Preoperative diagnosis of an extradural cyst arising from a spinal facet joint: case report

A ganglion cyst derived from a synovial cyst: A case report

The synovial and ganglion cysts originating from the facet joint have been named under the name of the Juxtafacet cyst by the several researchers. They put forward that the synovial cyst originated from the synovial joint. But, they failed to clarify the pathophysiology of the formation of the ganglion cyst. In this case report, we reported a 67-year-old male patient was referred to the emergency from another center with the complaint of a left leg pain and weakness in the left foot and patient was treated with microchirurgical technique. His patological examination was evaluated a ganglion cyst. We have discussed and explained the pathophysiology of the formation of a ganglion cyst derivered from a synovial cyst. And separately, we have presented the spinal cysts by grouping them under a new classification called a cystic formation of the soft tissue attachments of the mobile spine as well as dividing them into sub-groups.

Operation of Lumbar Zygoapophyseal Joint Cysts Using a Full-Endoscopic Interlaminar and Transforaminal Approach

In appropriate situations, extensive decompression with laminectomy often continues to be described as the method of choice for operations involving lumbar zygoapophyseal joint (z-joint) cysts. Tissue-sparing procedures are nevertheless becoming more common. Endoscopic techniques have become the standard procedures in many areas because of the advantages they offer in terms of surgical technique and in rehabilitation. One key aspect in spinal surgery was the development of instruments for sufficient bone resection carried out under continuous visual control. This enabled endoscopes to be used when operating on z-joint cysts. The objective of this prospective study was to examine the technical possibilities for the full-endoscopic interlaminar and transforaminal technique in lumbar z-joint cysts. A total of 74 patients were followed up for 2 years. The results show that 85% of the patients no longer have any leg pain or that the pain had been almost completely eliminated, and 11 % experience occasional pain. The complication rate was low. The full-endoscopic techniques brought advantages in the following areas: operation, complications, traumatization, and rehabilitation. The recorded results show that full-endoscopic resection of a z-joint cyst using an interlaminar and transforaminal approach provides an adequate and safe supplement, and is an alternative to conventional procedures when the indication criteria are fulfilled. It also offers the advantages of a minimally invasive intervention.

Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature

Synovial cysts are uncommon pathological entities in patients with cervical degenerative spinal disease, and there are only a few reports in the literature. Treatment typically involves decompression; however, biomechanical data indicate that laminectomies in the cervical spine also result in cervical instability, specifically within the cervicothoracic junction, supporting the use of fusion as well. The authors describe the use of fusion with decompression in the treatment of 3 patients with cervicothoracic synovial cysts that presented in an acute fashion with associated myelopathy and neurological decline, and they review the diagnostic elements, histopathology, and treatment of these cysts. All 3 of the patients did well with decompression via a posterior approach with a single-level instrumented fusion from C-7 to T-1. Each patient regained complete neurological function and had no residual neurological deficits. These results are promising, although the sample size of 3 cases is too small to make any conclusive evaluations. Future studies incorporating Class I and Class II data are imperative to make firm conclusions regarding general management of this rare entity.

Intraosseous ganglion cyst within the L4 lamina causing spinal stenosis

BACKGROUND CONTEXT

There are rare reports of intraosseous ganglion cysts in the cervical spine. However, to our knowledge, there are no previous reports of these cysts occurring in the lumbar spine.

PURPOSE

To report a case of symptomatic lumbar spinal stenosis caused by an intraosseous ganglion cyst of the L4 lamina that communicated with the spinal canal.

STUDY DESIGN

Case report.

METHODS

An 86-year-old woman was referred to our spine service for a 2-year history of anterior thigh and leg pain. Magnetic resonance imaging revealed a benign-appearing intraosseous cyst in the left L4 lamina communicating with a posterior epidural cyst at L4-L5 causing marked spinal stenosis. The patient was treated successfully with a laminectomy and resection.

RESULTS

The patient underwent partial laminectomies of L4 and L5 preserving the interspinous ligaments between L5-S1 and L3-L4. The cyst was removed en bloc without violation of the cyst wall. Histopathologic examination revealed focal myxoid changes without a cellular lining of the cyst wall, confirming the diagnosis of intraosseous ganglion cyst.

