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What is Ligamentum Flavum Hypertrophy, How Do You Get It, And What Is The Best Non-Surgical Treatment Option in Malaysia?

illustration of ligamentum flavum hypertrophy

HYPERTROPHY OF LIGAMENTUM FLAVUM

Ligamentum flavum hypertrophy is a condition in which the ligamentum flavum (LF) thickens due to stresses placed on the spine. With hypertrophy, ligamentum flavum (LF) increases in thickness (size). The thicker it becomes, the higher the risks of spinal nerve (foraminal stenosis) or spinal cord compression (spinal stenosis). In short, a thicker than average ligamentum flavum (LF) decreases the room or available areas a nerve root or the spinal cord has. Compression of spinal nerves or spinal cord can produce varying degrees of pain and even disability. Contrary to the common belief, a hypertrophied ligamentum flavum (ligamentum flavum hypertrophy) can be treated non-surgically. In this article, we will provide ample information about ligamentum flavum hypertrophy: what it is, how it gets damaged, and what are your non-surgical treatment options. Let’s began our review with the description of the ligamentum flavum.

What is Ligamentum Flavum?

Ligamentum flavum (Ligamenta Flava or yellow ligament) is highly specialized. It is an extremely elastic ligament, which connects the spinal bones through its two laminae, articular joints (facets and pedicles) attachment points on each side of the spine, from C2-S1. But, what makes it unique is the fact that it functions like a muscle as well. The muscular function of LF enables the spine to realign following forward bending motions.

In the cervical spine or the neck, Ligamenta Flava (ligamentum flavum) is thin, broad, and long. However, it is thickest in the mid back and lower back regions of the spine. This highly elastic ligament serves to hold an upright posture, especially following flexion (bending) in the neck or low back. Its’ abundance of elastin affords the increased elasticity of this ligament.

image explains ligamentum flavum hypertrophy

The clinical significance or relevance of LF is that it can compress spinal nerves and the cord, damaging nerves and the spinal cord. A thickened or hypertrophied LF (ligamentum flavum hypertrophy) is the number one cause of spinal canal stenosis. A hypertrophied or thickened LF compresses the spinal cord because of the increase in thickness and buckling. LF buckling becomes increasingly common with progression. The buckling of LF (ligamentum flavum hypertrophy) is the main reason why many complain of increased pain during weight-bearing positions or when they extend the spine.

multiple methods used to cure ligamentum flavum hypertrophy

What is the Function or Purpose of Ligamentum Flavum (LF)?

Elastin, which we will discuss in upcoming sections, provides ligamentum flavum (LF) its significant elasticity. The elastic nature of LF is critical to the maintenance of an upright or a standing posture. LF is a ligament that functions much like a muscle. The muscular component allows it to have contractibility. The contractile ability of LF assists in the proper realignment of the spinal joint after flexion or forward bending. The ligamentous characteristics of LF prevent excessive gaps or separation between the spinal bones. To understand these better, let’s look at LF attachments on the spine.

We mentioned that LF is attached to each spinal segment from C2-S1. Now, let’s see the actual attachment points. LF originates from the two lower surfaces (right lamina and left lamina) or the vertebra above and attaches downwards to the posterior upper margins of the right and left lamina of the vertebra below, as well as the articular facets (joints). The joint (spinal facet and pedicle) attachment prevents pinching or jamming of joints as the body resumes an upright posture. Now, let’s see how these attachments occur.

As soon as LF originates from the lamina above, it separates into two sections on each side, a medial component and a lateral component. The medial element is the portion that attaches to the lamina below. The lateral component traverses in front of the joint (facets), connecting to the joint capsules of spinal joints or facets. The articular component (spinal joint or facet portions) envelopes the entire joint capsule with its attachment to the pedicle of the vertebrae below. The articular facet (spinal joint) and pedicle attachments of LF prevent jamming or pinching of joint surfaces and joint soft tissues due to its marked elasticity.

“We understand that may be more anxious about finding effective treatment options that are surgical or invasive. As such, we plan on discussing the non-surgical treatments first, before elaborating on Elastin, symptoms or causes of ligamentum flavum hypertrophy.”

Is It Possible to Treat Hypertrophy of Ligamentum Flavum with Non-Invasive Conservative Treatment?

