Chronic subdural hematoma coexisting with ligamentum flavum hematoma in the lumbar spine: a case report.

摘要

We present a case of a chronic spinal subdural hematoma combined with a ligamentum flavum hematoma in the lumbar spine treated surgically. An 83-year-old woman receiving antiplatelet medicine due to an angina suffered from pain in her lower extremity and gait disturbance after a backward fall. Radiological findings including magnetic resonance imaging (MRI) revealed hematoma in the ligamentum flavum at the level of L2 - L3 and a chronic subdural hematoma at the level from L3 to L5. Laminectomy through L2 to L5 was performed and a hematoma existing in the ligamentum flavum and cystic mass was removed. A chronic subdural hematoma was spontaneously evacuated after splitting of the dura mater and an intact arachnoid membrane was observed with no leakage of cerebrospinal fluid. Her clinical symptoms completely disappeared after surgery. To the best of our knowledge, this is the first case of combination of chronic subdural hematoma and ligamentum flavum hematoma in the lumbar spine treated by surgery. Chronic spinal subdural hematoma and hematoma in the ligamentum flavum should be considered as a cause of progressive nerve root compression in patients with anticoagulant therapy, and an appropriate pre-operative diagnosis would be needed to achieve complete decompression of subdural and epidural hematoma.