CONCLUSIONS

This is the first report to describe an intraosseous ganglion cyst occurring in the lumbar spine. Although spinal stenosis is commonly a result of degenerative joint or disc disease, it occasionally may result from more obscure causes. This case illustrates a patient with an intraosseous ganglion cyst within the spinal lamina resulting in spinal stenosis, treated successfully with a laminectomy and resection.

Spontaneous hemorrhage in an upper lumbar synovial cyst causing subacute cauda equina syndrome

Lumbar spine synovial cysts are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. They are common in lower lumbar lesions but rare in upper lumbar lesions. Several cases of hemorrhage into lower lumbar juxtafacet cysts after trauma or anticoagulation therapy have been reported in the literature. This article describes a case of subacute cauda equina syndrome resulting from spontaneous hemorrhage into an upper lumbar synovial cyst. A 65-year-old man presented with a 3-month history of intermittent bilateral lumbar pain. One week before, he experienced a sudden exacerbation of lumbar pain and began falling frequently; he also reported weakness and tingling in his lower limbs. A hematic collection associated with a large juxtafacet cyst at L2-L3 was suspected on magnetic resonance imaging. He underwent surgical decompression, and the cyst was resected. Microscopic examination was consistent with the diagnosis of a synovial cyst. Two days postoperatively, he was walking independently. Although several descriptions exist of hemorrhagic lumbar juxtafacet cysts after trauma or anticoagulant therapy, to the authors' knowledge, this is the first documented case of hemorrhage in an upper lumbar synovial cyst with no previous traumatic event or medication use. Magnetic resonance imaging was essential in making the preoperative diagnosis. Surgical removal of the cyst was an effective treatment.

Management of lumbar spine juxtafacet cysts

OBJECTIVE

We review a series of 21 patients with lumbar juxtafacet cysts (LJFCs) treated in two institutions.

METHODS

The charts of 21 patients with a diagnosis of LJFCs during a 6- year period, January 2001 to December 2006, treated at Hamad Hospital, Doha, Qatar, and El Ribat University Hospital, Khartoum, Sudan, were reviewed. Demographic data, clinical and imaging findings, management, and outcome were reviewed.

RESULTS

Twenty-one patients with 23 LJFCs were identified (14 men, 7 women) with a mean age of 54 years. All presented with back pain and radicular symptoms. Ten patients presented with neurogenic claudication due to spinal canal stenosis. All had magnetic resonance imaging and dynamic spine radiographs. Fourteen LJFCs were found at L4-5 level, 8 at L5-S1 level, and 1 at L3-4 level. Three patients had sustained improvement with conservative treatment and 17 patients underwent surgical management, mainly through a microsurgical approach. Nine of 10 patients with lumbar canal stenosis underwent decompressive laminectomy; one patient refused treatment. One patient with bilateral LJFCs and mobile spondylolisthesis underwent spinal fusion. All patients, except one, were followed up for a period of 12-72 months.

CONCLUSIONS

LJFCs may lead to symptoms similar to degenerative disc disease. Surgery is reserved for symptomatic patients who do not improve satisfactorily with conservative treatment. The microsurgical approach is our preferred surgical method and spinal fusion should be reserved for patients with spinal instability. Long-term outcome with surgical treatment appears satisfactory.

Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes

BACKGROUND CONTEXT

With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear.

PURPOSE

To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence.

STUDY DESIGN

Systematic review of the literature.

PATIENT SAMPLE

All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion.

OUTCOME MEASURES

Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales.

METHODS

We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts.

RESULTS

Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4-L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion.

CONCLUSIONS

Surgical decompression results in symptomatic resolution in the vast majority of patients; however, recurrent back pain occurs in a significant number of patients. Cyst recurrence occurs in less than 2% of patients but has never been reported after cyst excision with concomitant fusion. The lack of cyst recurrence after concomitant fusion supports the need to investigate the value of fusion of the involved motion segment in the treatment of symptomatic synovial cysts of the spine.

Factors associated with recurrent back pain and cyst recurrence after surgical resection of one hundred ninety-five spinal synovial cysts: analysis of one hundred sixty-seven consecutive cases

STUDY DESIGN

Retrospective study.

OBJECTIVE

Compare outcomes of different treatment methods for intraspinal synovial cysts.

