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Badra M, Najjar E, Wardani H, Jamaleddine Y, Daccache E, Ezzeddine H, Moucharafieh R. Evaluation and Treatment of Lumbar Spine Extradural Cysts: A Narrative Review. Cureus 2024; 16:e60604. [PMID: 38894794 PMCID: PMC11185196 DOI: 10.7759/cureus.60604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
The main objective was to describe the different types and characteristics of lumbar spine extradural cysts and their optimal treatment options with a focus on endoscopic technique. We searched Pubmed, EMBASE, Medline, and Google Scholar for articles published between 1967 and 2020 using the keywords "Spinal Cyst," "Extradural Cyst," and "Lumbar Cyst." The various anatomical and histological types of the extradural cysts with their presentations, etiologies, imaging, and optimal treatment with a focus on endoscopic techniques were reviewed from the articles. Lumbar spinal cysts are relatively rare pathologies that might cause radicular symptoms similar to lumbar disc herniation. Spinal extradural cysts are classified either histologically based on the cyst lining tissues (synovial cysts or non-synovial, ganglion cysts) or anatomically based on the structure of origin (epidural cysts, ligamentum flavum cysts, discal cysts, post-discectomy pseudocysts, posterior longitudinal ligament cysts, facet cysts). Surgical excision is the recommended treatment of symptomatic cysts with endoscopic techniques being a viable option. Extradural lumbar cysts can be identified based on their histological structure or depending on their structure of origin. Regardless of their classification, they could all give similar clinical findings, and the optimal treatment would be surgical excision with endoscopic technique being a viable option with a satisfactory outcome.
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Affiliation(s)
- Mohammad Badra
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center, Johns Hopkins International, Beirut, LBN
| | - Elie Najjar
- Department of Orthopedics, Center for Spinal Studies and Surgery (CSSS) Queen's Medical Centee, Nottingham University Hospitals, Nottingham, GBR
| | - Hassan Wardani
- Department of Orthopedic Surgery, Faculty of Medicine, Lebanese University, Beirut, LBN
| | - Youssef Jamaleddine
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, LBN
| | - Elio Daccache
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, LBN
| | - Hady Ezzeddine
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
| | - Ramzi Moucharafieh
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
- Department of Orthopedics and Traumatology, Clemenceau Medical Center, Johns Hopkins International, Beirut, LBN
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Kumaria A, Wood A, Gakhar HPS, Howarth SPS, Bateman AH. Facet joint cyst haematoma: a rare cause of cauda equina syndrome. Br J Neurosurg 2019:1-2. [PMID: 31507217 DOI: 10.1080/02688697.2019.1662370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Facet joint cysts are a feature of lumbar spondylosis and are an uncommon cause of radiculopathy. Facet joint cyst haematoma is a very rare entity and has previously been reported as a subacute cause of leg pain, back pain, sensory deficit and lower limb weakness. We present the unique case of facet joint cyst haematoma presenting as cauda equina syndrome. An 81 year old lady presented with a 7 day history of back pain and left foot drop, a 1 day history of perineal numbness and urinary retention with absent rectal tone, perianal anaesthesia and left leg hypoaesthesia. Emergency MRI scan demonstrated spinal canal stenosis as the aetiology of her cauda equina syndrome. She was taken to theatre for emergency lumbar decompression. At operation a facet joint haematoma compressing the cauda equina was found and extirpated with complete resolution of symptoms. In this case, the aetiology of cauda equina compression was not demonstrated effectively on pre-operative MRI scanning.
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Affiliation(s)
- Ashwin Kumaria
- Royal Derby Spinal Centre , Derby , UK.,Department of Neurosurgery, Queen's Medical Centre , Nottingham , UK
| | - Alexandra Wood
- Department of Trauma and Orthopaedics, Lincoln County Hospital , Lincoln , UK
| | | | | | - Antony H Bateman
- Royal Derby Spinal Centre , Derby , UK.,Department of Neurosurgery, Queen's Medical Centre , Nottingham , UK
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Kaneko T, Oshima Y, Inoue H, Iwai H, Takano Y, Inanami H, Koga H. Successful treatment of lumbar ligamentum flavum hematoma using a spinal full-endoscopic system. JOURNAL OF SPINE SURGERY 2019; 4:744-749. [PMID: 30714006 DOI: 10.21037/jss.2018.09.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Percutaneous endoscopic lumbar discectomy (PELD) is a relatively less invasive treatment for lumbar disc herniation (LDH). This study investigated the usefulness of a full-endoscopic system for PELD in lumbar ligamentum flavum hematoma (LFH) treatment. Methods Between May 2017 and Jun 2018, a total of five patients with leg pain due to LFH underwent surgery using a full-endoscopic system for PELD. A percutaneous endoscopic translaminar approach (PETA) was performed right above the LFH. Pathological examination of the hematoma capsule was performed in all cases. Results The mean age of the patients was 64 years; there were 3 male and 2 female patients. Leg pain improved immediately after operation in all cases. Intraoperative findings and pathological examination revealed that the synovium at adjacent facet joints was not involved. Conclusions Full-endoscopic system is not only a safe and effective minimally invasive system for the treatment of lumbar LFH, but is also superior to acquire a correct diagnosis.
