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Matsunaga A, Saito M, Ijiri K, Tsuchiya M, Yasuda A, Kitamura K, Ogata S, Chiba K, Matsukuma S. Cysts of the ligamentum flavum are often linked to ischemic conditions: A morphological study. Pathol Int 2024; 74:475-481. [PMID: 38994749 DOI: 10.1111/pin.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
"Cysts of the ligamentum flavum (cysts-LF)" is the term for non-neoplastic cystic lesion involving LF. The aim of the present study was to elucidate the histopathological characteristics and pathogenesis of "cysts-LF". Herein, we defined cysts-LF as spinal cysts containing degenerative LF components. From archival cases, we investigated 18 symptomatic cysts-LF surgically removed from 18 patients (13 males and five females; median age 68.5 years [range, 42-86 years]). The elastic fibers of LF components in the wall were separated and/or torn, and cyst walls were accompanied by chondroid metaplasia (17 cases), myxoid changes (13 cases), ossification (11 cases), amyloid deposits (14 cases), hemosiderosis (six cases), granular/smudgy calcification (four cases), synovial cell linings (three cases), and severe inflammatory infiltrates (one case). These histologic features of our cysts-LF were shared by previously reported "cysts-LF." Fourteen cysts-LF demonstrated vascular stenosis/occlusion, and eight showed thick hyalinized vessels, suggesting local circulatory insufficiency. Eight cases (44%) exhibited lipomembranous fat necrosis, accompanied by hyalinized vascular changes (p = 0.003). Ischemic conditions were observed in nearly half of the present cysts-LF, and may be one of the main contributing factors for the formation of cysts-LF, via degeneration and cystic changes in the LF.
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Affiliation(s)
- Ayano Matsunaga
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Mariko Saito
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama, Japan
| | - Kaya Ijiri
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama, Japan
| | - Motohiro Tsuchiya
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Akimasa Yasuda
- Department of Orthopedic Surgery, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Kazuya Kitamura
- Department of Orthopedic Surgery, National Defense Medical College, Saitama, Japan
| | - Sho Ogata
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama, Japan
| | - Kazuhiro Chiba
- Department of Orthopedic Surgery, National Defense Medical College, Saitama, Japan
| | - Susumu Matsukuma
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama, Japan
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2
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Saremi A, Goyal KK, Benzel EC, Orr RD. Evolution of lumbar degenerative spondylolisthesis with key radiographic features. Spine J 2024; 24:989-1000. [PMID: 38199449 DOI: 10.1016/j.spinee.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Spondylolisthesis is a common finding in middle-aged and older adults with back pain. The pathophysiology of degenerative spondylolisthesis is a subject of controversy regarding not only its etiology but also the mechanisms of its progression. It is theorized that degeneration of the facets and discs can lead to segmental instability, leading to displacement over time. Kirkaldy-Willis divided degenerative spondylolisthesis into three phases: dysfunction, instability, and finally, restabilization. There is a paucity of literature on the unification of the radiological hallmarks seen in spondylolisthesis within these phases. The radiographic features include (1) facet morphology/arthropathy, (2) facet effusion, (3) facet vacuum, (4) synovial cyst, (5) interspinous ligament bursitis, and (6) vacuum disc as markers of dysfunction, instability, and/or restabilization. We discuss these features, which can be seen on X-ray, CT, and MRI, with the intention of establishing a timeline upon which they present clinically. Spondylolisthesis is initiated as either degeneration of the intervertebral disc or facet joints. Early degeneration can be seen as facet vacuum without considerable arthropathy. As the vertebral segment becomes increasingly dynamic, fluid accumulates within the facet joint space. Further degeneration will lead to the advancement of facet arthropathy, degenerative disc disease, and posterior ligamentous complex pathology. Facet effusion can eventually be replaced with a vacuum in severe facet osteoarthritis. Intervertebral disc vacuum continues to accumulate with further cleft formation and degeneration. Ultimately, autofusion of the vertebra at the facets and endplates can be observed. With this review, we hope to increase awareness of these radiographical markers and their timeline, thus placing them within the framework of the currently accepted model of degenerative spondylolisthesis, to help guide future research and to help refine management guidelines.
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Affiliation(s)
- Arvin Saremi
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, USA.
| | - Kush K Goyal
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Edward C Benzel
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - R Douglas Orr
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Ghimire P, Perera A, Lavrador JP, Bodi I, Jarosz J, Grahovac G, Ashkan K. Inter-dural spinal cyst with acute thoracic compressive myelopathy: anatomical aspects of spinal dura, case report and literature review. Br J Neurosurg 2023; 37:1567-1571. [PMID: 33050723 DOI: 10.1080/02688697.2020.1834507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Inter-dural juxta-facet spinal cysts occur rarely. They form as part of the degenerative spinal disease process and can be misdiagnosed as synovial cysts or ganglion cysts. We report the case of a thoracic inter-dural juxta-facet spinal cyst causing acute compressive thoracic myelopathy. METHODS The data was collected retrospectively from patient records. The literature review was performed in PubMed. RESULTS We report a case of symptomatic inter-dural juxta-facet thoracic spinal cyst. The literature review showed a variety of different spinal cysts including arachnoid cyst, discal cyst, ganglion cyst, epidermoid cyst and synovial cysts. Micro-instability and repeated microtrauma associated with degenerative changes are most likely contributors to its formation. Asymptomatic cysts can show spontaneous resolution. When symptomatic, they can be managed with surgical excision with good patient outcome. CONCLUSION Inter-dural spinal cysts can be diagnosed and surgically excised to produce excellent post-operative outcome. High pre-operative index of suspicion of this diagnosis together with good understanding of the intraoperative anatomy are essential to avoid inadvertent dural breach.
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Affiliation(s)
- Prajwal Ghimire
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Andrea Perera
- Department of Neurosurgery, King's College Hospital, London, UK
| | | | - Istvan Bodi
- Department of Neuropathology, King's College Hospital, London, UK
| | - Jozef Jarosz
- Department of Neuroradiology, King's College Hospital, London, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital, London, UK
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Ishihara Y, Morishita M, Kanzaki K. Efficacy of Percutaneous Image-Guided Rupture of Lumbar Facet Cysts: A Retrospective Study. Adv Orthop 2023; 2023:5591496. [PMID: 36950325 PMCID: PMC10027461 DOI: 10.1155/2023/5591496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/07/2023] [Accepted: 03/04/2023] [Indexed: 03/24/2023] Open
Abstract
Background Percutaneous rupture of lumbar facet cysts (LFC) is the only nonsurgical treatment which is effective in directly reducing cysts. However, this is not yet a common procedure, and its effectiveness, including the associated complications, remains unclear. Therefore, this study aimed to evaluate the clinical outcomes of percutaneous rupture for LFC and elucidate whether this minimally invasive procedure could become an alternative to surgeries for cases resistant to conservative treatments. Methods This study investigated 57 symptomatic patients with LFC for whom conservative treatments were ineffective and underwent percutaneous rupture of the LFC. All patients were followed up for >2 years posttreatment. Clinical evaluations (visual analogue scale (VAS) and recovery rate calculated using the Japanese Orthopedic Association (JOA) scores) and radiographic evaluations (size of LFC based on magnetic resonance imaging (MRI)) were performed from pretreatment to the final follow-up examination. Results Successful LFC rupture, without hospitalization and general anesthesia, was achieved in 48 patients. No severe complications occurred during treatment through the last observation. Satisfactory clinical results with significant improvements in the VAS and JOA scores were obtained (VAS: pre/posttreatment: 80.7 mm/11.2 mm, JOA: pre/posttreatment: 15.6 points/26.7 points, and recovery rate: 82.3%). A significant reduction in the LFC was also observed in all cases based on the posttreatment MRI findings. No successful rupture cases required subsequent surgical treatments, although four cases of LFC recurrence required additional percutaneous rupture treatment. Conclusions Percutaneous rupture for LFC is not only a safe and minimally invasive procedure without any severe complications or requirements for hospitalization and general anesthesia but also a beneficial procedure that can eliminate the need for surgery in cases resistant to conservative treatments.