SUMMARY OF BACKGROUND DATA

Intraspinal synovial cysts are cited as an increasing cause of back pain and radiculopathy. To date, few studies have compared outcomes of differing treatment methods in patients with synovial cysts.

METHODS

We retrospectively reviewed 167 consecutive patients undergoing surgical management of 195 symptomatic synovial cysts at a single institution over 19 years. The incidence of postoperative mechanical back pain, radiculopathy, and cyst recurrence was compared between patients undergoing unilateral hemilaminectomy (n = 51), bilateral laminectomy (n = 39), facetectomy with in situ fusion (n = 18), and facetectomy with instrumented fusion (n = 56).

RESULTS

A total of 155 (97.5%) patients presented with radiculopathy, 132(82.5%) with mechanical back pain, 31 (20%) with neurogenic claudication, and 5 (3.2%) with bladder dysfunction. Most cysts occurred in the lumbar spine. After surgery, back and radicular pain improved in 91.6% and 91.9% patients, respectively. By a mean follow-up of 16 +/- 9 months, 36 (21.6%) patients developed recurrent back pain, 20 (11.8%) recurrent leg pain, and 5 (3%) recurrent synovial cysts. Patients undergoing laminectomy had a significantly increased cyst recurrence incidence compared to fusion groups via log-rank test (P = 0.042), and this risk was decreased to baseline with instrumented fusion on reoperation. Laminectomy was also associated with the highest increased risk of recurrent back pain in both log-rank test (P = 0.018) and proportional hazards regression (HR): 1.64 (1.00-3.45), P = 0.05. Instrumented fusion had the lowest risk for back pain recurrence.

CONCLUSION

Hemilaminectomy or laminectomy remains one of the mainstay surgical treatments for symptomatic intraspinal synovial cysts. Our experience shows that the majority of patients undergoing decompression/excision of synovial cysts will have immediate improvement in back and leg pain. However, within 2 years, patients receiving hemilaminectomy or laminectomy alone have an increased incidence of back pain and cyst recurrence. Decompression with instrumented fusion appears to be associated with the lowest incidences of cyst recurrence or back pain.

Isolated unilateral hypoglossal nerve palsy secondary to an atlantooccipital joint juxtafacet synovial cyst

Juxtafacet cysts of the atlantooccipital joint that present with isolated hypoglossal nerve palsy are rare and may mimic more common pathological entities. The authors report on the third such case in the literature and discuss the differential diagnosis, imaging hallmarks, preoperative recognition, and surgical management of this lesion, and provide a review of the literature.

The authors discuss their experience with the treatment of a 67-year-old woman who presented with an isolated hypoglossal nerve palsy caused by a nonenhancing cystic septated lesion abutting the lateral medulla just medial to the left hypoglossal canal. The lesion was presumed to be a necrotic hypoglossal schwannoma or epidermoid tumor. Intradural surgical exploration failed to demonstrate an intradural lesion, but confirmed the presence of an extradural mass caudal to the hypoglossal nerve. Extradural exploration revealed a synovial cyst of the atlantooccipital joint, which was then resected. Postoperatively, the patient developed worsening dysphagia and hoarseness. Failure to recognize this rare entity preoperatively resulted in unnecessary intradural exploration and cranial nerve morbidity. In retrospect, the preoperative diagnosis of this lesion was suggested by lack of central enhancement, absence of dumbbell formation and the presence of erosive synovial changes. Regardless, the extreme rarity of this lesion at this location will always make its recognition challenging.

Spontaneous hemorrhage in a lumbar ganglion cyst

STUDY DESIGN

Case report.

OBJECTIVE

To describe a case of a subacute radiculopathy resulting from a spontaneous hemorrhage into a lumbar ganglion cyst.

SUMMARY OF BACKGROUND DATA

Ganglion and synovial cysts of the lumbar spine are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. Few cases of hemorrhage into lumbar juxtafacet cysts after trauma or anticoagulation therapy have been described in the literature.

METHODS

A case of a spontaneous hemorrhage in a lumbar ganglion cyst is presented.

