Abstract
The ligamentum flavum is considered to be one of the important causes of radiculopathy in lumbar degenerative disease. Although there have been several reports anatomically examining the positional relationship between the ligamentum flavum and nerve root, there are few reports on ventral observation. The purpose of this study is to clarify the shape of the ligamentum flavum seen ventrally, and to obtain anatomic findings related to nerve root compression. The subjects were 18 adult embalmed cadavers, with an average age of 78 years at the time of death. The ventral shapes of the ligamentum flavum were observed. The relationships between the morphological change of the ligamentum flavum and nerve root compression or radiographic findings were statistically evaluated. Among the shapes of the ligamentum flavum, bulging of the ligament was most frequently observed. Proximal bulging indicates the type with the cranial portion bulging from the subarticular zone to the foraminal zone of the ligamentum flavum. In this type associated with a decrease in disc height, nerve root compression was frequently observed. Thus, we could more realistically grasp the relationship between bulging morphology of the ligamentum flavum and nerve root compression.
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Abdullah AF, Ditto E, Byrd E, Williams R (1974) Extreme lateral lumbar disc herniations. J Neurosurg 41:229–234
Avrahami E, Wigler I, Stern D, Caspi D, Yaron M (1990) Computed tomographic (CT) demonstration of the ligamenta flava of the lumbosacral spine associated with protrusion of the intervertebral disc. Spine 15:21–23
Boden SD, Davis DO, Dina TS et al (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72:403–408
Brown HA (1938) Enlargement of the ligamentum flavum. J Bone Joint Surg 20:325–338
Dunlop RB, Adams MA, Hutton WC (1984) Disc space narrowing and the lumbar facet joints. J Bone Joint Surg Br 66:706–710
Epstein JA, Epstein BS, Lavine LS (1962) Nerve root compression associated with narrowing of the lumbar spinal canal. J Neurol Neurosurg Psychiatry 25:165–176
Hasegawa T, An HS, Haughton VM, Nowicki BH (1995) Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. J Bone Joint Surg Am 77:32–38
Hasue M, Kikuchi S, Sakuyama Y, Ito T (1983) Anatomic study of the interrelation between lumbosacral nerve roots and their surrounding tissue. Spine 8:50–58
Kirkaldy-Willis WH, Paine KWE, Cauchoix J, Maclvor G (1974) Lumbar spinal stenosis. Clin Orthop 99:30–50
Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J (1978) Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 3:319–328
Kikuchi S, Hasue M (1996) Radicular symptoms of lumbo-sacral spine—anatomic consideration. Kanehara, Tokyo pp 32–40
Macnab I (1971) Negative disc exploration. J Bone Joint Surg Am 53:891–903
Macnab I, McCulloch JA (1990) Backache, 2nd edn. Williams & Wilkins, Baltimore, pp 1–21
Mayoux-Benhamou MA, Revel M, Aaron C, Chomette G, Amor B (1989) A morphometric study of the lumbar foramen. Surg Radiol Anat 11:97–102
McCulloch J (1990) Microsurgical approach to the foraminal herniated nucleus pulposus. In: Watkins RG (ed) Microsurgery of the lumbar spine. Raven Press, New York, pp 187–198
Miller JA, Schmatz C, Schultz AB (1988) Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine 13:173–178
Nakai O, Ookawa A, Yamaura I (1991) Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am 73:1184–1191
Nathan H, Weizenbluth, Halperin N (1982) The lumbosacral ligament (LSL), with special emphasis on the “lumbosacral tunnel” and the entrapment of the fifth lumbar nerve. Int Orthop 6:197–202
Nowiki BH, Haughton VM, Schmidt TA, Lim TH, An HS, Riley LH, Yu L, Hong JW (1996) Occult lumbar lateral spinal stenosis in neural foramina subjected to physiologic loading. AJNR Am J Neuroradiol 17:1605–1614
Oishi Y, Ohnishi A, Suzuki K, Hojo T (1995) Lower number and thinner myelin of large myelinated fibers in human cervical compression radiculopathy. J Neurosurg 83:342–347
Olsewski JM, Simmons EH, Kallen FC, Mendel F (1991) Evidence from cadavers suggestive of entrapment of fifth lumbar spinal nerves by lumbosacral ligaments. Spine 16:336–347
Panjabi MM, Takata K, Goel VK (1983) Kinematics of lumbar intervertebral foramen. Spine 8:348–357
Postacchini F, Montanaro A (1979) Extreme lateral herniation of lumbar disks. Clin Orthop 138:222–227
Postacchini F, Gumina S, Cinotti G, Perugia D, DeMartino C (1994) Ligamenta flava in lumbar disc herniation and spinal stenosis. Spine 19:917–922
Ramani PS, Perry RH, Tomlinson BE (1975) Role of ligamentum flavum in the symptomatology of prolapsed lumbar intervertebral discs. J Neurol Neurosurg Psychiatry 38:550–557
Ramsey R (1966) The anatomy of the ligamentum flavum. Clin Orthop 44:129–140
Rauschning W (1987) Normal and pathologic anatomy of the lumbar root canals. Spine 12:1008–1019
Ray CD (1987) Far lateral decompression for stenosis: the paralateral approach to the lumbar spine. In: White AH, Rothman RH, Ray CD (eds) CV Mosby, St Louis, pp 175–186
Sato K, Kikuchi S (1993) An anatomic study of foraminal nerve root lesions in the lumbar spine. Spine 18:2246–2251
Schönström NR, Hansson TH (1991) Thickness of the human ligamentum flavum as a function of load: an in vitro experimental study. Clin Biomech (Bristol, Avon) 6:19–24
Sortland O, Magnaes B, Hauge T (1977) Functional myelography with metrizamide in the diagnosis of lumbar spinal stenosis. Acta Radiol Suppl 355:42–54
Videman T, Nurminen M, Troup JD (1990) Lumbar spinal pathology in cadaveric material in relation to history of back pain, occupation, and physical loading. Spine 15:728–740
Wiltse LL (1984) Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. Spine 9:31–34
Yong-Hing K, Reilly J, Kirkaldy-Willis W (1976) The ligamentum flavum. Spine 1:226–234
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Okuda, T., Fujimoto, Y., Tanaka, N. et al. Morphological changes of the ligamentum flavum as a cause of nerve root compression. Eur Spine J 14, 277–286 (2005). https://doi.org/10.1007/s00586-004-0782-5
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DOI: https://doi.org/10.1007/s00586-004-0782-5