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Ganglion cyst of the ligamentum flavum: a rare cause of cervical spinal cord compression. A case report
  1. V F Muzii1,
  2. P Tanganelli2,
  3. G Signori1,
  4. A Zalaffi1
  1. 1Department of Neurological, Neurosurgical and Behavioural Sciences, University of Siena, Siena, Italy
  2. 2Department of Human Pathology and Oncology, University of Siena, Siena, Italy
  1. Correspondence to Vitaliano Francesco Muzii, Assistant Professor of Neurosurgery, Department of Neurological, Neurosurgical and Behavioural Sciences, University of Siena, Policlinico “S. Maria alle Scotte”, V.le Bracci, 16, 53100 Siena, Italy; muzii{at}unisi.it

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Ganglion cysts of the ligamentum flavum are uncommon degenerative spinal lesions and are mostly encountered in the lumbar spine. Cervical localisation is rare and may cause severe myelopathy. They accompany degenerative changes of the spine and can be differentiated from synovial and other degenerative spinal cysts on the basis of location and histopathological features.

Ganglion cysts of the ligamentum flavum are unusual extradural spinal lesions and most have been reported in the lumbar region. Cervical localisation is an extremely rare cause of myelopathy and, to our knowledge, only three cases have been reported.1 2 Differentiation of ganglion cysts of the ligamentum flavum from other degenerative spinal cysts is still debated.1–4

We report a case of ganglion cyst of the ligamentum flavum in the cervical spine, presenting as progressive tetraparesis due to severe spinal cord compression.

History and examinations

A 60-year-old man presented with a 1-year history of progressive lower limb weakness and gait disturbance. Clinical examination revealed spastic tetraparesis with ataxic gait, positive Romberg test, diffuse tendon hyperreflexia, bilateral Achilles clonus, Babinski sign and proprioceptive sensory impairment. Electromyography showed a pattern of chronic denervation of the lower limbs, with indirect signs of motor pathway dysfunction.

Magnetic resonance imaging (MRI) revealed a hypertrophic C4–C5 ligamentum flavum containing an oval cystic mass, 8 mm in …

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