RESULTS

A 61-year-old man presented with a 2-month history of intermittent bilateral lumbar ache. Eight days before admission he had a sudden exacerbation of the lumbar pain and began to fall frequently and noticed weakness and tingling in his lower members, mainly in the right leg. Magnetic resonance imaging scan revealed a hematic collection associated with a large juxtafacet cyst at the L4-L5 level. He was submitted to surgery and the cyst was totally removed. Microscopic examination was consistent with the diagnosis of a ganglion cyst. Two days after surgery he had already an independent gait.

CONCLUSION

Although, there are a few descriptions of hemorrhagic lumbar justafacet cysts after trauma or anticoagulant therapy, this is the first case of a hemorrhagic ganglion cyst with no previous traumatic event or use of medication. Magnetic resonance imaging was essential for making the preoperative diagnosis. Neurosurgical cyst removal proved to be an effective treatment.

Lumbar spinal 'juxtaarticular' cyst in a Gordon setter

An 11-year-old Gordon setter bitch was presented with a history of progressive weakness in the right hind limb associated with pain in the lumbar spine. Neurological deficits consisted of ataxia, monoparesis, muscle atrophy and spontaneous over-knuckling of the affected limb. A large 'juxtaarticular' cyst located in a right dorsolateral position of the intervertebral foramen at L3-L4 was diagnosed by magnetic resonance imaging. The cyst was removed through a modified laminectomy. The dog recovered quickly and returned to the owners 4 days after surgery with slight neurological symptoms. During the follow-up examination 2 and 6 months later, the Setter showed normal gait and neurological examination.

Microsurgical treatment of juxta facet cysts of the lumbar spine

OBJECTIVES

Juxta facet cysts are a common cause of low back and radicular pain. They are mostly associated with degenerative facet joints and spondylolisthesis. The study focuses on long-term outcomes after microsurgical treatment without fusion.

METHOD

From April 2002 to April 2004, 31 patients (23 female and 8 male) underwent microsurgical resection of lumbar juxta facet cysts. The patient age ranged from 31 to 83 years (mean 67.2 years). The most affected level was L4-L5 (19 patients), followed by L3-L4 (9 patients). Fourteen patients additionally had spondylolisthesis of the involved segment. All patients had signs of nerve root compression and had received conservative treatment preoperatively. We performed limited bone removal (sparing the facet joints) and cyst resection in 27 patients. In four patients, cyst resection and standard laminectomy were performed owing to spinal stenosis.

RESULTS

Conservative treatment was without any effect in all patients. At follow-up, 12-30 months after surgery, excellent to good outcome was achieved in 25 of 31 patients (80.7%), and 6 patients (19.3%) showed fair results. Persistent low back pain was more common in patients with spondylolisthesis than in the other group (6/14 vs 3/17); this may be due to instability. Spondylolisthesis did not progress or become mobile after surgery radiographically in any of our patients.

CONCLUSIONS

Conservative therapy does not adequately improve symptoms in patients with intraspinal juxta facet cysts and radicular signs. Juxta facet cysts can be treated effectively with a minimally invasive microsurgical approach. This may be of particular significance when the cysts are associated with spondylolisthesis, minimizing the risk of instability and the need for fusion. In a selected group of patients with persistent low back pain, fusion may become necessary to improve symptoms.

Synovial cysts associated with cauda equina syndrome in two dogs

OBJECTIVE

To report synovial cysts associated with cauda equina syndrome in 2 dogs.

STUDY DESIGN

Clinical cases.

ANIMALS

Two German Shepherd dogs.

METHODS

After magnetic resonance imaging detection, cysts were surgically removed via dorsal laminectomy.

RESULTS

Six and 8 months after surgery, both dogs were free of clinical signs and no pain was elicited on lumbosacral joint manipulation.

CONCLUSION

Although described in dogs, cysts at the lumbosacral joint might cause compression of the cauda equina nerve roots. Radical excision of the cyst capsule can result in resolution of clinical signs.

CLINICAL RELEVANCE

Synovial cysts should be considered in the differential diagnosis of dogs with cauda equina compression syndrome when lumbosacral degenerative joint disease is present.

Cervical juxtafacet cysts: case report and literature review

BACKGROUND

Juxtafacet cysts of the cervical and thoracic spine are rare and often present with myelopathy. Juxtafacet cysts are well recognized entities found commonly in the lumbar spine but are unusual in the cervical and thoracic spine. We present a case of a patient with gait disturbance and early myelopathy who was found to have a juxtafacet cyst at the cervico-thoracic junction. We further review the literature.

