Elsevier

World Neurosurgery

Volume 106, October 2017, Pages 1055.e1-1055.e3
World Neurosurgery

Case Report
Ventral Lumbar Synovial Cyst Causing Cauda Equina Compression: Case Report and Literature Review

https://doi.org/10.1016/j.wneu.2017.07.068Get rights and content

Background

Juxtafacet spinal cysts are cystic synovial lesions that often are indistinguishable clinically or radiologically and require histopathology analysis to confirm the diagnosis. Lumbar synovial cysts usually arising from the synovium of the facet joints. They have been described posterolaterally or rarely in the posterior midline. However, we describe the first synovial cyst ventral to the dural sac.

Case Description

We report a lumbar 3–4 lesion causing cauda equina compression in a 57-year-old man who presented with a 3-month history of low back pain and bilateral sciatica, intermittent urinary incontinence, and erectile dysfunction. Preoperative magnetic resonance imaging suggested prolapsed disc, after decompression, histological analysis of the fragment confirmed a synovial cyst.

Conclusions

Hitherto synovial cysts have not been reported anterior to the dural sac. We describe a lumbar ventral cystic mass with cauda equina compression that mimicked a disc prolapse due to synovial metaplasia. The patient had urgent decompression with subsequent resolution of the symptoms.

Introduction

Synovial cysts, also known as intraspinal facet cysts, are pathologically encapsulated masses that are the result of breakdown of the epithelial articular lining. They usually reside adjacent to the facet joints; typically, they occur in the lower lumbar region and often in sites of degenerative changes and spinal dynamic instability.1, 2 Damage to the articular lining of a zygapophyseal joint or accumulation of fluid outside the facet joint may cause abnormal cyst formation. In this context, they usually are described as being in the posterolateral area of the lumbar canal.2 They are observed rarely in the midline under the lamina.1 Some studies described degenerative cysts without synovial lining that can occur in the ligamentum flavum, the intervertebral discs, or other parts of the vertebral column.3, 4, 5 Patients with these cysts may present with radicular symptoms due to foraminal stenosis and nerve root compromise.6 However, they rarely develop cauda equina nerve root compression.

Herein, we report a unique case of midline ventral synovial cyst in a patient who presented with cauda equina syndrome. We discuss the clinical presentation, imaging, intraoperative findings, and pathologic reports. We also have reviewed the literature for spinal synovial cysts.

Section snippets

Case Report

A 57-year-old man presented with a 3-month history of low back pain and bilateral sciatica radiating down to his calves. He had unremitting progressively worsening pain that did not respond to maximal analgesic therapy. No medical history of rheumatoid arthritis or chronic inflammatory disease was disclosed. On admission to hospital, he described reduced mobility due to pain, intermittent urinary incontinence for 1 month, and erectile dysfunction for 2 weeks.

Despite subjective leg weakness, on

Discussion

Patients with degenerative changes in the lumbar facet joints often present with low back pain. However, lumbar intraspinal facet or juxtafacet cysts commonly are present with radicular pain because of their proximity to the exiting and crossing nerve roots.6, 7 Rarely synovial cysts may cause cauda equina compression.8 This has been described in elderly patients with degenerative changes9 and in association with hemorrhage into the cyst.10 However, none of the previous cases was reported

References (14)

  • J. Pindrik et al.

    Midline synovial and ganglion cysts causing neurogenic claudication

    World J Clin Cases

    (2013)
  • M. Tillich et al.

    Symptomatic intraspinal synovial cysts of the lumbar spine: correlation of MR and surgical findings

    Neuroradiology

    (2001)
  • K. Chiba et al.

    Intraspinal cyst communicating with the intervertebral disc in the lumbar spine: discal cyst

    Spine (Phila Pa 1976)

    (2001)
  • O. Vernet et al.

    Cyst of the ligamentum flavum: report of six cases

    Neurosurgery

    (1991)
  • O. Hatem et al.

    Intraspinal cervical degenerative cyst. Report of three cases

    J Neurosurg

    (2001)
  • C.I. Sze et al.

    Synovial excrescences and cysts of the spine: clinicopathological features and contributions to spinal stenosis

    Clin Neuropathol

    (2004)
  • L.S. Timbo et al.

    Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report

    Einstein (Sao Paulo)

    (2014)
There are more references available in the full text version of this article.

Cited by (4)

  • Sudden Onset of Paraparesis Caused by a Hemorrhagic Thoracic Synovial Cyst

    2019, World Neurosurgery
    Citation Excerpt :

    Synovial cysts are usually located in the lumbar region but can rarely present in the cervical and thoracic spine.1-7 Although some authors have reported bilateral cysts,7 they usually originate from a single facet joint and are believed to be caused by degeneration and microinstability.8-12 Because of the low range of motion of the midthoracic spine, mainly caused by the restriction provided by the rib cage, it is very unusual for these lesions to arise in this location.

  • A proposal of degenerative anterior epidural cysts of the lumbar spine

    2019, Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
    Citation Excerpt :

    The so called disc cysts received a better characterization in literature: fluid containing lesions without synovial lining in communication with disc space (as proved by discography); associated with radiculopathy, younger age and lesser degree of spinal degeneration [11–13]. Conversely, there are only scattered reports on ventral synovial/ganglion cysts [1–3,14–17]. Table 1 is a synopsis of reported cases of anterior cysts.

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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