Stollman A, Pinto R, Benjamin V, Kricheff I
Department of Neuroradiology, New York University Medical Center, NY 10016.
AJNR Am J Neuroradiol. 1987 Nov-Dec;8(6):991-4.
Thickening of the ligamenta flava with and without ossification in the thoracic and lumbar regions is a frequent finding on CT scanning; however, it is not widely appreciated as a possible primary cause of compressive cord, cauda equina, and nerve-root symptoms. We present observations from a series of seven patients whose symptoms were caused exclusively or largely by thickened ligamenta flava in the thoracic and lumbar regions. The findings were best demonstrated on myelography. One of our cases had been missed on previous MR, as would be expected with the null signal of calcification. CT scanning necessitates an extended window to ensure discrimination of an ossified ligament from thecal metrizamide. Thickened ligamenta flava are often found in conjunction with degenerative disease and spinal stenosis at multiple levels and should not be ignored as a possible major contributing factor to the patient's symptoms. In addition, those patients with a secondary block from a thickened ligamentum flavum should be studied from above with C1-C2 puncture to rule out other levels of clinically significant disease. Attention to the particular findings of thickened ligamenta flava is important since surgical intervention must involve removal of the entire offending ligament(s); otherwise clinical symptoms may not be relieved.
在胸部和腰部区域，黄韧带增厚伴或不伴骨化是CT扫描中常见的表现；然而，它作为压迫脊髓、马尾和神经根症状的可能主要原因尚未得到广泛认识。我们报告了7例患者的观察结果，这些患者的症状完全或主要由胸段和腰段增厚的黄韧带引起。这些发现通过脊髓造影能得到最佳显示。我们的1例患者之前的磁共振成像（MR）检查漏诊了，钙化的无信号表现也在意料之中。CT扫描需要扩展窗宽以确保将骨化的韧带与鞘内甲泛葡胺区分开来。增厚的黄韧带常与多节段的退行性疾病和椎管狭窄同时存在，不应忽视其作为患者症状可能主要促成因素的作用。此外，对于因增厚的黄韧带导致继发性梗阻的患者，应从上方行C1-C2穿刺检查，以排除其他具有临床意义的病变节段。关注增厚黄韧带的特定表现很重要，因为手术干预必须切除整个致病韧带；否则临床症状可能无法缓解。