PURPOSE

To describe a case of a cervico-thoracic juxtafacet cyst and review the literature.

STUDY DESIGN

Case report and subject review.

METHODS

One patient presenting with early myelopathy and pain underwent surgery for resection of the lesion. Pathologic analysis revealed a juxtafacet cyst.

RESULTS

The patient recovered uneventfully with relief of his pain. Pubmed review revealed less than 30 similar cases in the literature.

CONCLUSION

Juxtafacet cysts of the cervical spine are rare entities. These lesions comprise both synovial cysts and ganglion cysts. The benign lesions present with myelopathy and should be considered in patients with cystic lesions in the cervical spinal canal.

Myelopathic presentation of cervical juxtafacet cyst: a case report

STUDY DESIGN

Case report.

OBJECTIVES

Discussion about the nature of the lesion, its various presentations, image characteristics, clinical features, surgical treatment, and patient outcome.

SUMMARY OF BACKGROUND DATA

Juxtafacet cysts are uncommon intraspinal lesions most frequently found in the lumbar region. They usually originate as monoradicular compression syndrome mimicking disc herniation. In the cervical spine, they are rare and also have similar clinical features to intervertebral disc protrusion. However, the image findings are highly discriminative and often lead to accurate diagnosis. The cyst occupies a posterolateral position within the spinal canal, displacing the nerve root anteriorly. This situation is better seen in magnetic resonance imaging, but computed tomography scan and plain myelography also point to a diagnosis. The posterolateral site in the spinal canal can be accessed directly by a single-level laminectomy or hemilaminectomy. These are epidural lesions, usually cystic, attached to the facet joint and protruding into the intervertebral foramen. Recurrence after surgery is extremely rare and has only been reported in the lumbar spine.

METHODS

In this article, we report the case of a male patient, 64 years of age, who presented with a progressive and severe myelopathy associated with multiple mononeuropathy, which delayed the diagnosis and treatment of the main neurologic condition, a cervical spinal compressive syndrome, proven to have originated as a juxtafacet cyst. The patient underwent complete surgical excision of the lesion.

RESULTS AND CONCLUSIONS

The patient had good recovery of the myelopathy, and 6 months after surgery, he was able to walk. A follow-up of 2.5 years has not revealed any recurrence or new neurologic conditions.

Trauma as a precipitant of haemorrhage in synovial cysts

Synovial cysts have been well reported as a cause of sciatica, with a sudden acute exacerbation being attributed to haemorrhage and subsequent enlargement of the cyst. Cyst formation is attributed to facet joint degeneration associated with a defect or rupture of the joint capsule. The mechanisms of haemorrhage have not been well described previously. Two cases of haemorrhagic synovial cysts causing acute exacerbation of sciatica are described. Both cases were directly attributable to manipulation of degenerate spines. The MRI and histopathological findings are discussed and we propose a mechanism whereby excessive stress on a degenerate revascularized synovium leads to haemorrhage within synovial cysts.

Lumbar intraspinal synovial cysts: conservative management and review of the world's literature

BACKGROUND CONTEXT

Lumbar intraspinal synovial cysts are an important cause of axial and radicular spine pain. Controversy about nonsurgical versus surgical treatment persists.

PURPOSE

To evaluate the efficacy of nonsurgical management of symptomatic lumbar intraspinal synovial cysts (LISCs).

STUDY DESIGN/SETTING

Retrospective review set in outpatient physiatry office.

PATIENT SAMPLE

Ten patients (8 women, 2 men; average age, 60 years) with LISCs and average symptom duration of 7.9 months.

OUTCOME MEASURES

Numerical pain rating scale (NRS-11), Roland-Morris disability outcome measure, patient satisfaction, and surgery.

METHODS

Patients with LISCs were identified and their charts were reviewed. Those patients whose symptoms correlated with the level of LISC-induced extradural compression were eligible. All patients received conservative care and a fluoroscopic-guided lumbar spine injection. The primary author conducted telephone follow-up.