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Affiliation(s)
- Yohei Ishihara
- 1Asao General Hospital Spine Center, 6-25-1, Kamiasao, Asao-ku, Kawasaki, Kanagawa 215-0021, Japan
| | - Masutaro Morishita
- 1Asao General Hospital Spine Center, 6-25-1, Kamiasao, Asao-ku, Kawasaki, Kanagawa 215-0021, Japan
| | - Koji Kanzaki
- 2Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-8501, Japan
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Schmidt D, Setzer M, Seifert V, Marquardt G, Bruder M. Resection of Lumbar Spinal Facet Joint Cysts and Cerebrospinal Fluid Leakage: Incidence, Prognostic Parameters, and Outcome in a Single-center Series. Clin Spine Surg 2022; 35:E534-E538. [PMID: 35276717 DOI: 10.1097/bsd.0000000000001309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Single-center series. OBJECTIVE Intraspinal facet joint cysts can lead to nerve root compression symptoms with severe discomfort and disability. Permanent improvement can be achieved by surgical resection of the cyst. However, cerebrospinal fluid (CSF) leakage is a common problem in resection of facet joint cyst.The aim of the study was to investigate the frequency of CSF leak after resection of a joint cyst and to determine predictive factors. METHODS A total of 176 consecutive patients underwent surgery for lumbar spinal facet joint cyst in our institution between 1997 and 2018. Patients with a CSF leak were compared with patients without a CSF leak (control group). RESULTS CSF leakage occurred in 14 patients (8.0%) In 2 of the cases (14.3%), the CSF leak was recognized only postoperatively, in 12 cases (85.7%), the CSF leak was detected intraoperatively. Despite intraoperative dura repair, 4 of these 12 patients (33.3%) presented with CSF leakage postoperatively. Altogether 6 patients had postoperative CSF leakage. Compared with patients without CSF leak, there were no differences in preoperative symptoms, surgical technique, complications, or postoperative findings. Adhesion of the cyst to the dura mater was present in all 14 patients with CSF leakage (100%), but only 61.7% of the control group ( P <0.005). All patients in the CSF leak group showed an improvement of their preoperative symptoms. CONCLUSIONS The rate of CSF leakage in resection of spinal facet joint cyst was 8% in the present study. The occurrence of a CSF leakage was independent of clinical factors, level, or side of the cyst, but significantly correlated to dural adhesion of the cyst.Since neither clinical recovery nor recurrence rates do depend on complete removal of the cyst, aggressive resection of dural adherend parts of the cyst wall should be avoided to prevent CSF leakage.
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Affiliation(s)
- Dominic Schmidt
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
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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.
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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
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7
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Buck LS, Farmer S, Stringer SP. Dysphagia and Pharyngeal Cyst. JAMA Otolaryngol Head Neck Surg 2020; 146:958-959. [PMID: 32790870 DOI: 10.1001/jamaoto.2020.1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lauren S Buck
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson
| | - Sarah Farmer
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson
| | - Scott P Stringer
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson
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8
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Piscoya AS, Clark DM, Wagner SC. Management of Postoperative Facet Cysts: A Report of 3 Cases. JBJS Case Connect 2020; 10:e2000134. [PMID: 32910589 DOI: 10.2106/jbjs.cc.20.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The exact underlying etiology behind synovial facet cysts remains unclear, and optimal surgical management continues to be a challenge. The authors present a series of 3 patients who underwent primary lumbar decompression and developed postoperative facet cysts within 6 months of index surgery requiring operative intervention. No patients had radiographic evidence of instability. Average follow-up after revision surgery was 14 months. CONCLUSION We report on the 3 cases with the phenomenon of postoperative facet cysts and present a complication that falls within the spectrum of lumbar decompression surgery with several successful treatment options.
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Affiliation(s)
- Andres S Piscoya
- 1Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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Hellinger S, Lewandrowski KU. Clinical outcomes with endoscopic resection of lumbar extradural cysts. JOURNAL OF SPINE SURGERY 2020; 6:S133-S144. [PMID: 32195422 DOI: 10.21037/jss.2019.08.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Lumbar extradural cysts may be associated with sciatica-type back and leg pain. The symptoms of clinical pain syndrome from synovial cysts are sometimes difficult to differentiate from those of lumbar disc herniation or spinal canal stenosis and may be identified to be a pain source when visualized endoscopically. The authors analyzed the clinical outcomes with their endoscopic resection to better establish clinical indications and prognosticators of favorable results. Methods Two-year Macnab outcomes, VAS scores, and complications were analyzed in a series of 48 patients treated with the endoscopic removal of extradural cyst encountered during routine transforaminal and interlaminar decompression for foraminal and lateral recess stenosis causing lumbar radiculopathy. Results There were 26 female and 22 male patients. The extradural cysts were most commonly encountered at L4/5 level in 26 patients (72.2%) followed by the L5/S1 level in 8 patients (22.2%), and in 2 patients (5.6%) at the L3/4 level, respectively. One patient underwent T9/10 decompression. At minimum 2-year follow-up, all patients were improved. Excellent results according to the Macnab criteria were obtained in 19/48 (39.6%) patients, good in 18/48 (37.5%), and fair in 11/48 (22.9%), respectively. The average preoperative VAS score for leg pain was 8.06±1.57 and reduced at a statistically significant level (P<0.000) postoperatively to 1.92±1.49, and 1.77±1.32 at final follow-up, respectively. The percentage of patients with unlimited walking endurance had improved at a statistically significant level (P<0.0001) from 33.3% preoperatively (16/48) to 81.3% (39/48) postoperatively. One patient had a recurrent disc herniation, and another patient did not improve. Two patients underwent fusion during the follow-up period. Patients with Fair outcomes had a statistically significant association (P<0.001) with facet instability as suggested by axial T2-weighted magnetic resonance imaging (MRI) findings of thickened ligamentum flavum, facet joint hypertrophy, and bright white fluid-filled joint gap of >2 mm. Conclusions Endoscopic resection of extradural spinal cysts during routine decompression for symptomatic foraminal and lateral recess stenosis is feasible with favorable clinical outcomes in the majority of patients. Fair outcomes were associated with advanced instability of the involved lumbar facet joint complex.
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Affiliation(s)
- Stefan Hellinger
- Department of Orthopedic Surgery, Isar Hospital, Munich, Germany
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, USA.,Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, DC, Colombia
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Downs E, Marshman LAG. Spontaneous Resolution of Lumbar Facet Joint Cyst. World Neurosurg 2018; 115:414-416. [PMID: 29747018 DOI: 10.1016/j.wneu.2018.04.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Juxtafacet cysts (JFCs) are uncommon spinal lesions that can cause neural compression and are typically managed surgically. Rarely, JFCs can spontaneously resolve. CASE DESCRIPTION We present the case of a spontaneously resolving right L4/5 JFC in an otherwise fit and well 60-year-old female. She presented with progressive chronic lower back pain and intermittent sciatica. She had no neurologic deficit. The patient was keen to avoid surgical intervention. After 19 months her symptoms had significantly improved, and repeat magnetic resonance image demonstrated complete resolution of the lesion. CONCLUSIONS While surgery to remove a JFC ± spinal stabilization remains the mainstay and definitive treatment for symptomatic JFCs, patients without neurologic deficit may be safely managed conservatively pending possible spontaneous resolution. Spontaneous resolution may reflect the natural history of the condition.
