Ligamentum flavum of the spine - what is it and how to treat it?

The spinal column is the most important part of the musculoskeletal system. It plays the role of a kind of support for the chest, skull, abdominal and pelvic cavities. The spinal canal is located in the center of the spinal column. It contains the most important part of the autonomic nervous system, which ensures the vital functions of the entire human body. This is the spinal cord and cerebrospinal fluid.

Hypertrophy of the ligamentum flavum is a fairly common finding based on the results of an MRI examination. Using an x-ray, it is impossible to detect that the ligamentum flavum is thickened, since they do not have a dense calcified structure. The patient may not experience any clinical symptoms indicating this pathology.

Therefore, a natural question arises about what it is - hypertrophy of the yellow ligament of the spine, why it is dangerous for human health, and how it can be restored to its physiological structure. This article provides a comprehensive answer to this question.

If your MRI results show that the yellow ligaments of the spine are thickened, but there are no clinical symptoms of pathology, then you should not think that everything will go away on its own. No, this pathology requires the correct approach to therapy in the early stages, when there is no significant pressure on the membranes of the spinal cord. Subsequently, conservative treatment will be ineffective, and sometimes completely impossible.

Sooner or later, the thickening of the yellow ligaments of the spine will begin to have a negative impact. These anatomical structures are located inside the oval foramina of the vertebral bodies. Any change in their thickness and mass automatically narrows the lumen of the spinal canal. If there are no other concomitant pathologies, such as intervertebral disc protrusion, dorsal herniation of the fibrous ring, vertebral displacement, etc., then a significant narrowing of the spinal canal will not be observed.

If a posterior hernia develops due to thickening of the ligamentum flavum, severe compression of the spinal cord may occur. This is fraught with the development of total paralysis. When this pathology is located in the cervical and cervicothoracic spine, there is a high probability of sudden cardiac arrest or cessation of respiratory activity.

If you have been diagnosed with a similar pathology, then we invite you to a free initial consultation with a vertebrologist in our manual therapy clinic. The doctor will conduct a full examination and review the data obtained during the examination. Then you will be given comprehensive individual recommendations for effective conservative treatment of this pathology.

General characteristics of connecting structures

The spine is the basis of the musculoskeletal system. One of its main functions is related to providing stable protection of the spinal cord and nerve roots from damage. In addition to the vertebrae and vertebral joints, the mobility functions of the spinal column are provided by the ligamentous apparatus, consisting of the yellow ligaments (transverse and longitudinal).

The ligamentum flavum is a connective tissue located between the upper and lower arches of the vertebrae. The ligamentous element is the posterior border of the spinal canal, the hollow tube of which is formed by the vertebral arches. Inside the canal is the spinal cord along with the spinal nerve roots extending from it. If the ligamentum flavum thickens, the spinal canal narrows; if its narrowing is significant (acquired or congenital), there is a risk of deformation of the spinal cord.

The yellow pigmentation of bundles of elastic fibers is reflected in the name of the most durable structures of fibrous tissue, capable of fourfold stretching. The ligaments of the lumbosacral spine are the shortest, but are considered the strongest. Their ability to stretch or contract guarantees the free space necessary for the normal functioning of the spinal cord. The tight fusion of collagen-rich fibers with the periosteum of the vertebrae ensures their reliable fixation.

Thanks to the presence of the yellow ligaments, tension in the back muscles is relieved during bending forward and bending backward, which protects against microtrauma and protects the muscles from sprains.

Standard surgical treatment

Standard treatment for central stenosis involves performing an open operation - microsurgical decompression of the spinal canal. For lateral stenosis, root decompression and interspinous implants are installed. Open surgery is effective in 90% of cases. The results persist 10 years or more after the intervention.

But such operations have a big drawback: they are very traumatic. The intervention is performed through a large incision. The doctor has to excise the bone structures, which disrupts the stability of the spinal column. The syndrome of unsuccessfully operated spine may develop; adjacent segments are often affected. With osteoporosis, fractures of the vertebral bodies are possible after treatment. As a result, many patients will require repeated interventions to correct the consequences of too traumatic treatment.

Recovery after open surgery is long and difficult. You need to wear a rigid corset for at least 1 month. Do not lean forward or lift more than 3 kg. It is advisable to completely avoid sitting. After a period of severe restriction, the muscles atrophy and the patient requires several months of rehabilitation to return to their previous physical condition.

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Causes of problems with the ligamentous apparatus

Since ligaments are made of connective tissue, inflammatory processes can develop in them. The causes of diseases of ligamentous structures localized along the entire length of the spine are due to the following factors:

Wear and tear of the ligamentous apparatus, loss of elasticity of fibers in old age;
Back diseases, various injuries, progression of inflammation in younger people;
Long-term overload of ligaments, instability of the ridge, disruption of metabolic processes.

Thanks to the elasticity of the yellow ligaments, the mobility of the spinal column is ensured. Ligamentous segments support the torso during spinal extension, taking over the function of the muscles and reducing their tension. Diseases of the structural elements of the ridge are mainly associated with excessive loads, injuries, and metabolic disorders.