The short answer is YES. Conservative treatment of ligamentum flavum hypertrophy is effective when provided by a team that has an expert understanding of the spine, and associated conditions. Chiropractic Specialty Center® uses specialized devices, methods, and systems of care that are significantly superior to the traditional techniques of non-invasive treatments rendered by most chiropractors or physiotherapists.

chiropractic analyse x-ray treat Treat hypertrophy of ligamentum flavum

Hypertrophy of ligamentum flavum is always present with associated conditions. Conditions such as herniated discs, facet arthritis, degenerated spinal discs, and bone spurs are all too familiar. Surgical or steroidal medications have failed to provide patients the cure they need to live healthy, active lives. We have treated thousands of patients with hypertrophy of ligamentum flavum at our centers. In the vast majority of these cases, we have been successful in reducing pain and increasing functional capacity to a point where the patient can live a healthy, active life.

Our non-invasive conservative method of chiropractic and physiotherapy are further enhanced with care provided through breakthrough spine technology that others do not have. In short, we target the malfunction in ligamentum flavum, as well as the secondary issues such as slipped discs, facet arthritis, and disc degenerations.

 

Our physiotherapists and chiropractors follow the precise therapy and treatment protocols of NSD Therapy®. NSD Therapy® is the most comprehensive means of treating the spine without medication, injections or surgery. But, for those who suffer from ligamentum flavum hypertrophy, we provide a proprietary method of physiotherapy, exercise, nutrition, and chiropractic discovered by our director Dr. Yama Zafer. Dr. Yama is an American chiropractor that has spent the better part of the last twenty years researching efficient means of non-invasive spine care. We will revisit treatment options after a thorough discussion on ligamentum flavum hypertrophy. So, lets began with Elastin and the critical role it plays in ligamentum flavum.

pictures shows hypertrophy of ligamentum flavum

What is Elastin? How does it Impact the Ligamentum Flavum or Ligamenta Flava?

Elastin is said to be 1000 times more elastic than cartilage. In basic terms, it is a protein in elastic connective tissues such as ligaments, tendons, muscles, and spinal discs. It enables our connective tissues to regain or “snap back” into position or their original shape after physical stress or when stretched. In addition to the skin, spinal discs, ligaments, tendons, or muscles, it is found abundantly in the heart. Blood vessels, lungs, and intestines also have elastin. Therefore, it is a critical protein in our bodies. How does elastin impact our spine?

As mentioned, elastin is highly elastic. The two primary structures that have high concentrations of elastin in the spine are the spinal discs and ligamentum flavum. In the spine, elastin is the bond that holds spinal disc fibers (annulus fibrosus) together. It prevents buckling or bulging of the spinal disc during load-bearing activates. Prolonged sitting or axial loading will cause depletion or decrease in the production of elastin in the spinal discs. When production decreases, the disc fibers that protrude in load-bearing activities do not snap back with rest. A reduced level of elastin in ligamentum flavum has a similar impact. A sufficient elastin level in ligamentum flavum prevents it from buckling into the spinal canal or neural foramina when extending the head and neck or the back.

Hypertrophy of ligamentum flavum is the results of traumatic injuries or repetitive activities that cause degenerative changes with the thickening of ligamentum flavum. A degenerated ligamentum flavum is one that lacks sufficient levels of the elastin protein. In other words, cord compression and nerve root compressions become increasingly common occurrences as the ligament thickens and degenerates.

The Elastin and Cartilage Roles in Hypertrophy of Ligamentum Flavum (LF)

According to numerous research articles, a hypertrophied LF is the result of mechanical stresses in which elastin fibers fragment and calcify. Interestingly enough, several new pieces of research also indicate collagen deposition. In healthy LF, the elastin fibers form a complex meshwork. A meshwork is defined as a structure that is interlaced or interwoven. When the spine is subjected to excessive stresses, the meshwork of elastin fibers are broken down and fragmented. The body responds to this fragmentation by increasing collagen content in LF. The combined impacts of elastin fragmentation, collagen deposition (collagen Type IV), and the eventual calcification of damaged elastin and collagens are the leading factors in the development of ligament flavum hypertrophy.

image explains the differences of lumbar vertebra
man holding his pain hip

What Causes the Hypertrophy or Thickening of Ligamentum Flavum?

The actual cause of LF hypertrophy is related to elastin fragmentation, collagen type IV deposition, and calcification of elastin and cartilage. In this section, we will discuss stresses and activities that accelerate LF hypertrophy. Hypertrophy of ligamentum flavum is said to be an age-related disorder in which there is a decrease in elastin-to-collagen ratios in ligamentum flavum. Although often seen in the elderly, it can happen at any age. The leading cause is neglect of minor injuries.

