1
|
Rana S, Pradhan A, Casaos J, Mozaffari K, Ghodrati F, Sugimoto B, Yang I, Nagasawa DT. Lumbar spinal ganglion cyst: A systematic review with case illustration. J Neurol Sci 2023; 445:120539. [PMID: 36638603 DOI: 10.1016/j.jns.2022.120539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Ganglion cysts are benign soft tissue lesions found in joints, most commonly wrists. The incidence for juxtafacet cysts, the condition under which spinal ganglion cysts are categorized, is between 0.06% and 5.8%. Spinal ganglion cysts often arise in the most mobile segment of the lumbar spine, L4-L5. Patients commonly present with pain, radiculopathy, and weakness. Conservative management is used, but surgical resection is the most common treatment modality. We aim to review the literature and present a rare case of an L2-L3 situated spinal ganglion cyst, treated with maximal safe resection. METHODS A systematic review of literature was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were queried using Boolean operators and search terms, "spinal ganglion cyst, lumbar ganglion cyst, and lumbar juxtafacet cyst". Presentation, surgical management, and postoperative course of a 29-year-old male with an L2-L3 spinal ganglion cyst are also described. RESULTS The search yielded 824 articles; 23 met inclusion criteria. These papers consisted of 27 spinal ganglion cyst cases with disaggregated patient data. 63.0% of patients were male, and 53.4 years (range: 23-86) was the average age at presentation. Mean symptom duration was 1.9 years (range: 3 days-12 years). 70.4% of patients reported complete symptom resolution. 14.8% of cases noted neural foramen involvement. CONCLUSIONS Spinal ganglion cysts are benign lesions typically presenting with radiculopathy. Maximal safe resection is an effective treatment modality with low complication rates. Future studies are needed to understand if neural foramen involvement leads to increased symptom severity.
Collapse
Affiliation(s)
- Shivam Rana
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Anjali Pradhan
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Joshua Casaos
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Khashayar Mozaffari
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Farinaz Ghodrati
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Brianna Sugimoto
- Achieve Brain & Spine, Santa Monica, CA, United States of America
| | - Isaac Yang
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Department of Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States of America; Department of Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, United States of America; Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, United States of America; Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America.
| | | |
Collapse
|
2
|
Allison CM, Bonanos G, Varma A. Bilateral ganglion cysts at L4/5 causing central canal stenosis and producing sciatica and neurogenic claudication: a case report. Ann R Coll Surg Engl 2021; 104:e41-e43. [PMID: 34414791 DOI: 10.1308/rcsann.2021.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Symptomatic bilateral juxtafacet ganglion cysts are relatively uncommon in the degenerated spine. The literature describes 16 cases of bilateral ganglion or synovial cysts, none reported sciatica and neurogenic claudication simultaneously. We present a case of a 60-year-old woman who presented with symptoms of bilateral sciatica and neurogenic claudication. Magnetic resonance imaging of the lumbar spine revealed bilateral lesions related to the facet joints at the L4/5 level, causing bilateral lateral recess stenosis and narrowing of the central canal due to encroachment of these bilateral lesions at the same level. She underwent an elective central canal decompression of the L4/5 level and excision of the facet cysts bilaterally with lateral recess decompression, which resulted in good relief of both the radicular and claudication symptoms.
Collapse
Affiliation(s)
- C M Allison
- James Cook University Hospital, Middlesbrough, UK.,Newcastle University Medical School, Newcastle upon Tyne, UK
| | - G Bonanos
- James Cook University Hospital, Middlesbrough, UK
| | - A Varma
- James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
3
|
Shah K, Segui D, Gonzalez-Arias S. Midline Ligamentum Flavum Cyst of Lumbar Spine. World Neurosurg 2017; 110:284-287. [PMID: 29174237 DOI: 10.1016/j.wneu.2017.11.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ligamentum flavum cysts are thought to develop due to facet joint hypermobility; however, the etiology of these lesions is not completely elucidated. These cysts may lead to compressive pathologies of the spine requiring surgical intervention. CASE REPORT We report the case of a 63-year-old male with chronic back pain and progressive neurogenic claudication for 6 months. He was found to have a ligamentum flavum cyst situated along the dorsal midline of the lumbar spinal canal contributing to spinal stenosis. The patient underwent a decompressive L4 laminectomy and en bloc excision of the ligamentum flavum cyst with complete resolution of his symptoms postoperatively. CONCLUSIONS We suggest that chronic mechanical stress leads to degeneration of the ligamentum flavum and contributes directly to cyst formation.
Collapse
Affiliation(s)
- Kevin Shah
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
| | - Daniel Segui
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Sergio Gonzalez-Arias
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| |
Collapse
|
4
|
Shtaya A, Sadek AR, Walker M, Nader-Sepahi A. Ventral Lumbar Synovial Cyst Causing Cauda Equina Compression: Case Report and Literature Review. World Neurosurg 2017; 106:1055.e1-1055.e3. [PMID: 28735122 DOI: 10.1016/j.wneu.2017.07.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Anan Shtaya
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom.
| | - Ahmed-Ramadan Sadek
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
| | - Mark Walker
- Neuropathology Department, University Hospital Southampton, Southampton, United Kingdom
| | - Ali Nader-Sepahi
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
| |
Collapse
|
5
|
Lista-Martínez O, Moreno-Barrueco V, Castro-Castro J, Varela-Rois P, Pastor-Zapata A. Lumbar synovial cysts: Presentation of a series of 10 cases and literature review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
6
|
Lista-Martínez O, Moreno-Barrueco VM, Castro-Castro J, Varela-Rois P, Pastor-Zapata A. Lumbar synovial cysts: presentation of a series of 10 cases and literature review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 61:28-34. [PMID: 27717625 DOI: 10.1016/j.recot.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/23/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Although they are freqqently described in the literature, lumbar synovial cysts are a relative uncommon cause of low back and radicular leg pain. OBJECTIVE To evaluate the treatment and surgical outcomes of the lumbar synovial cysts operated on in our hospital during a 5 year period. MATERIAL AND METHODS A retrospective study was conducted on patients surgically treated in our department from August 2009 to September 2014, using a visual analogue scale for the clinical follow-up in the first year after surgery. RESULTS After the surgical treatment (surgical removal of the synovial cyst with or without instrumented arthrodesis with transpedicular screws) of 10 patients (5 female and 5 male) with a mean age of 70.2 years (range 50-80), the clinical outcome was satisfactory in 80% of the patients, with the resolving of their symptoms. CONCLUSIONS Lumbar synovial cysts have to be considered in the differential diagnosis in patients with low back and radicular leg pain. The majority of the patients are in their sixties and have lumbar degenerative spondylopathy. Nowadays, surgical resection of the lumbar synovial cysts and spinal fusion are the recommended treatment, because it is thought that the increased movement of the spine is one to the causes of the cyst formation. More studies are still needed, hence the relevance of this article.
Collapse
Affiliation(s)
- O Lista-Martínez
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Orense, Orense, España.
| | - V M Moreno-Barrueco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital HM Modelo, A Coruña, España
| | - J Castro-Castro
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Orense, Orense, España
| | - P Varela-Rois
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Orense, Orense, España
| | - A Pastor-Zapata
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Orense, Orense, España
| |
Collapse
|
7
|
Sukkarieh HG, Hitchon PW, Awe O, Noeller J. Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases. J Neurosurg Spine 2015; 23:444-50. [DOI: 10.3171/2015.1.spine14996] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach.
METHODS
All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times.
RESULTS
There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m2. Sixty-nine percent (9 of 13) of the cysts were at L4–5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series.
CONCLUSIONS
The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.
Collapse
|