Compression of the Cauda Equina by the Ligamentum Flavum

The diagnosis of compression of the lumbosacral roots of the spinal cord following injury is sometimes quite difficult. The usual classic sequence of root pain, loss of motion and sensation, vesical or rectal incontinence and absent reflexes does not prevail in each case. The symptoms of root pain which is accentuated by lying on the back or on exertion should lead to a suspicion of compression of the cord. Hypertrophy of the ligamentum flavum in the lumbar region has been described on only three occasions. The case reported by Elsberg,1cited the instance of a woman, aged 39, who was thrown from a car ten months prior to her operation. She suffered from stiffness of the back, with pain over the distribution of the fourth lumbar root on the left side. Roentgenograms revealed an old fracture and thickening of the arches of the fourth and fifth lumbar vertebrae. On