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Affiliation(s)
- Elena Downs
- Department of Neurosurgery, The Townsville Hospital, Douglas, Queensland, Australia.
| | - Laurence A G Marshman
- Department of Neurosurgery, The Townsville Hospital, Douglas, Queensland, Australia; School of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
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Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To analyze the various anatomical parameters that influence segmental stability in patients suffering from lumbar intra spinal cysts (LISCs) and to determine the outcome of microscopic unilateral laminotomy and cystectomy. METHODS All patients that were surgically managed for a LISC between 2007 and 2013 with more than 3 years of follow-up were reviewed. Those without associated instability were evaluated for segmental mobility, segmental angulation, facet inclination, stage of disc degeneration, and level of involvement on MRI and dynamic radiographs. Outcomes of unilateral laminotomy and cystectomy were evaluated using VAS (Visual Analogue Score), ODI (Oswestry Disability Index), and Macnabs criteria. Dynamic radiographs were performed in all cases pre- and postoperatively and at the last follow-up. RESULTS Thirty patients were operated for a LISC between 2007 and 2013. The levels involved were L4-5(23), L3-4(4) and L5-S1(3). The mean facet angle was 42.6 (± 6.1) degrees. The stage of disc degeneration was scattered haphazardly across all the cases (Gr 2[17]; Gr 3[1]; Gr 4[8]; Gr 5[4]). VAS and ODI scores improved significantly in all patients. Mean follow-up was 46.5 months (36-96 months). No patient developed postoperative instability at the last follow-up. CONCLUSIONS The coronal inclination of the facet joints, absence of radiological instability, and poor co-relation with stages of disc degeneration suggests the presence of adequate residual stability. In this study, stand-alone decompression for LISCs without instability had well sustained good/excellent outcomes. Fusion is recommended for LISCs with associated instability.
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Affiliation(s)
- Arvind G. Kulkarni
- Bombay Hospital & Medical Research Centre, Mumbai, India
- Arvind G. Kulkarni, Department of Orthopedics, Mumbai Spine Scoliosis and Disc Replacement Centre, 2nd Floor, Room 206 New Wing, Bombay Hospital & Medical Research Centre, 12, New Marine Lines, Mumbai 400020, India.
| | - Shumayou Dutta
- Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Abhilash Dhruv
- Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Anupreet Bassi
- Bombay Hospital & Medical Research Centre, Mumbai, India
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Domenicucci M, Ramieri A, Marruzzo D, Missori P, Miscusi M, Tarantino R, Delfini R. Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review. World J Orthop 2017; 8:697-704. [PMID: 28979853 PMCID: PMC5605355 DOI: 10.5312/wjo.v8.i9.697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze different terms used in literature to identify lumbar extradural cysts and propose a common scientific terminology; to elaborate a new morphological classification of this pathology, useful for clinical and surgical purposes; and to describe the best surgical approach to remove these cysts, in order to avoid iatrogenic instability or treat the pre-existing one.
METHODS We retrospectively reviewed 34 patients with symptomatic lumbar ganglion cysts treated with spinal canal decompression with or without spinal fixation. Microsurgical approach was the main procedure and spinal instrumentation was required only in case of evident pre-operative segmental instability.
RESULTS The complete cystectomy with histological examination was performed in all cases. All patients presented an improvement of clinical conditions, evaluated by Visual Analogic Scale and Japanese Orthopaedic Association scoring.
CONCLUSION Spinal ganglion cysts are generally found in the lumbar spine. The treatment of choice is the microsurgical cystectomy, which generally does not require stabilization. The need for fusion must be carefully evaluated: Pre-operative spondylolisthesis or a wide joint resection, during the operation, are the main indications for spinal instrumentation. We propose the terms “ganglion cyst” to finally identify this spinal pathology and for the first time its morphological classification, clinically useful for all specialists.
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Affiliation(s)
- Maurizio Domenicucci
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Daniele Marruzzo
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Paolo Missori
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Massimo Miscusi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
| | - Roberto Tarantino
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberto Delfini
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
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Lutz GE, Nicoletti MR, Cyril GE, Harrison JR, Lutz C, Solomon JL, Cooke PM, Wyss JF, Herzog RJ, Moley PJ. Percutaneous Rupture of Zygapophyseal Joint Synovial Cysts: A Prospective Assessment of Nonsurgical Management. PM R 2017; 10:245-253. [DOI: 10.1016/j.pmrj.2017.07.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/19/2017] [Accepted: 07/30/2017] [Indexed: 10/19/2022]
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Saiwai H, Okada S, Miyazaki K, Nakano R, Iwamoto Y, Tsuchiya K. Clinical features and surgical management of rare cases of thoracic intraspinal cysts: Report of 3 cases. J Orthop Sci 2017; 22:578-582. [PMID: 26740453 DOI: 10.1016/j.jos.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/16/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Hirokazu Saiwai
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Japan.
| | - Seiji Okada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kosei Miyazaki
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Japan
| | - Ryuji Nakano
- Department of Pathology, Japan Community Health Care Organization, Kyushu Hospital, Japan
| | - Yukihide Iwamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kuniyoshi Tsuchiya
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, 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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Birch BD, Aoun RJN, Elbert GA, Patel NP, Krishna C, Lyons MK. Minimally Invasive Tubular Resection of Lumbar Synovial Cysts: Report of 40 Consecutive Cases. World Neurosurg 2016; 94:188-196. [DOI: 10.1016/j.wneu.2016.06.125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 01/24/2023]
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17
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Jinkins J. Acquired Degenerative Changes of the Intervertebral Segments at and Supradjacent to the Lumbosacral Junction. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140090201500405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In earlier evolutionary times, mammals were primarily quadrupeds, although other bipeds have been represented during the course of the Earth's several billion-year history. In many cases, either the bipedal stance yielded a large tail and hypoplastic upper extremities (e.g., Tyrannosaurus rex, the kangaroo), or it culminated in hypoplasia of the tail and further development and specialization of the upper extremities (e.g., nonhuman primates and human beings). In the human species this relatively recently acquired posture resulted in a more or less pronounced lumbosacral lordosis. In turn, certain compensatory anatomic features have since occurred. These include the normal characteristic posteriorly directed wedge-shape of the L5 vertebral body and the L5-S1 intervertebral disc; the L4 vertebral body and the L4-L5 and L3-4 disc may be similarly visibly affected. These compensatory mechanisms, however, have proved to be functionally inadequate over the present long-term of the human life span. Upright posture leads to increased weight bearing in humans that progressively causes excess stresses at and suprajacent to the lumbosacral junction. These combined factors result in accelerated aging and degenerative changes and a predisposition to frank biomechanical failure of the subcomponents of the spinal column in these spinal segments. One other specific problem that occurs at the lumbosacral junction that predisposes toward premature degeneration is the singular relationship that exists between a normally mobile segment of spine (i.e., the lumbar spine), and a normally immobile one (i.e., the sacrum). It is well known that mobile spinal segments adjacent to congenitally or acquired fused segments have a predilection toward accelerated degenerative changes. The only segment of the spine in which this is invariably normally true is at the lumbosacral junction (i.e., the unfused lumbar spine adjoining the fused sacrum). Nevertheless, biomechanical failures of the human spine are not lethal traits; in most cases today, mankind reaches sexual maturity before spinal biomechanical failure precludes sexual reproduction. For this gene-preserving reason, degenerative spinal disorders will likely be a part of modern societies for the foreseeable eternity of the race. The detailed alterations accruing from the interrelated consequences of and phenomena contributing to acquired degenerative changes of the lumbosacral intervertebral segments as detailed in this discussion highlight the extraordinary problems that are associated with degenerative disease in this region of the spine. Further clinicoradiologic research in this area will progressively determine the clinical applications and clinical efficacy of the various traditional and newer methods of therapy in patients presenting with symptomatic acquired collapse of the intervertebral discs at and suprajacent to the lumbosacral junction and the interrelated degenerative alterations of the nondiscal structures of the spine.