The actual causative factor is still somewhat unclear. However, recent research has proposed links to inflammation and scar tissue as main factors in elastin demise and collagen deposition. Repetitive motions or traumatic events cause inflammatory processes. Continued stresses and unabated inflammatory processes lead to the formation of scar tissues. A scar or scar tissue is the body’s response to repairing of injured tissue. Scar tissue is normal in healing. It becomes problematic when there is a continuous build-up of scar tissues due to daily stresses or micro-traumatic events. An inflammatory process by definition is the body’s response to an injury or disease.

Inflammatory processes in ligamentum flavum are often the results of micro-tears (small, tiny tears). It could result from lifting heavy objects, playing aggressive sports, bodybuilding, or automobile accidents. Micro-traumatic events cause small rips and even microscopic tears that are often painless. But, continued stresses from micro-traumatic events have a cumulative effect that leads to scar tissue or thickening of the ligamentum flavum.

So, the minor neck or back injuries we subjected our spine comes back to haunt us later in life. Therefore, to avoid such complications years or decades later, tend to even the most insignificant spine injuries as early as possible. Prevention is better than cure. Ligamentum flavum hypertrophy is a disorder that is preventable.

What are Ligamentum Flavum Hypertrophy Symptoms in the Low back or Lumbar Spine?

Ligamentum flavum hypertrophy symptoms can vary depending on the severity of condition and location or hypertrophy or thickening. Initial stages of hypertrophy are relatively asymptomatic (cause no pain), but its progress can rapidly become severe and even disabling. Ligamentum flavum hypertrophy in the low back (lumbar spine) produces sciatica-like symptoms. Sciatica is descriptive of symptoms of pain (leg pain) along the course of the sciatic nerve. The sciatic nerve emerges from the lower lumbar segments and provides nerve innervations to the buttocks, thighs, legs, and feet.

image illustrates pain of ligamentum flavum hypertrophy

A hypertrophied LF in the lumbar spine (low back) can produce pain in the back, buttocks, legs, and feet. In addition to leg pain, most will also complain of numbness, tingling, or burning sensations. In severe cases, weakness and foot drop may result. Foot drop is in a condition that occurs from nerve damage. Prolonged compression of the spinal nerves or spinal cord can compress, injure, and even kill nerves that control the functions of the bowels, bladder, reproductive organs, and legs. Yes, a severely hypertrophied ligamentum flavum can cause impotence, paralysis, or loss of bowel and bladder function!

To give you a better understating of the symptoms associated with hypertrophy of the ligamentum flavum in the lower back, we have provided a detailed list below:

A lumbar or low back hypertrophied ligamentum can cause symptoms or pain in one or both sides of the lower body. As mentioned earlier, it can also cause bowel and bladder issues or dysfunction in reproductive systems and organs. We have provided a detailed list of musculoskeletal symptoms for your review below:

  • Back pain or leg pain that worsens with staining or sitting and is relieved by lying down
  • Pain in the buttocks; pain can be constant or intermittent, on one or both sides
  • Leg pain: the result of pinched spinal nerves or the thecal sac (housing of the spinal cord)
  • “Pins and needles” sensation in the back, buttocks, or lower limbs
  • Numbness in the buttocks, legs, feet, or toes
  • Pain upon bending at the waist or when standing for a period
  • Pain and discomfort when rising from a seated position
  • Varying degrees of back pain or leg pain with sudden movements, coughing or sneezing
  • Leg pain that is more severe than back pain, or leg pain alone – i.e., without any pain in the back
  • Discomfort or pain when turning in bed during sleep, severe enough at times to wake patients up from a nap or sleep
  • Inability to walk due to weakness or pain in legs
  • Incontinence
  • Impotence, infertility
  • Paralysis of one or both legs as the condition progresses
male holding neck pain of hypertrophy of ligamentum flavum

What Symptoms are Present when Hypertrophy of Ligamentum Flavum is in the Neck or Cervical Spine?