Causes of pathology

Hypertrophy of the ligamentum flavum usually occurs due to a combination of several negative factors. The risk group includes people over 40 years of age and those who are obese. The problem also occurs among people who abuse alcohol, athletes and loaders.

Main reasons:

Endocrine, vascular diseases. With their development, degenerative and dystrophic processes develop in certain parts of the body.
Passive lifestyle. With a small load on the spinal column, a degenerative process develops in the structural tissues.
Displacement of vertebral bodies.
Slowing metabolism. When there is a shortage of nutrients, in order to compensate, the ligament increases its volume.
Prolapse of the hernia into the spinal protrusion.
Poor posture.
Metabolic disease.
Inflammation of the intervertebral disc.
Spondyloarthrosis.
Violation of diffuse metabolism with muscle tissue. Against this background, the ligamentous fiber is dehydrated and scarred again.

In 10-15% of cases, isolated hypertrophy of the ligamentum flavum occurs. But more often this pathology is a complication of diseases characterized by damage to the dural membranes of the spinal canal and intervertebral discs.

Danger of sprains

People of any age are at risk of spinal ligament sprains. With weak back and abdominal muscles, the supporting function of the spine fails. Due to insufficient training, ligamentous structures are subject to high stress, which leads to their stretching and sometimes rupture. The main causes of sprains include leading a sedentary lifestyle, as well as playing strength sports.

What are the symptoms of sprained yellow ligaments of the spine?

Pain syndrome immediately after a sudden load, reaching its maximum threshold on the second day;
Muscle tension at the location of damaged ligaments;
The pain increases during movement, but when returning to a state of rest, the pain goes away.

Diagnostic and treatment methods

One of the methods of therapy is spinal traction.
The most informative diagnostic method is MRI of the lumbar region with contrast. In this case, the patient is given intravenous gadolinium. Usually, due to hypertrophy of the yellow ligaments at the level of the l4-l5 vertebrae, mixed stenosis of the spinal canal is detected.

If an MRI is not possible, the patient is referred for a computed tomography scan.

At a clinically significant level (l4-l5, or l3-s1-l4-s1), laminectomy and removal of the hypertrophied ligamentum flavum are performed.

In 90% of cases, after surgery, regression of the pain syndrome is observed. The feeling of weakness and numbness in the legs also recedes.

If moderate pain is present in the lumbar region (this is usually associated with dysfunction of the facet joints), the patient is subsequently prescribed conservative therapy. He is prescribed NSAIDs and is given blockades with local anesthetics. Additionally, the patient is prescribed physiotherapy and therapeutic exercises.

Additional treatments

Massage is used in treatment. To enhance the effect, it should be combined with osteopathy - this allows you to restore impaired blood microcirculation.

It is also possible to treat the patient using laser exposure and reflexology. This helps to mobilize the hidden reserves of the human body. In order to improve the condition of the ligaments, traction traction of the spinal column is practiced.

Physiotherapy

For hypertrophy of the yellow ligaments, Makeev's gymnastics is useful.
It is necessary to do physical therapy exercises after surgery or after undergoing drug therapy. Makeev’s gymnastics – “yoga of everyday movements” – is recommended. The basis of gymnastics are straight bending and extension.

Instructions:

As you inhale, with tension, move your head back. As you exhale, also using tension, tilt it forward. Repeat 3-5 times.
Perform lateral flexion and extension. As you inhale, tilt your head towards your right shoulder, then as you exhale, straighten up. On your next inhalation, tilt your head toward your left shoulder, then straighten up. Repeat 3-5 times.
Perform rotations in the cervical spine. As you inhale, turn to the left and hold for 2-3 seconds, exhale. On your next inhalation, turn to the right, and after exhaling, hold for 2-3 seconds. Repeat 4-5 times.
Clasp your hands at the back of your head. Take a shallow breath and push your neck back well. At the same time, create support with your hands and try not to “let go” of your neck. Apply pressure for 10 seconds. Then, as you exhale, lower your head forward under the weight of your arms. This stretches the back muscles of the neck and all the structures of the spine. Inhale again and push your neck back again for 10 seconds. Repeat the exercise 3 times.
Work on the spinal-costal joints. Slowly lift your right shoulder up. At the same time, lower your left shoulder. Then move your right shoulder back and your left shoulder forward. Perform this movement with tension.
Perform a slight twist in the thoracic region. Place your feet wider than your shoulders and bend them slightly at the knees. Place your hands on your knees. Bend your right arm and straighten your left to perform a twist. Hold at the end point for 3-5 seconds, return to the starting position. Repeat the exercises, working the other side.

It is recommended to do gymnastics 2-3 times a week. As a result, painful sensations disappear and numbness in the arms and legs goes away. These exercises also help strengthen the body as a whole.

Hypertrophy of the ligamentum flavum: what is it?