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Affiliation(s)
- J.R. Jinkins
- Department of Radiologic Sciences, Neuroradiology Section, Medical College of Pennsylvania-Hahnemann, Drexel University, Philadelphia, Pennsylvania; U.S.A
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Kim HS, Ju CI, Kim SW, Kim SH. Contralateral Juxtafacet Cyst Development after the Spontaneous Resolution of a Previous Facet Cyst. J Korean Neurosurg Soc 2015; 58:563-5. [PMID: 26819695 PMCID: PMC4728098 DOI: 10.3340/jkns.2015.58.6.563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/23/2014] [Accepted: 08/13/2014] [Indexed: 12/17/2022] Open
Abstract
Juxtafacet cysts are implicated in neural compression. Thus far, it is known that surgical removal is the definitive treatment for symptomatic juxtafacet cyst because spontaneous regression is rare, and the failure rate of conservative treatment is high. We have reported a rare case of right-sided juxtafacet cyst development after the spontaneous resolution of contralateral left-sided facet cyst. The left-sided facet cyst resolved spontaneously without surgical treatment, but a juxtacyst developed on the contralateral facet on the right side, as illustrated on 4-year follow-up magnetic resonance images. To the best of our knowledge, this is the first report of newly developed contralateral juxtafacet cyst after spontaneous regression. Herein, we have discussed the natural history and the management of this rare case.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Heori Sarang Hospital, Daejeon, Korea
| | - Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Lameness caused by an extradural lumbosacral foraminal synovial cyst in three German Shepherd Dogs. Vet Comp Orthop Traumatol 2015; 29:83-8. [PMID: 26511526 DOI: 10.3415/vcot-15-04-0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/04/2015] [Indexed: 11/17/2022]
Abstract
Three German Shepherd Dogs that were presented for investigation of chronic unilateral hindlimb lameness and pain in the lumbosacral region were diagnosed with an intraspinal, extradural synovial cyst and reactive fibrosis protruding into the foramen of the lumbosacral articulation using magnetic resonance imaging and histology. This extradural mass compressed the nerve root in the foramen and the cauda equina. During a dorsal laminectomy and unilateral partial foraminotomy, the cyst and the fibrotic tissue were removed with the aid of a 2.4 mm 30° arthroscope for visualization of the foramen. The fibrotic tissue surrounding the cysts was in all cases confluent with the annulus of the intervertebral disc. The histological examination confirmed the diagnosis of a synovial cyst in all three cases by finding inflamed synovial membrane in the samples from the wall of the cyst as well as reactive fibrosis and cartilaginous metaplasia in the surrounding tissue. The three patients improved after the surgery and were pain free during the follow-up evaluations.
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Sakka L, Gabrillargues J, Coll G. Anatomy of the Spinal Meninges. Oper Neurosurg (Hagerstown) 2015; 12:168-188. [DOI: 10.1227/neu.0000000000001048] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/18/2015] [Indexed: 12/31/2022] Open
Abstract
Abstract
BACKGROUND
The spinal meninges have received less attention than the cranial meninges in the literature, although several points remain debatable and poorly understood, like their phylogenesis, their development, and their interactions with the spinal cord. Their constancy among the chordates shows their crucial importance in central nervous system homeostasis and suggests a role far beyond mechanical protection of the neuraxis.
OBJECTIVE
This work provides an extensive study of the spinal meninges, from an overview of their phylogenesis and embryology to a descriptive and topographic anatomy with clinical implications. It examines their involvement in spinal cord development, functioning, and repair.
METHODS
This work is a review of the literature using PubMed as a search engine on Medline.
RESULTS
The stages followed by the meninges along the phylogenesis could not be easily compared with their development in vertebrates for methodological aspects and convergence processes throughout evolution. The distinction between arachnoid and pia mater appeared controversial. Several points of descriptive anatomy remain debatable: the functional organization of the arterial network, and the venous and lymphatic drainages, considered differently by classical anatomic and neuroradiological approaches. Spinal meninges are involved in neurodevelopment and neurorepair producing neural stem cells and morphogens, in cerebrospinal fluid dynamics and neuraxis functioning by the synthesis of active molecules, and the elimination of waste products of central nervous system metabolism.
CONCLUSION
The spinal meninges should be considered as dynamic functional formations evolving over a lifetime, with ultrastructural features and functional interactions with the neuraxis remaining not fully understood.
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Affiliation(s)
- Laurent Sakka
- Laboratoire d'Anatomie, Université Clermont Auvergne, Université d'Auvergne, Clermont-Ferrand, France
- Service de Neurochirurgie, Pole RMND, CHU Gabriel Montpied, Clermont-Ferrand, France
- Neurosensory Biophysics, INSERM Unit 1107, University of Auvergne, France
| | - Jean Gabrillargues
- Service de Neuroradiologie, Pole RMND, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Guillaume Coll
- Laboratoire d'Anatomie, Université Clermont Auvergne, Université d'Auvergne, Clermont-Ferrand, France
- Service de Neurochirurgie, Pole RMND, CHU Gabriel Montpied, Clermont-Ferrand, France
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Lopez WOC, Vialle EN, Barbosa DC, Vialle LRG. Sciatica due to heterotopic ossification: case illustration. J Neurosurg Spine 2014; 22:192-3. [PMID: 25478821 DOI: 10.3171/2014.10.spine14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kalevski SK, Haritonov DG, Peev NA. Lumbar intraforaminal synovial cyst in young adulthood: case report and review of the literature. Global Spine J 2014; 4:191-6. [PMID: 25083362 PMCID: PMC4111946 DOI: 10.1055/s-0034-1370694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 01/07/2014] [Indexed: 01/15/2023] Open
Abstract
Study Design Case report. Objective Lumbar juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Most patients with lumbar cysts are in their sixth decade of life and have significant facet joint and disk degeneration. Lumbar synovial cysts (LSCs) are extremely rare in adolescence and young adulthood, and to our knowledge, only two pediatric cases of LSC have been reported in the literature. We aim to prove the existence of LSC in adolescent patients as a real entity that causes low back and radicular complaints and to discuss the possibility of traumatic injury as a pathogenic cause of LSC formation in adolescence. A case of an 18-year old patient with LSC is presented. We report the clinical presentation, management, outcome, and review of the literature, focusing on issues that remain debatable. Methods The case is presented together with its clinical course, the diagnostic techniques, the surgical findings, histologic results, and the treatment outcome. Results After surgical treatment, the patient's complaints were alleviated and almost no complaints were registered during the next 6 months' follow-up. Conclusions LSCs are extremely rare in adolescence, but they could be considered in the differential diagnosis in adolescent patients with low back pain and radiculopathy. Surgical removal of LSC could be considered as a treatment option to provide immediate and safe symptomatic relief.
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Affiliation(s)
| | | | - Nikolay Angelov Peev
- Department of Neurosurgery, Medical University of Varna, Varna, Bulgaria,Address for correspondence Nikolay Angelov Peev, MD Department of Neurosurgery, Medical University of Varna55 Marin Drinov str., BG-9002 VarnaBulgaria
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Lowrie ML, Platt SR, Garosi LS. Extramedullary spinal cysts in dogs. Vet Surg 2014; 43:650-62. [PMID: 24798122 DOI: 10.1111/j.1532-950x.2014.12200.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/01/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To (1) synthesize the terminology used to classify extramedullary spinal cysts in dogs to clarify some of the commonly reported misconceptions, and (2) propose a classification scheme to limit confusion with terminology. STUDY DESIGN Literature review. METHODS An online bibliographic search was performed in January 2013 for articles relating to extramedullary spinal cysts in dogs using PubMed (http://www.pubmed.gov/) and Google Scholar (http://scholar.google.com/) databases. Only peer-reviewed clinical literature describing cystic lesions pertaining to the spinal cord and associated structures was included. RESULTS From 1962 to 2013, 42 articles were identified; 25 (95 dogs) reported meningeal cysts, 10 (24 dogs) described 60 extradural cysts, 3 reports (18 dogs) described discal cysts or acute compressive hydrated nucleus pulposus extrusions (HNPE). Spinal cysts were categorized by location based on cross-sectional imaging as meningeal or extradural non-meningeal. Sub-classification was then performed based on surgical findings and pathology. Meningeal cysts included arachnoid diverticulae and Tarlov (perineural) cysts. Extradural non-meningeal cysts included intraspinal cysts of the vertebral joints, ligaments and discs. Discal cysts also fit this category and have been reported extensively in humans but appear rare in dogs. CONCLUSIONS Extramedullary spinal cysts should be first classified according to location with a sub-classification according to pathologic and surgical findings. Previous canine cases of discal cysts appear to represent a different disease entity and the term acute compressive HNPE is therefore preferred.