Thickening of Ligamentum Flavum (LF) can occur at any point in the spine. We have already covered the most common site: the lower back. Now, let us look at the second most common place, or the neck, for ligamentum flavum hypertrophy. The neck is the second most common site for LF overgrowth, but it is critically dangerous. A severely thickened or hypertrophied LF in the neck can cause severe spinal canal stenosis or myelopathy. Severe canal stenosis in the neck can cause severe symptoms due to myelopathy. Myelopathy is severe compression of the spinal cord that often results from trauma, degeneration, hypertrophy, or congenital disabilities. Symptoms or malfunction can be present from the neck all the way down to the feet. It can cause paralysis from the neck down.

Earlier, we mentioned that the ligamentum flavum was thinnest in the neck. We also said that it was the longest as well. Both statements are true. In addition to what was discussed, the neck portions of LF have the highest levels of elastin. Higher levels of elastin are needed to provide better stretchability and retraction of this ligament during forward-bending or backward tilting of the head and neck.

Poor posture, text neck, slip-disc in the neck, spondylosis, and subluxation damage to the ligamentum flavum lead to varying degrees of pain or symptoms.

We have provided a list of the most common symptoms of the cervical spine below:

Cervical spine hypertrophy of the ligamentum flavum produces symptoms when the spinal cord or spinal nerves are pinched. In most cases, the symptoms gradually develop over a period. However, there are scenarios where symptoms are not felt in early or even moderate stages of hypertrophy. As such, most are diagnosed in moderate or severe stages. In almost all cases, there will be some level of associated spinal disc damage. The most common spinal disc damage in patients presenting with a hypertrophied LF is degenerative disc disease, bulging discs, herniated discs, extruded discs or fragmented spinal discs.

Here is a list of symptoms for thickened ligamentum flavum to watch out for:

  • Mild cases are often asymptomatic (no pain). However, it can cause stiffness in the neck.
  • Neck pain, upper back pain or mid back pain
  • Shoulder pain, arm pain, elbow pain or wrist pain
  • Carpal tunnel-like sensations
  • Weakness in shoulder, arms, wrists or hand
  • Burning sensation in the neck, upper back or upper extremities
  • Pins and needles sensations in upper extremities, neck or the upper back. In moderate or severe cases, it can even cause pins and needles in the legs and the feet
  • Poor coordination of legs, arms, wrists or hands
  • Unable to balance or walk with a shuffling gait
  • Loss of bladder (incontinence) and bowel functions, as well are interruptions or complete loss of sexual or reproductive systems
  • Chest pain, difficulty breathing, heart issues, lung problems, and digestive issues
  • Earaches, migraines, dizziness, vertigo, tinnitus or blurred vision

To conclude, hypertrophy of ligamentum flavum in the neck can be crippling or worse. Your goals should be to seek centers, clinics or hospitals that provide non-invasive therapy solutions for the neck pain. However, most hospitals recommend a surgical intervention as they lack the non-surgical experts needed for a non-surgical recovery.

Chronic Back Pain, Chronic Neck Pain, and Hypertrophied LF Patients Must Avoid Steroid Injections

Back pain, neck pain, and hypertrophied LF are mechanical conditions that result from accumulated daily stresses. Chronic neck pain and chronic back pain patients will always have some degree of damage or thickening in LF. Steroidal injections are an orthopedic surgeon’s favorite injectable. They love to inject patients with steroids even though it has limited application and many harmful impacts. Perhaps the love for the injectable such as steroids stems from their years of training, education, and research centered around invasive methods.

guy facing a bad back pain

Steroid injections for neck and back pain are useless as it only addresses the inflammatory nature of a health condition. However, the poking of a rather large needle in the spine, passing through the Ligamentum Flavum (LF), can harm more than it can help. As mentioned, in almost all cases of chronic back pain or chronic neck pain, LF is hypertrophied with scar tissues. Piercing a hypertrophied (scared) LF will only add more scar tissue to an already hypertrophied ligamentum flavum, but, what is even worse is the steroid itself.

While piercing the LF with a large needle can harm and create more scarring, the steroid itself is even more detrimental. The U.S. National Library of Medicine has over 60,000 published research articles that allude to the side effects of steroid injections.

