Cervical Ligamentum Flavum Cyst Causing Myelopathy: A Case Report

REPORTwas normal, and there were no constitutional symptoms.Physical examination revealed an unsteady gait with increased tone in both upper and lower limbs, shoulder abductor power was 3/5 bilaterally, and hand grip was weak bilaterally.Lower limb motor power was normal.Deep tendon reflexes were exaggerated in all four limbs with evidence of ankle clonus, positive Hoffman's and Babinski's sign bilaterally.Perianal sensations were normal, and distal pulses were well felt.The range of movements of the cervical and thoracolumbar spine was full and painless.Plain radiographs (Fig. 1) of the cervical spine revealed degenerative changes in the cervical spine, and dynamic views showed grade I instability at the C3-C4 level.The cervical spine magnetic resonance imaging (MRI) scan (Fig. 2) showed a cystic fluid-filled lesion about 4 mm in maximum thickness arising from the ventral midline ligamentum flavum causing cord IntroductIonVarious intraspinal extradural cysts have been reported, including synovial cysts, 1 ganglion cysts of the ligamentum flavum, 2-4 posterior longitudinal ligament cyst, 5 and intervertebral disc cyst 6 each with its distinctive origin, location and histological features.Synovial cysts typically arise from the facet joints, contain clear fluid, and have a characteristic synovial lining. 7Ganglion cysts, on the contrary, contain a gelatinous/viscous fluid without a distinct synovial lining. 7Although these cysts, more common in the lumbar 1,8-10 than the cervical spine, differ in etiology, location, and histopathology, they have a similar clinical presentation and management.Since ligamentum flavum cysts are seen predominantly in older people, myxoid degeneration of the ligamentum flavum is the proposed etiology of this condition. 2By virtue of their spaceoccupying nature, these lesions can cause symptomatic neural compression leading to myelopathy (77%), radiculopathy (20%) or myeloradiculopathy (3%). 7Surgical excision of the cyst and neural decompression to alleviate the compressive symptoms, 1,11 along with an instrumented fusion if deemed necessary, is the treatment of this condition.This case report discusses the clinical presentation, imaging findings and management of a cervical ligamentum flavum cyst causing myelopathy. case descrIptIonA 68-year-old gentleman presented with progressive paresthesia and weakness of both upper limbs of six months duration, along with clumsiness of both hands and difficulty in walking of 20 days duration in the absence of any trauma.Bladder and bowel function 1,