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Affiliation(s)
- Mark L Lowrie
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, England
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Lumbar L4-L5 ganglion cyst with hemicauda equina syndrome. Report of a case and review of the literature. ROMANIAN NEUROSURGERY 2013. [DOI: 10.2478/romneu-2013-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Mostly associated with degenerative facet joints and spondylolisthesis, symptomatic lumbar juxta facet cysts - ganglion and synovial cysts are uncommon lesions of the spine. They can mimic herniated discs, causing low back pain, radiculopathy or even cauda equina syndrome; also some of them are associated with spinal instability. Referring to a case with hemicauda equina syndrome where microsurgical decompression was performed with very good result; alternative treatment solutions are discussed: conservative therapy for symptomatic lesions is often unsuccessful, spinal fusion should be made for those cases with spinal instability, although there are reports of spontaneous resolution of these cysts as well as the symptoms associated with them.
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Abrams J, Hsu K, Kondrashov D, McDermott T, Zucherman J. Treatment of facet cysts associated with neurogenic intermittent claudication with x-stop. JOURNAL OF SPINAL DISORDERS & TECHNIQUES 2013; 26:218-21. [PMID: 22134735 DOI: 10.1097/bsd.0b013e31823fadda] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facet degeneration often leads to the formation of synovial facet cysts. As facet cysts invade the spinal canal, they become a contributing factor to spinal stenosis. Previous studies have demonstrated successful treatment of neurogenic intermittent claudication (NIC), a major symptom of spinal stenosis, with an interspinous process device. PURPOSE To compare clinical outcomes of patients with and without synovial facet cysts treated with an interspinous process device. STUDY DESIGN Retrospective review of prospective data of consecutive patients undergoing the X-Stop procedure at an institution. OUTCOME MEASURES Visual Analog Scale; Oswestry Disability Index; sitting, standing, and walking tolerances; and satisfaction survey. METHODS Review of all patients from 2006 to 2010 undergoing X-Stop procedure at an institution. Imaging studies were used to identify the presence and measure the size of the facet cysts in 285 patients with a minimum of 6-month follow-up. Comparative clinical outcomes determined if X-Stop is a successful treatment option for patients with NIC in conjunction with synovial facet cysts (<3 mm, ≥3 mm). RESULTS Fifty-eight of 285 patients (20.4%) were determined to have a synovial cyst as a contributing component of spinal stenosis. Twelve of 58 patients were noted to have a cyst ≥3 mm. The mean follow-up time for patients with and without a facet cyst was 21 months (6-55±12 mo) and 22 months (6-61±12 mo), respectively. The age of the patient at the time of the operation with and without facet cysts was 73 (±10 y). Patients without synovial cysts, with synovial cysts, and cysts ≥3 mm had an average change in Oswestry Disability Index of 15.6, 15.8, and 16.2, respectively. Visual Analog Scale scores were 2.3, 1.8, and 2.3, respectively. In addition, on satisfaction surveys 72.4%, 82.0%, and 77.8% were either very or somewhat satisfied, respectively. Overall complications included 4 spinous process fracture, 4 hematomas, 1 wound infection, and 1 implant migration. CONCLUSIONS No statistical difference was noted in any of the outcome measures among patients with small facet cysts, large facet cysts, or without facet cysts when treated with an interspinous process device. We can thus conclude that X-Stop is an appropriate treatment consideration for NIC with or without the presence of synovial facet cysts.
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Affiliation(s)
- Joshua Abrams
- St Mary's Spine Center, San Francisco, CA 94117, USA.
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26
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Kazanci B, Tehli O, Türkoglu E, Guclu B. Bilateral thoracic ganglion cyst : a rare case report. J Korean Neurosurg Soc 2013; 53:309-11. [PMID: 23908708 PMCID: PMC3730036 DOI: 10.3340/jkns.2013.53.5.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 02/12/2013] [Accepted: 04/08/2013] [Indexed: 11/27/2022] Open
Abstract
Ganglion cysts usually arise from the tissues around the facet joints. It is usually associated with degenerative cahanges in facet joints. Bilateral thoracic ganglion cysts are very rare and there is no previous case that located in bilateral intervertebral foramen compressing the L1 nerve root associated with severe radiculopathy. We report a 53 years old woman who presented with bilateral groin pain and severe numbness. Magnetic resonance imaging revealed bilateral cystic mass in the intervertebral foramen between 12th thoracal and 1st lumbar vertebrae. The cystic lesions were removed after bilateral exposure of Th12-L1 foramens. The result of hystopathology confirmed the diagnosis as ganglion cyst. The ganglion cyst may compromise lumbar dorsal ganglion when it located in the intervertebral foramen. The surgeon should keep this rare entity in their mind for differential diagnosis.
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Affiliation(s)
- Burak Kazanci
- Neurosurgery Clinic, Ministry of Health, Sevket Yilmaz Education and Research Hospital, Bursa, Turkey
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Cambron SC, McIntyre JJ, Guerin SJ, Li Z, Pastel DA. Lumbar facet joint synovial cysts: does T2 signal intensity predict outcomes after percutaneous rupture? AJNR Am J Neuroradiol 2013; 34:1661-4. [PMID: 23449657 DOI: 10.3174/ajnr.a3441] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar facet synovial cysts are a cause of back pain and radiculopathy with facet joint degeneration, the most common cause for cyst formation. Typically, LFSCs are T2 hyperintense on MR imaging, but the signal intensity is variable. Treatment options include percutaneous rupture and surgical resection. This study evaluates the relationship between LFSC signal intensity on MR imaging and outcomes as it relates to percutaneous rupture success and need for subsequent surgery. MATERIALS AND METHODS A retrospective review of 110 patients who underwent CT fluoroscopic-guided rupture of symptomatic LFSCs was performed. The LFSCs were characterized by their T2 signal intensity on MR imaging and divided into 3 groups: high, intermediate, and low T2 signal intensity. The rates of successful cyst rupture and need for subsequent surgery were recorded. RESULTS Percutaneous LFSC rupture was technically successful in 87% of all cases. Cyst rupture was successful in 89% and 90% of high and intermediate signal intensity cysts, respectively, and in 65% of low signal intensity cysts (P = .017, .030). High signal intensity cysts had lower postprocedural surgical rates (29%) when compared with intermediate and low signal cyst as a group (P = .045). CONCLUSIONS T2 hyperintense and intermediate signal intensity LFSCs are easier to rupture, perhaps because the cysts contain a higher proportion of fluid and are less gelatinous or calcified than T2 hypointense cysts. Patients with T2 hyperintense LFSCs are less likely to need surgery.
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Affiliation(s)
- S C Cambron
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA.
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SAMESHIMA T, SHIBAHASHI K, NOZAKI T, AKABANE A, KIHARA A, HORIUCHI H, MORITA A. Atlantoaxial Intraspinal Juxtafacet Cyst. Neurol Med Chir (Tokyo) 2013; 53:125-8. [DOI: 10.2176/nmc.53.125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Akio MORITA
- Department of Neurosurgery, NTT Medical Center Tokyo
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Marteleto Filho M, Aguiar PH, Maldaun MVC, Panagopooulos AT, Zambom AA, Souza Filho AMD, Ferreira NPFD, Santana Junior PAD. Cisto intraespinal em comunicação com o disco intervertebral na coluna lombar: relato de um caso e revisão da literatura. COLUNA/COLUMNA 2012. [DOI: 10.1590/s1808-18512012000400017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A hérnia discal lombar é causa importante bem como a mais freqüente de lombalgia e ciática. Muitos dos casos podem prontamente ser diagnosticados através do simples exame semiológico. A ressonância nuclear magnética (RNM) estabelece um diagnóstico definitivo mesmo em bases ambulatoriais. Diversos tipos de cistos intraespinais com diferentes patogenias foram descritos no passado como cistos perineurais, cistos sinoviais, cistos aracnóides e cistos ganglionares, que são doenças difíceis de diferenciar da hérnia de disco lombar. Os autores observaram recentemente um caso de cisto intraespinal comunicante com o disco intervertebral correspondente, apresentando sinais e sintomas e mesmo alguns achados radiológicos indistinguíveis daqueles da herniação discal lombar. O diagnóstico foi estabelecido pela RNM e confirmado no momento da cirurgia. Este artigo descreve as características dessa entidade clínica, incluindo quadro clínico, aparência radiográfica e achados histológicos, a fim de discutir possíveis patogenias e tratamento.