The tissues of the ligamentous apparatus of the spine are subject to pathological changes; excessive sprains and other non-physiological reasons lead to injuries to the ligaments and transformation of their structure.
With the development of degenerative or inflammatory processes, as well as as a result of severe overheating or hypothermia of the body, fibrous tissue thickens. A disease accompanied by changes in the spinal canal is called hypertrophy of the yellow ligaments.

The pathology is accompanied by the following dangerous problems:

Disturbance of normal motor activity;
Deterioration of blood supply to the lower extremities;
Pain due to advanced stage of the disease;
Loss of control over urination and bowel movements in severe cases of the disease.

The dominant causes of hypertrophy of the yellow ligament of the spine include the development of the inflammatory process that accompanies osteochondrosis, as well as arthritis or spondyloarthritis.

Early stage moderate

hypertrophy is usually not signaled by pain, but the process of further thickening of the yellow ligaments results in a narrowing of the lumen of the spinal canal. As a result, subsequent compression of the spinal cord leads to pain. Further progress of hypertrophy with an increase in the size of the ligamentum flavum is complicated by the formation of hernias and the appearance of bone growths (osteophytes).

More often, thickening of the yellow ligaments is diagnosed in the lumbosacral spine; the ligaments of the lumbar spine are the most developed. The pathology is manifested by the spread of severe pain along the nerve endings of the thighs and buttocks, dysfunction of the reproductive system, which ends in infertility, and decreased libido.

If the process of hypertrophy of the yellow ligaments affects the thoracic spine, pathologies of the respiratory system and heart disease develop. When the ligaments of the cervical area of the spinal column are damaged, the upper limbs suffer due to compression of the nerve processes extending from the brain by the intervertebral hernia. The situation threatens partial or complete paralysis of the limbs, inflammation of the spinal membranes (arachnoiditis).

Symptoms

The classic symptom of central spinal stenosis in the lumbar region is intermittent claudication syndrome. A person feels pain while walking. To reduce it, he must squat or lean forward.

Other symptoms:

cramps in the leg muscles;
muscle weakness.

Lateral stenosis rarely occurs in isolation; it is usually detected simultaneously with the central one. The pathology is manifested by pain, numbness, and weakness of the leg muscles. In severe cases, urinary and fecal incontinence, paresis and paralysis, and complete loss of sensation in the leg on the affected side develop.

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Calcification syndrome

Common pathologies of the ligamentous apparatus include calcification of its connective tissues. The development of chronic inflammation of the yellow ligaments due to dystrophic changes (ligamentosis) leads to the following problems:

Calcification is caused by the accumulation of calcium salts in the connective structures;
Ossification is associated with ossification of ligamentous elements at the sites of their attachment to the bone surface.

The development of an irreversible calcification process results in a loss of connective tissue strength. This threatens the spine with the appearance of pain in the back area with an increasing likelihood of injury.

Without adequate treatment to stop ossification, loss of mobility of the spinal column is predicted. Calcification usually spreads along several yellow ligaments, which leads to the destruction of cartilaginous discs, fusion of the vertebrae, and symptoms of ankylosing spondylitis.

Prevention

One of the most important aspects of prevention is monitoring correct posture. It is also necessary to ensure that the load is not exceeded during physical activity. During the exercises, it is necessary that the muscles and parts of the body work alternately, and the load on them is the same. You should visit your doctor regularly for preventive examinations. It is necessary to take measures to prevent the development of inflammatory diseases and prevent them from becoming chronic.

After physical activity, a restorative or relaxing massage is recommended. Hardware techniques designed for relaxation can also be used. This could be shock wave therapy, muscle relaxation. With the development of pathology, exercise therapy classes are necessary. The physical therapy doctor will need MRI results, so you must first undergo an examination. Based on the MRI results, as well as the conclusion of a traumatologist, the rehabilitation doctor draws up a lesson plan, which is developed individually for each patient.

Nutrition plays an important role in the prevention of metabolic disorders. Doctors recommend limiting salt intake. Proper nutrition can reduce the risk of salt deposition in connective tissues.

Hypertrophy of the sacrolumbar ligamentum flavum is a serious pathology that can lead to disability. This disorder is easier to prevent than to treat. It is enough to follow safety measures while playing sports, avoiding excessive stress, monitoring your posture and visiting a specialist for a preventive examination.

Which is better - MRI, CT or X-ray for spinal osteochondrosis?

In addition to magnetic resonance imaging, osteochondrosis can also be diagnosed using a computed tomography scan of the spine or x-ray. All these types of studies will show whether a person has osteochondrosis. If you give preference to one of these forms of diagnosis, then, without a doubt, it will be an MRI of the spine. This scanning method, unlike radiation diagnostics, does not cause harmful radiation to humans. During the examination there is no x-ray radiation, no painful sensations. The diagnostic value of MRI images will also be higher than CT and X-ray tomograms. MRI for osteochondrosis will show not only the bone tissue of the vertebrae, but also connective tissue and articular cartilage.