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What is Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening?
Ligamentum Flavum Hypertrophy which is also know by the name of Ligamentum Flavum Thickening is a pathologic condition of the spine in which there is devolution and excrescence of the Ligamentum Flavum . This condition is quite common for mass who have continuing back painful sensation .
In some cases , Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening may also result inspinal stenosiswhich may give further to the pain that an individual suffers due to Ligamentum Flavum Hypertrophy .
Anatomically talk , the ligamentum flavum is form by thick layer of fibrous tissue which holds the vertebra together . The ligament flavum is a longitudinal striptease of tough stringy tissue that is spread from neck to sacrum . The ligament flavum lie later ( behind ) spinal cord in spinal channel and attached to lamina ivory of vertebral column . The section of Ligamentum Flavum that ’s hypertrophy or exposit protrudes into spinal canal and lies against thespinal cord . Such condition is also known as spinal stenosis .
This may not be a problem for level-headed individual with all-encompassing spinal epithelial duct but it tends to be a problem in individuals who already are dealing with innate spinal stricture , break of vertebra or spinal stenosis reason by disc bulge or thinning of magnetic disk .
There is no clear-cut cut reason as to why the thickening fall out but commonly it is seen in individual who have irregularity in the vertebral column that has stimulate spinal electric cord harm . The degenerative disease of vertebral column like osteoarthritis causes in few cases hypertrophy of Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening .
What Causes Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening?
As put forward above , there is no clear crusade for Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening . study have suggested that this condition is usually see in senior hoi polloi who have irregularity of vertebral column and disc.1Traumatic backinjury following motor fomite or motor bike injury may do traumatic hypertrophy of ligamentum flavum .
Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening can also be caused due to normal wear and tear of the spinal cord with age . Animal survey suggests stress on back cause hypertrophy of ligamentum flavum.2Such stress may cause hypertrophy of ligamentum flavum in manual prole . The severe symptoms like back pain in the neck , tingling , numbness and muscle helplessness are observed in patient suffering with abnormal spina column disease likescoliosis.3There are many cases where there is no cause for Ligamentum Flavum Hypertrophy identified and such cases are stated as idiopathic Ligamentum Flavum Hypertrophy .
What are the Symptoms of Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening?
somebody suffering with Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening and not spinal stenosis may complain of periodic back pain reason by brawn tiredness or cramp . But pain sensation become severe and may be associated with prickling , numbness and musculus helplessness when ligamentum flavum hypertrophy causes spinal stenosis or narrowing of spinal canal . This is because the thickening or hypertrophy may cause the already existing spinal condition to get decline . The symptoms experienced in such case are normally feel below the affected level of the node or hypertrophy . The symptom like annoyance , tinging , numbness and weakness in muscles are caused because of irritation or emergency of spinal corduroy and spinal nervus . Spinal cord is either irritated or pinch within spinal canal . likewise , spinal nerve is pinched in spinal hiatus when ligamentum flavum thickens on side and encroaches into spinal hiatus on lateral side .
If the individual suffering with asymptomatic spinal anesthesia stricture because of enlarged ligamentum flavum also has aherniated discor has severe degenerative arthritis then the spinal hiatus get further smaller and narrow-minded . Such conditions further increases insistence over spinal corduroy and spinal nerve that aggravate the symptom of hurting and nerve lesion . Such cases may demand emergency surgical process to foreclose permanent cheek damage resulting in lasting numbness and impuissance in tissue as well as muscle that is supply by the spite spinal nerve .
Normal senescence cause degeneration of the disk that cause narrowing of spinal foramina , hypertrophy of ligamentum flavum and osteoporosis that may result in geological fault of trunk of vertebra . Such status associated with ligamentum flavum hypertrophy may cause an injury to the spinal electric cord and further cause infliction and difficultness with movement . Normally individuals who are above age 50 are most predisposed to suffer Ligamentum Flavum Hypertrophy .
How is Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening Diagnosed?
The expert way to diagnose Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening is by doing an MRI scan of the spine , which will uncover clear node of the ligamentum flavum on the images . In some slip , Ligamentum Flavum Hypertrophy is key out when the MRI is being done for other spinal issues like predominate in or out adisc herniationordisc bulge .
How is Ligamentum Flavum Hypertrophy or Ligamentum Flavum Thickening Treated?
The treatment plan count on stiffness of pain in the neck and presence of associated complains like prickling , numbness and weakness in muscles .
Conservative treatment- Mild to temperate pain is treat with conservative discourse . materialistic treatment does not avail if pain is associate with symptom like tingling , indifference and muscle weakness .
Heat therapy- Mild to moderate hurting is treat with heal therapy and stretching of back . Heat discourse is applied over most painful sphere of back . rut treatment involves placing of warm wet towel or hot water supply in gum elastic bac over the most abominable area . During physical therapy infra - crimson light is used for heat therapy .
dusty therapy - Cold therapy involves lotion of chalk in plastic or rubber grip over most painful area of back .
Stretching andYogatherapy- The stretch or yoga of back often concentrate pain by removing the pressure level over the spinal cord . Stretching or yoga therapy is often coalesce with heat or cold treatment .
Massage therapy – Massage therapy is advised only if pain cause by ligamentum hypertrophy is associated withmuscle spasm .
