Case report
A cervical ligamentum flavum cyst in an 82-year-old woman presenting with spinal cord compression: a case report and review of the literature
Alexandros G. Brotis, Eftychia Z. Kapsalaki, Evangelos K. Papadopoulos and Kostas N. Fountas
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Journal of Medical Case Reports 2012, 6:92 doi:10.1186/1752-1947-6-92
Published: 29 March 2012
Abstract (provisional)
Introduction
We report on a very rare case of a cervical ligamentum flavum cyst, which presented
with progressive myelopathy and radiculopathy. The cyst was radically extirpated and
our patient showed significant recovery. A review of the relevant literature yielded
seven cases.
Case presentation
An 82-year-old Greek woman presented with progressive bilateral weakness of her upper
extremities and causalgia, cervical pain, episodes of upper extremity numbness and
significant walking difficulties. Her neurological examination showed diffusely decreased
motor strength in both her upper and lower extremities. Magnetic resonance imaging
of her cervical spine demonstrated a large, well-demarcated cystic lesion on the dorsal
aspect of her spinal cord at the C3 to C4 level, significantly compressing the spinal
cord at this level, in close proximity to the yellow ligament and the C3 left lamina.
The largest diameter of this lesion was 1.4cm, and there was no lesion enhancement
after the intravenous administration of a paramagnetic contrast. The lesion was surgically
removed after a bilateral C3 laminectomy. The thick cystic wall was yellow and fibro-elastic
in consistency, while its content was gelatinous and yellow-brownish. A postoperative
cervical-spine magnetic resonance image was obtained before her discharge, demonstrating
decompression of her spinal cord and dural expansion. Her six-month follow-up evaluation
revealed complete resolution of her walking difficulties, improvement in the muscle
strength of her arms (4+/5 in all the affected muscle groups), no causalgia and a
significant decrease in her preoperative upper extremity numbness.
Conclusion
Cervical ligamentum flavum cysts are rare benign lesions, which should be included
in the list of differential diagnosis of spinal cystic lesions. They can be differentiated
from other intracanalicular lesions by their hypointense appearance on T1-weighted
and hyperintense appearance on T2-weighted magnetic resonance images, with contrast
enhancement of the cystic wall. Surgical extirpation of the cyst is required for symptom
alleviation and decompression of the spinal cord. The outcome of these cysts is excellent
with no risk of recurrence.
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