“We will cover of these findings to help you understand why we oppose the steroid injections for chronic neck pain, chronic back pain or in-patient with LF hypertrophy below:”

  • Our ligaments, tendons, muscles, cartilage, joints, and bones all have living stem cells. These stem cells are needed to regenerate and repair following damage or injury. According to published research, steroid injections harm the living stem cells in your body.
  • When injected, cortisone (steroid) crystallizes. The crystallization of steroids in tendons leads to weaknesses in their supportive and protective abilities or functions.
  • Steroid injections have been found to deplete bone and cartilage densities, increasing your risks of arthritis and osteoporosis. For the arthritic and osteoporotic patient, steroid injections can progressively increase the rate of progression.
  • According to an article from The Lancet in 2010, patients injected with steroid injections have a slower rate of recovery when compared to physiotherapy. What is worse is the fact when the injection if repeated. Perhaps, this is why some orthopedic surgeons limit the number of injections to three times within a twelve-month period. However, many consider this as three-too-many.
doctors ready to surgery ligamentum flavum hypertrophy

Should you opt for spine surgery for a hypertrophied LF?

Spine surgery should be the last option. Spinal canal stenosis is a common condition in chronic neck pain and chronic back pain patients. The most common cause of spinal canal stenosis is hypertrophy of the ligamentum flavum. The second most common cause of spinal canal stenosis is a slipped disk. The third most common cause is bone spur or osteoarthritis. Having said that, the vast majority of chronic neck pain and back pain patients present with varying degrees of all three types: hypertrophied LF, slipped disk, and bone spurs. To complicate matters, multiple segments are involved in more than 90% of cases.

Spine surgery has never been touted as a cure, and those that claim it as a cure are enormously mistaken. A cure is a 100% reversal of a normal function. You cannot obtain 100% normal function when parts are cut, screwed, plated or caged. It is just that simple. However, there are scenarios when spinal surgery becomes a necessity. Surgery on the spine for LF, spurs, a slipped disc, or spinal canal stenosis should be opted for when targeted non-invasive conservative measures have been exhausted. Also, surgery on the spine becomes a necessity when a patient presents with a loss of bowel or bladder function.

Pain in the back or neck, pain down the arms, and even weakness in the legs or arms can be effectively treated non-surgically. Even foot drop and mild incontinence issues can be resolved through targeting research-based methods of treatments.

What is the Best Non-Invasive Conservative Treatment for Neck Pain, Back Pain, Slipped Disc, Hypertrophied Ligamentum Flavum, and Spinal Canal Stenosis?

Chiropractic Specialty Center® uses a proprietary system of spine care through an integrative approach backed with breakthrough spine-specific technology. This system of treatment is termed NSD Therapy®. NSD Therapy® (Non-Surgical Decompression Therapy) is provided through the collaborative efforts of clinical physiotherapists (physical therapists) and our researched-based doctors of chiropractic medicine. In short, NSD Therapy® is the combination of physical therapy, chiropractic, physiotherapy, rehabilitation, nutrition, and lifestyle changes. It is the most compressive non-invasive form of spine care.

heal hypertrophy of ligamentum flavum with non-surgery

The physical therapy component of NSD Therapy® includes soft-tissue mobilizations, gentle osseous manipulations, trigger point therapy, and myofascial release. Physical therapy treatments in NSD Therapy® are the manual procedures rendered. The physiotherapy aspects of NSD Therapy® are provided through medical devices specifically for the spine. With physiotherapy, some of your treatments are delivered through modality-assisted therapeutic measures. We may recommend one or all of the following physiotherapy treatments after assessing you: ultrasound therapy, interferential current therapy, shockwave therapy, the RxDecom®, and Spinercise®.

The chiropractic treatment rendered in our centers for chronic neck pain, back pain, a slipped disc, spinal canal stenosis, and ligamentum flavum hypertrophy is through the Activator methods. We do not use the traditional rotatory spine adjustments, as these can further aggravate patients with chorionic conditions. Our Activator method of chiropractic treatment is specific to facet joints (spinal joints). In addition to using the Activator treatments, our chiropractors will use proprietary methods involving chiropractic manipulations specifically for elongating soft tissues that include LF.

Chiropractic Specialty Center Offers Comprehensive Treatment for Hypertrophy of Ligamentum Flavum. 

Nutrition, spinal rehabilitation, and lifestyle changes will also be needed. Our clinical teams will customize a specific plan for your nutritional needs, rehabilitative needs, and any modification of your lifestyle or activities. If you are seeking the best non-surgical spine center for ligamentum flavum hypertrophy, we are it. No other practice in Malaysia offers the same level of spine care that we provide.

 

Chiropractic Specialty Center® is Malaysia’s premier non-surgical center for conservative treatments of the spine and joints. If you have been diagnosed with a slipped disc, hypertrophy of facets, spinal stenosis, or ligamentum flavum hypertrophy, we are your best choice; call us today.