RESULTS

All 10 patients had unilateral radicular pain. Seven had stable neurologic deficits. Magnetic resonance imaging and computed tomography/myelography, respectively, identified a LISC in 8 and 2 patients. Five patients had cyst aspiration followed by steroid instillation; 5 patients had cyst aspiration followed by a transforaminal epidural steroid injection. Average length of follow-up was 50.4 weeks. Only 1 patient had sustained benefit. One patient had no benefit and refused surgery. Eight patients underwent surgery and had a good result.

CONCLUSION

In our opinion, nonsurgical management in patients with LISC-induced radicular pain does not appear to be as successful as surgery.

Degenerative intraspinal cyst of the cervical spine: case report and literature review

STUDY DESIGN

A case report and a literature review are presented.

OBJECTIVE

To describe and review the clinical presentations, characteristic findings from imaging studies, and treatment of synovial and ganglion cysts arising within the cervical spinal canal.

SUMMARY OF BACKGROUND DATA

Synovial and ganglion cysts in the cervical spine are rare. To the authors' knowledge, 24 sporadic cases in all, designated by various terms, have been reported in the literature.

METHODS

Three cases of synovial and ganglion cysts in the cervical spine are reported as well as a review of the literature.

RESULTS

Characteristic findings from imaging studies included a fluid-containing extradural lesion demonstrated on magnetic resonance images and gas content in the lesion demonstrated on ordinary or sagittally reconstructed computed tomography images. A laminectomy with removal of the cyst was the treatment of choice in most cases.

CONCLUSIONS

Neither communication with an adjacent facet joint nor histopathology of the cyst wall provides a persuasive basis for differentiating ganglion, synovial cyst, and cyst arising from the ligaments. To accommodate the varied presentations, the authors propose a comprehensive term for these lesions: "degenerative intraspinal cyst."

Patient outcome after resection of lumbar juxtafacet cysts

STUDY DESIGN

Retrospective review of patients who underwent lumbar juxtafacet cyst resection with questionnaire follow-up.

OBJECTIVES

Determine the long-term outcome after resection of lumbar juxtafacet cysts.

SUMMARY OF BACKGROUND DATA

Juxtafacet cysts are uncommon causes of radicular pain and are often associated with significant spinal degenerative disease. Previous studies have not focused on the outcome of patients who have undergone resection.

METHODS

Charts of 29 patients who underwent lumbar juxtafacet resection were reviewed and an outcomes questionnaire was sent to each.

RESULTS

Thirty-three lumbar juxtafacet cysts were resected from 29 patients. Cysts, 31 (94%) from facets and 2 (6%) from the ligamentum flavum, most commonly arose at the L4-L5 level (51%). Twelve patients (41%) were found to have some degree of spondylolisthesis before surgery, while 26 patients (90%) had facet arthropathy. Two patients (7%) underwent concurrent resection and fusion. Recurrence occurred in 3%. Three patients (9%) had subsequent lumbar spine operations, including 2 fusions (6%). Incidental durotomy was the most common surgical complication occurring in 3 cases (9%). Twenty-four patients (83%) responded to follow-up questionnaire or phone interview. Mean length of follow-up was 24 months (4-64 months). Twenty patients (83%) reported improvement in pain, and 16 (67%) reported an improved level of function. All respondents reported some degree of improvement in their condition after surgery.

CONCLUSIONS

Juxtafacet cysts are an uncommon cause of radiculopathy. Surgical resection is the treatment of choice with low rates of complications, recurrences, and residual complaints.

Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience

OBJECT

The authors report a retrospective analysis of 194 patients surgically treated at their institutions for symptomatic lumbar synovial cysts from January 1974 to January 1996.