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Lin JD, Koehler SM, Garcia RA, Qureshi SA, Hecht AC. Intraosseous ganglion cyst within the L4 lamina causing spinal stenosis. Spine J 2012; 12:e9-12. [PMID: 23158970 DOI: 10.1016/j.spinee.2012.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/27/2012] [Accepted: 10/13/2012] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- James D Lin
- Leni and Peter W. May Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 East 98th St, 9th Floor, New York, NY 10029, USA
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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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Takeuchi M, Yasuda M, Takahashi E, Funai M, Joko M, Takayasu M. A large retro-odontoid cystic mass caused by transverse ligament degeneration with atlantoaxial subluxation leading to granuloma formation and chronic recurrent microbleeding case report. Spine J 2011; 11:1152-6. [PMID: 22177924 DOI: 10.1016/j.spinee.2011.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 09/03/2011] [Accepted: 11/15/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Noninfectious nontumorous retro-odontoid masses are rare, and masses have not been reported to extensively compress the spinal cord. We encountered a case of a large retro-odontoid lesion that extensively compressed the spinal cord. CASE REPORT A 76-year-old-man reported experiencing a sudden onset of neck pain, hand and foot paresthesia, dysarthria, and dysphagia. When symptoms had not eased by 10 days of treatment with external stabilization and bed rest, he was referred to our hospital. Dynamic radiographs of the cervical spine showed that the atlantodental interval widened from 2 mm on extension to 7 mm on flexion. Computed tomography did not reveal abnormality of the odontoid process or the presence of a high-density area that could suggest calcification in or near the cystic mass. Fluid-attenuated inversion recovery axial magnetic resonance image showed a mass that was 3.0-cm wide, 2.7-cm high, and 2.5-cm thick that severely compressed the lower brain stem. T2-weighted magnetic resonance imaging showed that the mass contained a solid part posterior to the C2 dense area, extending rostrally, compatible with the presence of degenerated and hypertrophic ligaments. We performed surgical decompression of the lesion combined with atlantoaxial fixation. The partly cystic mass, which was located extradurally, had xanthochromic content, indicating microbleeding. Dysarthria and dysphagia immediately disappeared, and neurologic symptoms disappeared by 1 month. At 1-year follow-up, the patient remained symptom free, and computed tomography scans did not show recurrence of the mass. The pathologic diagnosis of degenerative ligament tissue with chronic recurrent microbleeding and associated granulation was made. DISCUSSION A possible explanation why the cyst grew to an exceptionally large size is that the transverse ligament of axis became degenerated and hypertrophic because of chronic mechanical stress by atlantoaxial subluxation. Then, a part of the ligament developed reactive granulation with small vessel formation. Finally, rupture of these small vessels caused repeated episodes of microbleeding, resulting in formation of a large cyst. The observation of degenerative ligament tissue, granulation formation, and microbleeding differentiated it from a synovial cyst or a ganglion cyst. The presence of hemosiderin deposits suggested chronic recurrent microbleeding. Taking all our findings together, we believe that our case of retro-odontoid cystic mass is different from the others that have been reported. Atlantoaxial instability may cause a large mass, such as we described here, so that careful observation is important.
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Affiliation(s)
- Mikinobu Takeuchi
- Department of Neurosurgery, Aichi Medical University Hospital, Nagakute, Aichi-gun, Aichi, Japan.
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Nojiri H, Sakuma Y, Uta S. Degenerative intraspinal cyst of the cervical spine. Orthop Rev (Pavia) 2011; 1:e17. [PMID: 21808679 PMCID: PMC3143991 DOI: 10.4081/or.2009.e17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 07/28/2009] [Accepted: 07/28/2009] [Indexed: 11/23/2022] Open
Abstract
We describe two cases of degenerative intraspinal cyst of the cervical spine that caused a gradually progressive myelopathy. One case had a cyst that arose from the facet joint and the other case had a cyst that formed in the ligamentum flavum. The symptoms improved immediately after posterior decompression by cystectomy with laminoplasty.
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Using precisely controlled bidirectional orthopedic forces to assess flexibility in adolescent idiopathic scoliosis: comparisons between push-traction film, supine side bending, suspension, and fulcrum bending film. Spine (Phila Pa 1976) 2011; 36:1679-84. [PMID: 21221052 DOI: 10.1097/brs.0b013e31820e6265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE To validate the effectiveness of push-traction film (PTF) in assessment of curve flexibility in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA There is no agreement among surgeons about the most advantageous method in flexibility evaluation of scoliosis. As all methods available provide the orthopedic force from one direction and use a single torque, it is difficult for them to achieve the postoperative correction; also they could not meet the needs for different types of curves. METHODS Precisely controlled bidirectional (push and traction) orthopedic forces were applied for curve flexibility evaluation in 31 consecutive adolescent idiopathic scoliosis patients. The correction rate (CR) of postoperation, supine side-bending, suspension, and fulcrum bending radiographs were compared with PTF in instrumented main thoracic (MT) and thoracolumbar/lumbar curves. Correlation and linear regression analyses were also been done to find the best predictor among the four methods. RESULTS In MT group, CR of PTF was significantly higher than that of side bending (P = 0.010) and suspension (P = 0.000) but not significantly different from that of fulcrum bending (P = 0.335). In TL/L group, CR of PTF was significantly higher than that of suspension (P = 0.000), but not significantly different from that of side bending (P = 0.681) and fulcrum bending (P = 0.382). There was no significant difference between CR of PTF and postoperation in both MT (P = 0.122) and TL/L (P = 0.068) groups. Correlation and linear regression analyses showed that PTF provided the highest correlation of the four methods, with the postoperative angle in both MT (r = 0.957) and MT/L group (r = 0.779). CONCLUSION To our knowledge, this was the first report about using precisely controlled bidirectional correction forces for curve flexibility evaluation. Although it did not achieve the best CR among the four methods studied, correlation and regression analyses confirmed that PTF was a more stable and accurate method to predict flexibility. We believe that further exploration of a more rational push-traction force ratio would help to obtain a better flexibility.
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Subaxial cervical synovial cysts: report of 35 histologically confirmed surgically treated cases and review of the literature. Spine (Phila Pa 1976) 2011; 36:E1285-9. [PMID: 21358479 DOI: 10.1097/brs.0b013e31820709a8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study OBJECTIVE The authors' aim of the present study is to report their experience with subaxial cervical synovial cysts hoping to provide further insight into these lesions including the presenting symptoms, possible mechanisms of cyst development associated with cervical level, surgical treatments and clinical outcomes. SUMMARY OF BACKGROUND DATA Synovial cysts are relatively common in the lumbar spine and very uncommonly identified in the subaxial cervical spine. Several case reports and a few small series have been reported in the literature over the past four decades. METHODS The authors retrospectively reviewed the cases of 35 patients who underwent surgical treatment for histologically confirmed symptomatic subaxial cervical synovial cysts between 1993 and 2009. The presenting symptoms, age, sex, cervical level, operation, complications and outcomes were analyzed in this cohort. Preoperative and postoperative neurologic assessments were done by staff neurologists independent of the operating surgeon. This study was approved by the Mayo Clinic institutional review board. RESULTS Thirty-five patients underwent surgical treatment for their synovial cysts and follow-up for at least 12 months postoperatively. The mean follow-up time was 49 months (range, 12-134). There were no deaths associated with the surgery. There was one postoperative infection in a patient undergoing a decompressive laminectomy and posterior instrumented fusion. Patient outcomes were assessed using the Modified Rankin Score for 12 patients was 0, 17 patients was 1, 4 patients was 2, and 2 patients was 3. CONCLUSION This series of 35 patients with subaxial cervical synovial cysts surgically treated over a period of 17 years illustrates the relative rarity of these lesions. Magnetic resonance imaging is currently the optimal radiographic study to identify these lesions. Surgical resection can be an effective treatment.
