What is the thickening of the yellow ligament and what are the treatments?

Thickening of the yellow ligament is a condition that we often encounter in daily life. It is mostly caused by trauma, inflammation, etc. It is very harmful to human health and seriously affects people's lives. So what exactly is the thickening of the ligamentum flavum? Let’s take a closer look at the causes and treatments of yellow ligament thickening!

The yellow ligament is not continuous, and there is a fissure on the midline of the yellow ligament on both sides. It starts from the anterior and inferior aspect of the superior lamina and ends at the posterior and superior aspect of the inferior lamina. Hypertrophy of the yellow ligament may be related to chronic degeneration, trauma, inflammation, metabolic disorders and other factors. It can occur at any age, progress rapidly and be more severe.

The etiology or pathogenesis of ligamentum flavum hypertrophy is still unclear, and it may be related to factors such as chronic degeneration, trauma, inflammation, and metabolic disorders. When the lumbar spine degenerates, the stress on the yellow ligament is abnormally high, and its elastic fibers will degenerate or rupture. The long-term injury and repair process will inevitably cause the yellow ligament to become thickened and fibrotic, and eventually lead to calcification of the yellow ligament.

Hypertrophy of the yellow ligament is one of the main causes of lumbar spinal stenosis, and is often the cause of lumbar spinal stenosis together with factors such as hyperplasia and cohesion of the articular processes and thickening of the vertebral lamina. Lumbar spinal stenosis caused by simple hypertrophy of the ligamentum flavum is rare in clinical practice, but it must be taken seriously.

Degenerative hypertrophy of the ligamentum flavum is common in the elderly, has a long course, and may have an acute exacerbation process. It often occurs between the L4 and L5 vertebral lamina, causing compression of the cauda equina and nerve roots. The nerve roots may be affected bilaterally or unilaterally. Clinical symptoms are similar to those of lumbar spinal stenosis. The main symptom is lower back pain, which can be relieved or disappear after rest, and there may be neurogenic intermittent claudication.

MRI can complement CT in diagnosing hypertrophy of the ligamentum flavum, because CT can reveal causes such as calcification of the ligamentum flavum and hyperplasia of the facet joints, while the sagittal plane of MRI can directly show the overall picture of the lesion for hypertrophy of the ligamentum flavum involving multiple spinal canals.

Differential diagnosis of ligamentum flavum hypertrophy:

Neurological symptoms caused by hypertrophy of the ligamentum flavum are often misdiagnosed clinically, such as cerebrovascular disease, myelitis, spinal cord tumors, peripheral neuritis, etc., and need to be carefully identified.

Treatment

(1) Manual therapy: The purpose of manual therapy is to promote blood circulation and relax muscles, disperse blood stasis, loosen adhesions, and relieve symptoms. Commonly used techniques include kneading, massaging, grasping, rubbing, and rubbing, as well as passive movements of flexion and extension of the lower limbs.

(2) Acupuncture treatment: You can use acupoints such as Yaoyangguan, Shenshu, Dachangshu, Qihaishu, Mingmen, Huantiao, Fengshi, Weizhong, and Kunlun, once a day, and 10 times as a course of treatment.

(3) Drug treatment: Analgesic and anti-inflammatory drugs such as Voltaren and Ibuprofen can be used for aseptic inflammation of the nerve roots. Traditional Chinese medicine treatment is aimed at warming and unblocking the meridians, strengthening the tendons and bones, and the Bushen Zhuangjin Decoction can be used with modifications. Commonly used medicines include Rehmannia glutinosa, Paojiang, Eucommia ulmoides, Achyranthes bidentata, processed Cibotium barometz, Dipsacus asper, etc. For those with qi deficiency and blood deficiency, add astragalus, codonopsis, angelica, and white peony root. For those who suffer from cold pain in the waist and legs, add Millettia reticulata, Angelica dahurica, cinnamon twig, epimedium, etc.

(4) Blockade therapy: Epidural blockade can be used to eliminate swelling, loosen adhesions, and relieve symptoms. The commonly used method is 12.5 mg of prednisolone acetate plus 10 ml of 1% procaine, once a week.

(5) Medical sports: It can strengthen the back extensor muscles and abdominal muscles, increase the stability of the lumbar spine, and thus delay the rate of lumbar joint degeneration. Practicing Tai Chi has a good effect on this disease.