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Affiliation(s)
- Takeshi Kaneko
- PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Yasushi Oshima
- PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Inoue
- PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Hiroki Iwai
- PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Yuichi Takano
- PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
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Abstract
Lumbar facet cysts are a rare but increasingly common cause of symptomatic nerve root compression and can lead to radiculopathy, neurogenic claudication, and cauda equina syndrome. The cysts arise from the zygapophyseal joints of the lumbar spine and commonly demonstrate synovial herniation with mucinous degeneration of the facet joint capsule. Lumbar facet cysts are most common at the L4-L5 level and often are associated with spondylosis and degenerative spondylolisthesis. Advanced imaging studies have increased diagnosis of the cysts; however, optimal treatment of the cysts remains controversial. First-line treatment is nonsurgical management consisting of oral NSAIDs, physical therapy, bracing, epidural steroid injections, and/or cyst aspiration. Given the high rate of recurrence and the relatively low satisfaction with nonsurgical management, surgical options, including hemilaminectomy or laminotomy to excise the cyst and decompress the neural elements, are typically performed. Recent studies suggest that segmental fusion of the involved levels may decrease the risks of cyst recurrence and radiculopathy.
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Ikeda O, Minami N, Yamazaki M, Koda M, Morinaga T. Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level. J Spinal Cord Med 2015; 38:239-44. [PMID: 24976137 PMCID: PMC4397208 DOI: 10.1179/2045772314y.0000000216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. FINDINGS A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5-S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. CONCLUSION We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions.
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Affiliation(s)
- Osamu Ikeda
- Department of Orthopedic Surgery, Kashiwa City Kashiwa Hospital, Kashiwa, Chiba, Japan,Correspondence to: Osamu Ikeda, Department of Orthopedic Surgery, Kashiwa City Kashiwa Hospital, 1-3 Fuse, Kashiwa, Chiba 277-0825, Japan.
| | - Norihiko Minami
- Department of Orthopedic Surgery, Kashiwa City Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Tsukuba University, Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Tatsuo Morinaga
- Department of Orthopedic Surgery, Kashiwa City Kashiwa Hospital, Kashiwa, Chiba, Japan
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Krishnan P, Sanyal S, Das S. Radiculopathy due to spontaneous facetal cyst hemorrhage. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 5:167-9. [PMID: 25558148 PMCID: PMC4279280 DOI: 10.4103/0974-8237.147085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Facetal cysts are usually encountered as incidental radiological findings in spinal imaging studies. Only rarely can neurological symptoms be attributed to them. These cysts are lined by vascularized synovial tissue. There are few reports in literature of hemorrhagic transformation in these cysts with sudden increase in size precipitating symptoms acutely. We report one such case where the existence of a hitherto undiagnosed cyst was unmasked by the haemorrhage. There is a need to be aware of this complication in patients with untreated or incidentally diagnosed cysts so that any sudden neurological deterioration can be dealt with promptly.
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Affiliation(s)
- Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Centre, Peerless Hospital Complex, Kolkata, West Bengal, India
| | - Sugat Sanyal
- Department of Pathology, Peerless Hospital and B K Roy Research Centre, Peerless Hospital Complex, Kolkata, West Bengal, India
| | - Sayan Das
- Department of Radiology, Peerless Hospital and B K Roy Research Centre, Peerless Hospital Complex, Kolkata, West Bengal, India
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Cheng YP, Lee KW, Lin PY, Huang APH, Cheng CY, Ma HI, Chen CM, Hueng DY. Full-endoscopic interlaminar removal of chronic lumbar epidural hematoma after spinal manipulation. Surg Neurol Int 2014; 5:55. [PMID: 24872917 PMCID: PMC4033759 DOI: 10.4103/2152-7806.131106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/06/2014] [Indexed: 12/17/2022] Open
Abstract
Background: Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH) is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature. Methods: We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany). Results: After surgery, the patient's radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI) follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up. Conclusions: Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits.
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Affiliation(s)
- Yen-Po Cheng
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Kwo-Whei Lee
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Yi Lin
- Transplant Medicine and Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan
| | - Abel Po-Hao Huang
- Department of Neurosurgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Yuan Cheng
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Oliveira J, Silva PS, Pereira P, Vaz R. Paraparesis as the Presenting Form of a Lumbar Hemorrhagic Synovial Cyst: A Case Report and Review of the Literature. JBJS Case Connect 2013; 3:e136. [PMID: 29252292 DOI: 10.2106/jbjs.cc.m.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Joana Oliveira
- Neurosurgery Department, Hospital São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
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Namazie MRBM, Fosbender MR. Calcium pyrophosphate dihydrate crystal deposition of multiple lumbar facet joints: a case report. J Orthop Surg (Hong Kong) 2012; 20:254-6. [PMID: 22933691 DOI: 10.1177/230949901202000225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pseudogout of the lumbar facet joints is rare. We report on a 69-year-old woman with 2-level symptomatic synovial cysts of the facet joints caused by calcium pyrophosphate dihydrate crystal deposition. She underwent surgical decompression for sciatica and low back pain. At one-year follow-up, she had recovered completely.
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Hemorrhagic facet cyst in the lumbar spine causing contralateral leg symptoms: a case report. Asian Spine J 2011; 5:196-200. [PMID: 21892394 PMCID: PMC3159070 DOI: 10.4184/asj.2011.5.3.196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 06/13/2010] [Accepted: 06/22/2010] [Indexed: 11/08/2022] Open
Abstract
Here we present a case of hemorrhagic lumbar facet cyst presenting with progressive radiculopathy only on the contralateral side. If a patient has previous back pain or neuropathy for several months and then suddenly deteriorates, hemorrhagic facet cyst of the lumbar spine should be part of the differential diagnosis. However, as in the present case, we should be aware that there is a possibility of a contralateral lesion.
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