METHODS

Patient characteristics including age, sex, symptoms, signs, and preoperative neuroimaging studies were reviewed. Surgical procedures, complications, results, and pathological findings were correlated with preoperative assessment. One hundred ninety-four patients were surgically treated for symptomatic lumbar synovial cysts. Eighty percent were diagnosed and treated between 1987 and 1996. There were 100 men and 94 women with an average age of 66 years (range 28-94 years). The most common symptoms were painful radiculopathy (85%) and neurogenic single or multiroot claudication (44%). However, sensory loss (43%) and motor weakness (27%) were also presenting symptoms. Eleven percent of patients had undergone previous lumbar surgery prior to being referred to the Mayo Clinic. Preoperative neurological examination demonstrated motor weakness (40%), sensory loss (45%), reflex changes (57%), and variants of cauda equina syndrome (13%). In 19% of patients, normal neurological status was demonstrated. There was equal left/right-sided laterality, and eight patients presented with bilateral synovial cysts. The most commonly affected level was L4-5 (64%). All patients underwent laminectomy and resection of the cyst. Concomitant fusion was performed in 18 patients in whom clinical evidence of instability had been observed. However, subsequent fusion was required in only four patients who developed symptomatic spondylolisthesis. Surgery-related complications included cerebrospinal fluid leak (three patients), discitis (one patient), epidural hematoma (one patient), seroma (one patient), and deep vein thrombosis (one patient). One patient died 3 days after surgery of cardiac dysrhythmia. Follow-up data obtained for at least 6 months postoperatively were available in 147 patients. Of these, 134 (91%) reported good relief of their pain and 82% experienced improvement in their motor deficits.

CONCLUSIONS

Lumbar synovial cysts are a more common cause of lumbar radicular pain than previously thought. Surgical removal of the cyst is a safe and effective treatment for symptomatic relief in patients with lumbar synovial cysts. A concomitant fusion procedure may be performed in select cases. In this study, only a few patients developed symptomatic spinal instability requiring a second operation.

Acute traumatic myelopathy secondary to a thoracic cyst in a professional football player

STUDY DESIGN

Case report of acute traumatic myelopathy secondary to thoracic synovial cyst in a professional football player.

OBJECTIVE

To emphasize examination for myelopathy and describe the radiographic and magnetic resonance findings of a rare source of traumatic myelopathy.

BACKGROUND

Magnetic resonance imaging is the best initial evaluation for myelopathy in a traumatic setting. Heightened awareness during evaluation of a player involved in a traumatic incident allowed the diagnosis of potential cord damage and paralysis.

METHODS

A subject with symptoms resulting from a direct blow to the back was evaluated for myelopathy, with diagnosis assisted by magnetic resonance imaging used to pinpoint the source of the disorder.

RESULTS

The diagnosis allowed a surgical excision of the traumatic synovial cyst and full recovery of the injured football player.

CONCLUSIONS

Awareness during examination for myelopathy in an acutely injured athlete is imperative to prompt the clinician to order the proper diagnostic studies and thereby embark on a surgical correction of the problem.

A series of 60 juxtafacet cysts: clinical presentation, the role of spinal instability, and treatment

Spinal instability may be a cause of juxtafacet cyst formation and the pain and disability that occur after surgical excision of the cyst. To determine the role of instability, a retrospective review of charts identified 60 facet cysts in 56 patients treated over a 6-year period. Three patients developed an asynchronous cyst at the same level but on the opposite side of the previously resected cyst and one patient had a recurrent cyst in the same location. Forty-one cysts were present in patients with radiculopathy and 16 in patients with neurogenic claudication. Two patients presented with myelopathy and one had cauda equina syndrome. Thirty-six of the 60 cysts were located at L4-5, the most mobile segment. Fifteen patients had spondylolisthesis, of whom two experienced worsening spondylolisthesis postoperatively. Seven patients had scoliosis and 20 had systemic arthritis. Fifty-five cysts were resected via mesial facetectomy. Six of the patients undergoing this procedure had transverse process fusions at initial surgery for preoperative instability. Two others required fusion for post-operative instability and increased spondylolisthesis. Follow-up review was available in 95% of patients with an average duration of 12 months. Forty patients had excellent relief of symptoms, 12 had occasional back pain, and one patient did poorly. Flexion/extension views of the spine are recommended both pre- and postoperatively to identify the need for fusion in patients with juxtafacet cysts.

Hemorrhage into a lumbar synovial cyst causing an acute cauda equina syndrome. Case report

Juxtafacet cysts of the lumbar spine have been reported with increasing frequency but their pathogenesis remains obscure. These cysts most frequently present with back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms of spinal canal compromise. The authors report an unusual case of hemorrhage into a right L3-4 synovial cyst causing an acute cauda equina syndrome and describe its successful surgical treatment. The clinical, radiographic, and pathological features are discussed.