Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 6125-6129
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.6125
Ligamentum flavum hematoma following a traffic accident: A case report
Dongwoo Yu, Wonho Lee, Min Cheol Chang
Dongwoo Yu, Department of Neurosurgery, College of Medicine, Yeungnam University, Taegu 705-717, South Korea
Wonho Lee, Department of Radiology, Topspine Hospital, Taegu 41931, South Korea
Min Cheol Chang, Department of Physical Medicine and Rehabilitation, Spine Center, College of Medicine, Yeungnam University, Taegu 705-717, South Korea
Author contributions: Yu D, Chang MC conceived the study and carried out the clinical research; Yu D, Lee W, and Chang MC participated in the design of the manuscript; all authors participated in the revision of the manuscript and figure; the authors read and approved the final manuscript.
Supported by the National Research Foundation of Korea Grant funded by the Korean government, No. NRF-2021R1A2C1013073.
Informed consent statement: The patient provided written informed consent for participation.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Cheol Chang, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, Spine Center, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu 705-717, South Korea. wheel633@gmail.com
Received: March 25, 2021
Peer-review started: March 25, 2021
First decision: April 29, 2021
Revised: April 30, 2021
Accepted: May 19, 2021
Article in press: May 19, 2021
Published online: July 26, 2021
Abstract
BACKGROUND

Ligamentum flavum hematoma (LFH) can cause compression of the spinal cord or nerve root, which results in neurological symptoms. We report a case of lumbar radicular pain due to LFH following a traffic accident.

CASE SUMMARY

A 59-year-old man complained of left buttock and lateral thigh pain that was dull in nature after a traffic accident 18 d prior to presentation. Magnetic resonance imaging (MRI), taken 17 d after the traffic accident, revealed a mass lesion at the L4-5 Level. These MRI findings suggested subacute LFH. The patient’s pain was not alleviated with conservative treatment, including oral medication and epidural steroid injection. After a partial-hemilaminectomy and removal of LFH, the patient’s pain completely disappeared.

CONCLUSION

Because early operation for decompression is important for a good outcome, clinicians should be able to determine LFH from MRI results and be aware of the possibility of LFH, especially in patients with a history of trauma.

Keywords: Ligamentum flavum hematoma, Traffic accident, Radicular pain, Laminectomy, Magnetic resonance imaging, Case report

Core Tip: Magnetic resonance imaging is the method of choice for diagnosis of ligamentum flavum hematoma (LFH). In the acute stage of LFH, the hematoma appears hypointense in T2-weighted images and isointense in T1-weighted images. Between 3 and 7 d of LFH, the methemoglobin causes the hematoma to be hyperintense in T1-weighted images. At 1 wk after the onset, the hemolysis of erythrocytes results in the accumulation of extracellular meta-hemoglobin, which appears hyperintense in T1-weighted and T2-weighted images. Also, clinicians should be aware of the possibility of LFH, especially in patients with a history of trauma.