Acupuncture – stylostixis is yet another alternative treatment for treating Ligamentum Flavum Hypertrophy where the acupuncturist utilizes phonograph needle as a means of induce certain areas under the skin . There has been some efficaciousness find out with this form of intervention for Ligamentum Flavum Hypertrophy .
Chiropractic therapy- The chiropractic therapy involves manipulation of back and repositioning of ligament . Chiropractic use of back may stabilize the spine column and also tone the paravertebral muscles . Chiropractic therapy is utilitarian inpatient suffer mild to moderate hypertrophy of ligamentum flavum . citizenry with
Medications-
NSAIDS - Non - steroidal anti - rabble-rousing drugs are used for mild to moderate pain that may have do by nerve inflammation . Spinal stricture stimulate by ligamentum flavum hypertrophy often stimulate inflammation of centripetal and motor nerve fibers because of irritation or pinch . Such ignition causes mettle swelling and infliction . The NSAIDs handling helps to reduced nervus swelling and bother . The NSAIDS frequently used are Motrin , Naproxen and Celebrex . publish enquiry information suggests NSAIDs is helpful to relive symptoms in patient role suffering spinal stenosis cause by ligamentum flavum hypertrophy.4
Muscle relaxants- Ligamentum hypertrophy causes irritation of motor roughage of spinal nerve that results in muscle spasm . muscularity spasm is treated with muscle relaxants . Most vulgar muscle relaxant used are Flexeril , Soma and Relaxants .
Opioids - Opioids are used for spartan pain that is not answer to conservative treatment , NSAIDs and forcible therapy . Long term opioid therapy have addiction and addiction . Opioids are prescribed for severe bother only and medications discontinued after surgery or when pain intensity level become tolerable . Opioids dictate are Vicodin , Lortab , Oxycodone and Morphine .
Physical therapy-
forcible therapyoften does not help if pain is severe . meek to moderate pain is treated with physical therapy and NSAIDs .
Cortisone Injection- Patient sustain with botheration , tingling , numbness and weakness in muscle supplied by the spunk that is crimp most often need operative handling to prevent permanent brass damage . In such case Cortone Acetate injectant is recommended to diagnosed the nerve that is twinge and also to relieve the symptom until surgery is docket . Cortone Acetate injection helps to lessen the mettle swelling and edema of nerve that decreases the symptoms like pain , prickling , numbness and weakness in muscles .
Surgery- Surgery is recommended when all above intervention fails to relieve the symptom .
Endoscopic surgery- The surgical procedures done for treating Ligamentum Flavum Hypertrophy are commonly minimally invasive procedures which require a very small incision through which instruments are introduce along with a camera and the irregularity is plow . Surgery involves removal lamina and part of ligamentum flavum that is compressing the spinal nerve or spinal corduroy .
Laminectomy- Minor spinal anesthesia stricture triggered by hypertrophy of ligamentum flavum is treated by single or multiple level fond or everlasting laminectomy . fond or staring removal of lamina make prominent space for spinal electric cord and spinal nerve . The ligamentum flavum bulges alfresco once lamina is removed that relieves the pressure inside spina channel and facilitate to take the pressure off the spinal cord and spinal nerve .
Spinal fusion surgery- Severe spinal stricture causes by large ligamentum flavum hypertrophy is treated with spinal nuclear fusion reaction surgery . Spinal fusion surgery involves remotion single or multiple level lamina and then adjacent vertebra are fused with metal home and screw.5Spinal fusion surgery is send word when symptoms like pain , tingle , apathy and weakness of muscles does not respond to all alternative treatment .
Also Read :
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Prevalence and Distribution of Incidental Thoracic Disc Herniation , and Thoracic Hypertrophied Ligamentum Flavum in Patients with Back or Leg Pain : A Magnetic Resonance Imaging - Based Cross - sectioned Study .
Han S1,Jang IT2.,World Neurosurg . 2018 Dec;120 : e517 - e524 .
Mechanical stress induces elastic fibre disruption and gristle matrix increase in ligamentum flavum .
Hayashi K1,Suzuki A2,Abdullah Ahmadi S1,Terai H1,Yamada K1,Hoshino M1,Toyoda H1,Takahashi S1,Tamai K1,Ohyama S1,Javid A1,Suhrab Rahmani M1,Hasib MM1,Nakamura H1.,Sci Rep. 2017 Oct 12;7(1):13092 .
Lumbar scoliosis associated with spinal stenosis in idiopathic and degenerative vitrine .
Le Huec JC1,Cogniet A2,Mazas S2,Faundez A3.,Eur J Orthop Surg Traumatol . 2016 Oct;26(7):705 - 12 .
Clinical outcome of lumbar spinal stenosis base on fresh classification concord to hypertrophy ligamentum flavum .
Sakai Y1,Ito S2,Hida T3,Ito K3,Harada A2,Watanabe K4.,J Orthop Sci . 2017 Jan;22(1):27 - 33 .
Fusion Surgery for Lumbar Spinal Stenosis .
Peul WC , Moojen WA.,N Engl J Med . 2016 Aug 11;375(6):601 . doi : 10.1056 / NEJMc1606502 .