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Moon HJ, Kim JH, Kim JH, Kwon TH, Chung HS, Park YK. Cervical juxtafacet cyst with myelopathy due to postoperative instability. Case report. Neurol Med Chir (Tokyo) 2011; 50:1129-31. [PMID: 21206195 DOI: 10.2176/nmc.50.1129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 74-year-old man presented with a cervical juxtafacet cyst on the right side of C5-6 and prominent myelopathy. He had been treated with anterior cervical discectomy and fusion at C4-5 as well as anterior foraminotomy of the right C5-6 lesion 20 months previously. The patient underwent complete surgical excision of the lesion. The patient recovered uneventfully, and the myelopathy resolved. Reexamination of the images revealed that we failed to investigate a suspicious minimal cervical juxtafacet cyst on the initial preoperative images and that the degree of subluxation at C5-6 on flexion radiography had increased postoperatively. Therefore, the surgeon should be aware that juxtafacet cyst can be progressive in planning of cervical spinal surgery which can cause or aggravate instability in the presence of an incidental, suspicious juxtafacet cyst on preoperative imaging at the same level, even if the lesion is very small and subclinical.
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Affiliation(s)
- Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, R.O.K
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Kim SW, Choi JH, Kim MS, Chang CH. A ganglion cyst in the second lumbar intervertebral foramen. J Korean Neurosurg Soc 2011; 49:237-40. [PMID: 21607185 DOI: 10.3340/jkns.2011.49.4.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/12/2010] [Accepted: 03/27/2011] [Indexed: 11/27/2022] Open
Abstract
Ganglion cysts usually arise from the tendon sheaths and tissues around the joints. It is usually associated with degenerative arthritic changes in older people. Ganglion cyst in the spine is rare and there is no previous report on case that located in the intervertebral foramen and compressed dorsal root ganglion associated severe radiculopathy. A 29-year-old woman presented with severe left thigh pain and dysesthesia for a month. Magnetic resonance imaging revealed a dumbbell like mass in the intervertebral foramen between second and third lumbar vertebrae on the left side. The lesion was removed after exposure of the L2-L3 intervertebral foramen. The histological examination showed fragmented cystic wall-like structure composed of fibromyxoid tissue but there was no lining epithelium. A ganglion cyst may compromise lumbar dorsal root ganglion when it located in the intervertebral foramen. Although it is very rare location, ganglion cyst should be included in the differential diagnosis for intervertebral foraminal mass lesions.
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Affiliation(s)
- Sang Woo Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
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BLAIR WAKAH, LEVINE JONATHANM, KERWIN SHARONC, SPAULDING KATHYA, YOUNG BENJAMIND, POOL ROYR. IMAGING DIAGNOSIS-SYNOVIAL MYXOMA OF LUMBAR VERTEBRAE ARTICULAR PROCESS JOINT. Vet Radiol Ultrasound 2011; 52:309-12. [DOI: 10.1111/j.1740-8261.2010.01795.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lee JH, Jung TG, Kim HS, Jang JS, Lee SH. Symptomatic isolated lumbar interdural arachnoid cyst. Neurol Med Chir (Tokyo) 2010; 50:1035-8. [PMID: 21123994 DOI: 10.2176/nmc.50.1035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 72-year-old man presented with an extremely rare case of symptomatic isolated lumbosacral interdural arachnoid cyst manifesting as pain and weakness in the right buttock and lower extremity that had aggravated for 2 weeks. Although the surgical strategy for the interdural cyst was not complicated, the origination of the cyst was not clearly understood. Surgery found an isolated membrane of the cyst inside double-layered dura without communication with the intact arachnoid membrane. Cerebrospinal fluid with hemorrhage accumulated within the interdural cyst indicated recent bleeding into the cyst. Our experience suggests that this cyst was congenital based on the surgical results and imaging studies.
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Affiliation(s)
- Jung-Hoon Lee
- Department of Neurosurgery, Seoul Wooridul Hospital, Seoul, ROK
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Chan APH, Wong TC, Sieh KM, Leung SSM, Cheung KY, Fung KY. Rare ligamentum flavum cyst causing incapacitating lumbar spinal stenosis: Experience with 3 Chinese patients. J Orthop Surg Res 2010; 5:81. [PMID: 21047439 PMCID: PMC2988014 DOI: 10.1186/1749-799x-5-81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 11/04/2010] [Indexed: 11/24/2022] Open
Abstract
Three Chinese patients suffered from severe lumbar spinal stenosis with debilitating symptoms due to a rare condition of ligamentum flavum cysts in the midline of the lumbar spine. This disease is distinct from synovial cyst of the facet joints or ganglion cysts, both intraoperatively and histopathologically. Magnetic Resonance imaging features of the ligamentum flavum cyst are also demonstrated. We share our surgical experiences of identification of the ligamentum flavum cysts, decompression and excision for two of the patients with demonstrably good recovery. This disease should be considered in the differential diagnosis of an extradural instraspinal mass in patients with lumbar spinal stenosis.
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Affiliation(s)
- Alexander Pak-Hin Chan
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong SAR, China.
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Bydon A, Xu R, Parker SL, McGirt MJ, Bydon M, Gokaslan ZL, Witham TF. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. Spine J 2010; 10:820-6. [PMID: 20488765 DOI: 10.1016/j.spinee.2010.04.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 03/14/2010] [Accepted: 04/08/2010] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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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. Spine (Phila Pa 1976) 2010; 35:1044-53. [PMID: 20173680 DOI: 10.1097/brs.0b013e3181bdafed] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Cho SM, Rhee WT, Lee SY, Lee SB. Ganglion cyst of the posterior longitudinal ligament causing lumbar radiculopathy. J Korean Neurosurg Soc 2010; 47:298-301. [PMID: 20461173 DOI: 10.3340/jkns.2010.47.4.298] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 09/11/2009] [Accepted: 03/15/2010] [Indexed: 11/27/2022] Open
Abstract
Degenerated conditions such as herniated disc or spinal stenosis are common etiologies of lumbar radiculopathy. Less common etiologies include spinal extradural cyst such as synovial cysts and ganglion cysts. Ganglion cyst of the posterior longitudinal ligament (PLL) of the spine is a rare entity that can result in classical sciatica. Posterior longitudinal ligament cyst has no continuity with the facet joint and has no epithelial lining. Two young male patients presented with unilateral sciatica and were found to have intraspinal cystic lesions causing lumbar radiculopathy. Magnetic resonance imaging demonstrated rounded, cystic lesions (i.e., hypointense on T1- but hyperintense on T2-weighted images) adjacent to minimally dehydrated, nonherniated disc spaces in both cases. These patients underwent posterior decompression and cysts were excised, and their sciatic symptoms were completely resolved. Histological examination showed typical features of ganglion cysts in these cases.
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Affiliation(s)
- Sung-Min Cho
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Martha JF, Swaim B, Wang DA, Kim DH, Hill J, Bode R, Schwartz CE. Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients. Spine J 2009; 9:899-904. [PMID: 19664971 DOI: 10.1016/j.spinee.2009.06.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 03/17/2009] [Accepted: 06/18/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar facet joint synovial cysts are benign degenerative abnormalities of the lumbar spine. Previous reports have supported operative and nonoperative management. Facet joint steroid injection with cyst rupture is occasionally performed, but there has been no systematic evaluation of this treatment option. PURPOSE To profile the role of facet joint steroid injections with cyst rupture in the treatment of lumbar facet joint synovial cysts. STUDY DESIGN/SETTING Retrospective chart review and long-term follow-up of patients treated for lumbar facet joint synovial cysts. PATIENT SAMPLE One hundred one patients treated for lumbar facet joint synovial cysts with fluoroscopically guided corticosteroid facet joint injection and attempted cyst rupture. OUTCOME MEASURES Oswestry Disability Index and numeric rating scale score for back and leg pain. METHODS A retrospective review and a subsequent interview were conducted to collect pretreatment and posttreatment pain and disability scores along with details of subsequent treatment interventions. Group differences in pain and disability scores were assessed using paired t test. Multiple clinical factors were analyzed in terms of risk for surgical intervention using logistic regression modeling and Cox proportional hazards modeling. RESULTS Successful cyst rupture was confirmed fluoroscopically in 81% of cases. Fifty-five patients (54%) required subsequent surgery over a period averaging 8.4 months because of inadequate symptom relief. All patients reported significant improvement in back pain, leg pain, and disability at 3.2 years postinjection, regardless of their subsequent treatment course (p<.0001 in all groups). There was no significant difference in current pain between patients who received injections only and those who underwent subsequent surgery. CONCLUSIONS This study presents the largest clinical series of nonsurgical treatment for lumbar facet joint synovial cysts. Lumbar facet joint steroid injection with attempted cyst rupture is correlated with avoiding subsequent surgery in half of treated patients. Successful cyst rupture does not appear to have added benefit, and it was associated with worse disability 3 years postinjection. Long-term outcomes are similar, regardless of subsequent surgery.
