Hematoma of the ligamentum flavum in the thoracic spine: report of two cases and possible role of the transforming growth factor beta-vascular endothelial growth factor signaling axis in its pathogenesis

Matsumoto, Yoshihiro; Fujiwara, Toshifumi; Imamura, Ryuta; Okada, Yuko; Harimaya, Katsumi; Doi, Takehiko; Kawaguchi, Kohei; Okada, Seiji; Yamada, Yuichi; Oda, Yoshinao; Iwamoto, Yukihide

doi:10.1007/s00776-011-0150-3

Cited by 6 publications

(7 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding the inducement (external factor) of LFH in the lower thoracic spine of the mobile segment and lumbar spine, studies have speculated that the rupture of proliferated capillaries in the degenerated LF is induced by minor back trauma [ 12 ], exercise [ 13 - 16 ], physical exertion [ 3 , 5 , 9 , 13 , 15 , 16 ], or other unknown reasons [ 2 , 4 , 7 , 17 - 19 ] as also shown in this study. Furthermore, many studies have reported that patients with LFH had a medical history of hypertension (50% of patients with LFH whose past medical histories were described in the literature) [ 4 , 9 , 12 , 14 , 16 , 18 , 19 ] as our case did, and the elevation of intra-capillary pressure may induce the spontaneous rupture of the capillaries in the LF resulting in LFH.…”

Section: Discussionmentioning

confidence: 99%

Ligamentum Flavum Hematoma Accompanied by Intraspinal and Extraspinal Hematomas: A Case Report

Sugita¹,

Tomari²,

Kitahara³

et al. 2023

Cureus

View full text Add to dashboard Cite

Studies on ligamentum flavum hematoma (LFH) have been gradually increasing; however, no study has reported an LFH spreading to the intraspinal and extraspinal spaces. The purpose of this report is to discuss this rare condition and report that extraspinal hematoma can be formed by LFH. The authors present the case of a 78-year-old man presented with right L5 radiculopathy caused by a space-occupying lesion with intraspinal and extraspinal expansions at the L4-L5 vertebral levels demonstrated on MRI. We tentatively diagnosed these lesions as intraspinal and extraspinal hematomas originating from the ligamentum flavum based on the chronological changes seen on MRI and computed tomography-based needle biopsy. After the extirpation of these lesions, the symptoms were relieved. Three months later, the patient could walk without a cane. From the intraoperative findings and pathological examination, we concluded that the extraspinal hematoma in paravertebral muscle was caused by an LFH of unknown etiology. This case report describes the difficulty in diagnosing LFH accompanied by an extraspinal hematoma with wide-spreading expansion and highlights the usefulness of repetitive MRI over time in capturing chronological changes of the hematoma. As far as we know, this is the first study on an LFH accompanied by an extraspinal hematoma in the multifidus.

show abstract

Section: Discussionmentioning

confidence: 99%

Ligamentum Flavum Hematoma Accompanied by Intraspinal and Extraspinal Hematomas: A Case Report

Sugita¹,

Tomari²,

Kitahara³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…In the literature, the majority of reported cases of LFH have been seen in the mobile lumbar spine and cervical spine. [ 21 31 ] However, in these reported cases, the lumbar spine was the prominent involvement location [ Table 6 ]. It is suggested that the reason for this is that the lumbar spine is stressed more often by load-bearing forces than the thoracic spine and the cervical spine.…”

Section: Discussionmentioning

confidence: 99%

“…Common pathological findings in the degenerated LF are dispersed ligamental elastic fibers, increased collagen tissues, granulation of fibrous tissues, lymphocyte infiltration, and small capillary proliferations. [ 21 ] Although prior studies have been performed in this area, the pathophysiology of loss of elasticity and hypertrophy is not completely understood. [ 44 ] During LF hypertrophy, there are increases in the expression and activity of various molecules[ 6 ] including matrix metalloproteases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ligamentum flavum hematomas: Why does it mostly occur in old Asian males? Interesting point of reported cases: Review and case report

