PMC6288563_01
Magnetic resonance images showing a posterior epidural mass at L4/5 compressing the thecal sac and spinal cord and linking with the ligamentum flavum.
CRIOR2018-2860621.001.jpg
PMC6288563_01_CRIOR2018-2860621.001.jpg
fig1
A lumbar MRI without gadolinium (Gd) had been performed prior to evaluation (4 months after symptom onset) in a previous hospital (Figure 1). On T1-weighted images (Figure 1(a)), the mass was isointense, with a few hyperintense areas within. On T2-weighted images, the mass was hyperintense in the center and hypointense in the periphery (Figure 1(b)). T1-weighted image (Figure 1(a)) and the hyperintense area in the lesion was a little extended on T2-weighted imaging (Figure 2(b)). There was no significant enhancement with Gd-based contrast (Figures 2(c) and 2(d)).
2nd magnetic resonance images (MRI) showing left posterior mass at the same area of the 1st MRI. (a) Sagittal T1-weighted axial MRI reveals that there was a newly isointense mass present within the anterior part of the previously identified lesion. (b) Sagittal T2-weighted axial MRI reveals that the intensity inside the mass was a little extended. (c, d) T1-weighted axial MRI at L4/5 reveals the well-defined extradural mass in the left posterior aspect of the thecal sac. (c) There was no significant enhancement with Gd-based contrast (d).
CRIOR2018-2860621.002.jpg
PMC6288563_01_CRIOR2018-2860621.002.jpg
fig2
T1-weighted image (Figure 1(a)) and the hyperintense area in the lesion was a little extended on T2-weighted imaging (Figure 2(b)). There was no significant enhancement with Gd-based contrast (Figures 2(c) and 2(d)).
(a) The ligamentum flavum after L4/5 partial laminectomy. (b) The solid blackish, swelling ligament in left side.
CRIOR2018-2860621.003.jpg
PMC6288563_01_CRIOR2018-2860621.003.jpg
fig3
After L4/5 partial laminectomy, the solid blackish ligamentum flavum was visible and firmly adherent to the dural sac at L4/5 posteriorly (Figure 3(a)). After removing the ligament (Figure 3(b)), both L5 roots were decompressed perfectly.
A hematoma inside the removal ligament.
CRIOR2018-2860621.004.jpg
PMC6288563_01_CRIOR2018-2860621.004.jpg
fig4
A hematoma was found inside the ligamentum flavum (Figure 4).