The ligamentum flavum (yellow ligament) connects adjacent vertebral laminae. It has the highest elastin content of any spinal ligament. Hypertrophy of the ligamentum flavum is a major contributor to which clinical syndrome, and at which level is this most common?

• A Cervical myelopathy; most common at C5–C6
• B Thoracic disc herniation; most common at T4–T5
• C Spondylolysis; most common at L5
• D Lumbar spinal stenosis; most common at L4–L5 ✓

Explanation

Hypertrophy of the ligamentum flavum (which lies in the posterior spinal canal between laminae and forms the posterior wall of the spinal canal) is one of the primary causes of degenerative lumbar spinal stenosis. The L4–L5 level has the greatest degree of spinal motion and mechanical stress and is the most common level for ligamentum flavum hypertrophy causing central canal and lateral recess stenosis. Clinical features include neurogenic claudication (bilateral buttock and leg pain with walking, relieved by flexion). Cervical myelopathy from ligamentum flavum involvement is more common at C3–C6 but overall less common than lumbar stenosis.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.