Özdemi̇r¹,

Kanat²,

Batçık³

et al. 2016

J Craniovert Jun Spine

View full text Add to dashboard Cite

Hematoma of the ligamentum flavum (LF) is a rare cause of neural compression and sciatica. Currently, the etiology and epidemiological characteristics of ligamentum flavum hematoma (LFH) are unknown and epidemiological investigations using rewieving of reported cases have not been performed. We report the case of a 63-year-old man with a LFH compressing the spinal canal at the left L2–L3 level, rewieved relevant literature. In Medline research, wefound a total of 50 reported cases with LFHs, and the interesting point of these cases were analyzed. Many of cases were old males. Interestingly, 39 of the 50 cases were reported from Asian countries. The ages of 42 patients could be verified. The youngest age was 45 years, oldest age was 81 years, and mean age was 66.07 years. Thirty-three out of these 42 patients (78.53%) were older than 60 years. An important aspect of the present review is to bring attention for occurrence in older Asian males. With an increasing number of elderly people in the general population, there is a need to investigate risk factors such as sexual gender, age, and geographic location for LFH.

show abstract

“…Continuous mechanical stress causes degeneration of the LF ( 5 , 6 ). Common pathological characteristics in the degenerated LF are the loss of elastic fibers and tissue fibrosis, and increased collagen in tissues ( 6 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

TGF-β1, in association with the increased expression of connective tissue growth factor, induce the hypertrophy of the ligamentum flavum through the p38 MAPK pathway

Cao

Duan

Zhu

et al. 2016

International Journal of Molecular Medicine

View full text Add to dashboard Cite

Hypertrophy of the ligamentum flavum (LF) is one of the key pathomechanisms of lumbar spinal stenosis (LSS). Transforming growth factor (TGF)-β1 is abundantly expressed in hypertrophied degenerative LF tissues from LSS. However, the molecular mechanisms underling the association between TGF-β1 and LF hypertrophy have not yet been fully elucidated. In this study, we investigated the important role of the mitogen-activated protein kinase (MAPK) pathway in the pathogenesis of LSS by analyzing the expression of connective tissue growth factor (CTGF) and extracellular matrix (ECM) components (collagen I and collagen III) in TGF-β1-treated LF cells. Cell growth assay revealed that TGF-β1, in association with CTGF, enhanced the the proliferation of LF cells, and we found that TGF-β1 also elevated CTGF expression and subsequently enhanced the mRNA expression of collagen I and collagen III. The increased mRNA expression levels of CTGF, collagen I and collagen III were abolished by p38 inhibitors. Both immunofluorescence imaging and western blot analysis of p38 and p-p38 revealed the increased expression and phosphorylation of p38. Silencing the expression of p38 by siRNA in LF cells decreased the protein expression of p38, p-p38 and CTGF, as well as the mRNA expression of CTGF, collagen I and collagen III. Taken together, our findings indicate that TGF-β1, in association with the increased expression of CTGF, contribute to the homeostasis of the ECM and to the hypertrophy of LF through the p38 MAPK pathway.

show abstract

Hematoma of the ligamentum flavum in the thoracic spine: report of two cases and possible role of the transforming growth factor beta-vascular endothelial growth factor signaling axis in its pathogenesis

Cited by 6 publications

References 17 publications

Ligamentum Flavum Hematoma Accompanied by Intraspinal and Extraspinal Hematomas: A Case Report

Ligamentum Flavum Hematoma Accompanied by Intraspinal and Extraspinal Hematomas: A Case Report

Ligamentum flavum hematomas: Why does it mostly occur in old Asian males? Interesting point of reported cases: Review and case report

TGF-β1, in association with the increased expression of connective tissue growth factor, induce the hypertrophy of the ligamentum flavum through the p38 MAPK pathway

Contact Info

Product

Resources

About