An acute neurological symptom caused by a ligamentum flavum cyst with hemorrhage in an 84-year-old male patient: a case report

In older adults, degenerative changes within the spine can contribute to rare spinal pathologies, such as ligamentum flavum cysts (LFCs), which may cause significant neurological symptoms. However, it is exceedingly rare for LFCs to cause hemorrhagic complications. This report presents the case of an 84-year-old man on clopidogrel therapy who developed severe left buttock pain following active physical therapy. Magnetic resonance imaging revealed extradural cystic masses adjacent to both facet joints at the L4/5 level, compressing the thecal sac, which were absent on previous imaging. After left unilateral laminectomy with bilateral decompression and cyst removal, a histopathological examination confirmed an LFC with hemorrhage. The patient experienced significant symptom relief and restored mobility. This case underscores the importance of recognizing hemorrhagic LFC as a potential cause of acute neurological symptoms in older adults and highlights the value of prompt imaging and surgical intervention for favorable outcomes. Furthermore, understanding the interaction between age-related degeneration, medication use, and cyst development is crucial for effectively managing similar cases in older patients.