN: 2214-7519 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system
Website: http://www.journals.elsevier.com/interdisciplinary-neurosurgery/

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