PMC9805610_01
(a) Lumbar MRI T1WI showed high-intensity left-sided L4-L5 epidural mass/ligamentum flavum hematoma (LFH). (b) Lumbar MRI T2WI showed low-intensity LFH and high-intensity epidural mass on the left at L4-5. (c) CT at L4-5 showed thickened degenerated facet joints and lumbar canal stenosis.
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F1
The lumbar MR showed a left-sided L4-L5 epidural hematoma and LFH within the left HLF [Figures 1a and b]. In addition, the CT demonstrated bilateral degenerated/ thickened facet joints [Figure 1c].
Midline fenestration at L4-5 level: intraoperative findings. (a) A left-sided L4-L5 hematoma (asterisk) within hypertrophied ligamentum flavum (HLF) (arrow). (b) Hematoma (asterisk) in dorsal layer of left HLF (arrow); image after removed of the right HLF. (c) Epidural hematoma (double asterisks) on the ventral side of HLF (double arrows). (d) Resection of the left HLF revealed an epidural hematoma (double asterisks).
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F2
She underwent a bilateral L4-L5 lumbar fenestration/decompression on the 15th day following the original onset of symptoms [Figure 2a]. At surgery, the dorsal surface of the left ligamentum flavum was dark brown and hematoma was observed within the multiple layers of the HLF [Figures 2b-d].
En bloc resection of the left ligamentum flavum hematoma. (a) Dorsal hematoma (asterisk) seen within the layers of the hypertrophied ligamentum flavum (HLF). (b) Epidural hematoma (double asterisks) on ventral side of HLF.
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F3
The LFH pathology revealed neovascularization (i.e., arterial feeding vessels from paramuscular/prelaminar lumbar branches) and an epidural hematoma within the ventral layers of the HLF [Figure 3].