Ligamentum flavum hypertrophy is also called ligamentum flavum thickening.
What is Ligamentum Flavum Hypertrophy?
In the simplest terms, ligamentum flavum hypertrophy is when “the ligamentum flava grows wider and larger and expands toward the central spinal canal”. Its other name is ligamentum flavum thickening. The purpose of the ligamentum flava is to link vertebrae together, allowing for “controlled vertebral movement”. But if the ligament expands, it impinges “on the sides of the central spinal canal”, which causes “partial spinal stenosis, a narrowing of open spinal spaces”. If this situation becomes combined with thickening on the front of the canal, then “extreme spinal stenosis” could occur, leading to a potential surgical intervention.1 Facet and ligamentum flavum hypertrophy are different things. Facet hypertrophy is a condition in which “a spinal nerve root is pinched by vertebral joint enlargement”. The purpose of the facet joints is to allow the spine to twist and bend, and the facet joints are located “between the vertebrae”. The nerve roots pass through facet joints, so if there is swelling or injury, patients experience stiffness and pain.2
Ligamentum flavum hypertrophy symptoms may actually be “a nonissue”; however if there is central spinal stenosis, patients will experience pain. The basic ligament thickening may be compounded by a “narrowed spinal canal due to congenital condition, developmental condition, back injury or other narrowing process”. Symptoms, in these situations, will arise below the level of the thickening. Arthritis or a herniated disc could worsen the problems, eventually leading to surgery. The ligamentum might thicken just due to the aging process, but it could be a result from a spinal injury or abnormality. When the cause is unknown, it is called “idiopathic”.3 Interestingly, the origin of the term “ligamentum flavum hypertrophy” is from the Latin for “ligare” which is “to bind or tie” and “flavus” is “yellow”. The Greek “hyper” means “oversized” and “trophe” refers to “nourishment or food”. Hence, the “ligament in the spine is thickening”. The people most vulnerable to degenerative spinal conditions are people over 50, but the real problems arise when the spinal nerves are compressed. Most degenerative conditions occur in the lower back (lumbar) or neck (cervical) regions.4
Ligamentum Flavum Hypertrophy Treatment
When a condition is so painful that anti-inflammatory medications no longer work, patients may be referred for surgery. Some surgical options include “minimally invasive decompression and minimally invasive stabilization procedures”. The Laser Spine Institute says that they have “a 98 percent patient recommendation rate and a 97 percent patient satisfaction rate”.5 Surgery, however, carries risks. Before engaging in that last resort, there are some conservative measures patients could try. In addition to the anti-inflammatory medication, patients could be prescribed stretches and exercise, or physiotherapy. These conservative treatments are useful in “lengthening the spine to reduce pressure and realign the spinal components” in order to relieve the pressure on the nerve. It may take months of therapy for results, but if those options do not help, then a doctor might recommend surgery. Another surgical option, aside from the ones mentioned earlier, is a laminectomy. In this procedure, “stabilizing implants (metal rods, screws, plates or screens)” are used for “spinal fusion”. It is important to remember that surgery should be considered a final option. The risks of this invasive surgery include “infection and prolonged recovery” and “failed back surgery syndrome”. There is a “minimally invasive laminotomy procedure” option, which is “performed through a small, 1-inch incision without disrupting the surrounding elements of the spine”.6
Alternatives and Surgical Complications
Chiropractic treatment, such as flexion distraction spinal manipulation, can be useful for patients with spinal stenosis.7 Traction is another treatment option for spinal stenosis pain, and chiropractic has been found in research to be “about as effective as conventional, nonoperative treatments for acute back pain”. Chiropractors “restore normal spinal movement”, and they can also recommend various exercises to their patients “to maintain motion of the spine, strengthen abdominal and back muscles, and build endurance” to “stabilize the spine”. Some patients may wish to try the alternative treatment of acupuncture, which uses thin needles to penetrate and stimulate certain places on the skin. Research has also shown that acupuncture benefits some people with lower back pain. These alternatives to surgery and medical treatments might also be used as complementary therapies to traditional care. Alternatives can help patients avoid the risks of surgery. Anesthesia could be dangerous, especially with older patients. Complications of spinal stenosis surgery include “a tear in the membrane covering the spinal cord at the site of the operation, infection, or a blood clot”. Even after surgery, patients may end up with no improvement, numbness, or more pain. This is especially true if there was a lot of nerve damage prior to the surgery. Degeneration might continue, and problems would then reappear. It is very important that patients with other medical conditions or poor physical condition consider all of their options when thinking about surgery.8
Find our more about chiroractic care for spinal stenosis.