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Affiliation(s)
- Julia F Martha
- Department of Orthopedics, New England Baptist Hospital, Boston, MA 02120, USA
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DePalma MJ. Driving the lane: a clearer view of facet joint cyst intervention. Spine J 2009; 9:921-3. [PMID: 19775940 DOI: 10.1016/j.spinee.2009.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 08/13/2009] [Indexed: 02/03/2023]
Affiliation(s)
- Michael J DePalma
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Spine Center, 8700 Stony Point Pkwy, Suite 260, Richmond, VA 23235, USA.
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Dumay-Levesque T, Souteyrand AC, Michel JL. Steroid injection performed with fluoroscopy for treatment of a discal cyst. J Rheumatol 2009; 36:1841-3. [PMID: 19671827 DOI: 10.3899/jrheum.090050] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cho SM, Rhee WT, Choi SJ, Eom DW. Lumbar intraspinal extradural ganglion cysts. J Korean Neurosurg Soc 2009; 46:56-9. [PMID: 19707495 DOI: 10.3340/jkns.2009.46.1.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 12/30/2008] [Accepted: 06/29/2009] [Indexed: 11/27/2022] Open
Abstract
The lumbar intraspinal epidural ganglion cyst has been a rare cause of the low back pain or leg pain. Ganglion cysts and synovial cysts compose the juxtafacet cysts. Extensive studies have been performed about the synovial cysts, however, very little has been known about the ganglion cyst. Current report is about two ganglion cysts associated with implicative findings in young male patients. We discuss about the underlying pathology of the ganglion cyst based on intraoperative evidences, associated disc herniation at the same location or severe degeneration of the ligament flavum that the cyst originated from in young patients.
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Affiliation(s)
- Sung Min Cho
- Department of Neurosurgery, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Korea
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Surgical approach for synovial cyst of the atlantoaxial joint: a case report and review of the literature. Spine (Phila Pa 1976) 2009; 34:E528-33. [PMID: 19564758 DOI: 10.1097/brs.0b013e3181ab22c3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report and review of the literature. OBJECTIVE We describe the first case of a synovial cyst arising from pseudarthrosis of a previous dens fracture. The literature is reviewed and etiological, diagnostic, and therapeutic options of atlantoaxial cysts are discussed. SUMMARY OF BACKGROUND DATA Symptomatic synovial cysts of the atlantoaxial joint are rare. To the authors' knowledge only 24 cases have been reported.A 60-year-old patient presented with bilateral hand numbness, quadrihyperreflexia, and gait deterioration. Magnetic resonance imaging of the cervical spine disclosed a cystic mass located at the transverse ligament of dens axis causing bulbomedullary compression. METHODS Surgery was performed via transoral image guided approach. The ventral atlas arch, dens, transverse ligament, tectorial membrane, and the compressing cyst were removed, followed by a C0-C3 fusion. RESULTS Two months postsurgery the patient recovered completely from the cervical myelopathy with transient remnant dysparesthesia of the finger tips. CONCLUSION Magnetic resonance imaging findings are not specific enough to establish a preoperative diagnosis. Radical resection via image-guided transoral route followed by posterior fusion allows complete resection of the cystic lesion and results in excellent long-term decompression.
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Ikuta K, Tono O, Oga M. Prevalence and clinical features of intraspinal facet cysts after decompression surgery for lumbar spinal stenosis. J Neurosurg Spine 2009; 10:617-22. [DOI: 10.3171/2009.2.spine08769] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Object
Although many cases of primary intraspinal facet cysts in the lumbar spine have been reported, there have only been a few reports of postoperative intraspinal facet cysts in the lumbar spine. The purpose of this study was to investigate the prevalence and clinical features of postoperative intraspinal facet cysts in the lumbar spine.
Methods
Data from 81 patients undergoing microendoscopic posterior decompression to treat lumbar spinal stenosis were reviewed. The development of a postoperative intraspinal facet cyst was observed using MR imaging during 1 year after surgery. If the patient demonstrated a postoperative intraspinal facet cyst, additional MR imaging was performed to evaluate the natural course of the cyst. Furthermore, the authors conducted a comparative evaluation to identify the factors associated with the causes of cyst development.
Results
A postoperative intraspinal facet cyst developed in 7 patients (8.6%) during 1 year after surgery. Spondylotic spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis were revealed before surgery in 2, 4, and 1 patient, respectively. In 5 patients, the cysts developed within 3 months after surgery. Although 3 patients exhibited symptoms caused by cyst development, all symptoms were relieved by conservative treatment. On radiographic evaluations, postoperative segmental spinal instability, including a progression of spondylolisthesis and disc degeneration, was revealed in 6 (86%) of the 7 patients. Spontaneous regression of the cysts was observed in 5 (71%) of these 7 patients. On comparative evaluation of patients with and without postoperative intraspinal facet cysts, the presence of segmental spinal instability before surgery (including degenerative spondylolisthesis) and the appearance of postoperative segmental spinal instability were related to the development of the cysts.
Conclusions
The prevalence of postoperative intraspinal facet cysts, including asymptomatic cysts, was 8.6% during 1 year after decompression surgery for lumbar spinal stenosis. The development of postoperative intraspinal facet cysts was related to the presence of segmental spinal instability before surgery (including degenerative spondylolisthesis) and postoperative segmental spinal instability, including a progression of spondylolisthesis and disc degeneration after surgery. A postoperative intraspinal facet cyst, which can be expected to regress spontaneously with a probability > 50%, should be recognized as one of the postoperative complications of decompression surgery for lumbar spinal stenosis.
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Affiliation(s)
- Ko Ikuta
- 1Department of Orthopedic Surgery, Karatsu Red Cross Hospital, Karatsu City; and
| | - Osamu Tono
- 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Masayoshi Oga
- 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
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Allen TL, Tatli Y, Lutz GE. Fluoroscopic percutaneous lumbar zygapophyseal joint cyst rupture: a clinical outcome study. Spine J 2009; 9:387-95. [PMID: 18809358 DOI: 10.1016/j.spinee.2008.08.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 08/05/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar zygapophyseal joint (Z-joint) synovial cysts can cause low back pain (LBP), spinal stenosis, and lower extremity radiculopathy. In the literature, there are several minimally invasive techniques described with mixed results. Typical recommended treatment is surgical resection of the cyst. Currently, there is little information available concerning the efficacy and outcome with treatment of Z-joint synovial cyst by percutaneous, fluoroscopic, contrast-enhanced distention, and rupture. PURPOSE To evaluate the therapeutic value and safety of Z-joint cyst rupture in symptomatic patients. STUDY DESIGN/SETTING Retrospective cohort study in an academic outpatient physiatric spine practice. PATIENT SAMPLE Thirty-two patients with moderate-to-severe LBP and leg pain (18 women and 14 men with an age range of 46-86 y; mean age, 66 y) with an average preprocedure symptom duration of 5 months. The patient's clinical symptoms correlated with magnetic resonance imaging studies documenting the presence of a synovial cyst at the corresponding level and side of symptoms. Patients had at least 6 months follow-up (range, 6-24). OUTCOME MEASURES Numerical Pain Rating Scale, Roland-Morris Disability Questionnaire, North American Spine Society four-point patient satisfaction survey, recurrence of synovial cyst requiring repeat rupture, and need for surgical intervention. METHODS Patients with symptomatic lumbar Z-joint synovial cyst were identified and their charts were reviewed. Patients included in the study either had symptomatic lumbar LBP or LBP with associated lower extremity radiculopathy. All patients in the study had magnetic resonance imaging's documenting Z-joint synovial cyst that corresponded with the patients' clinical symptoms. All patients received fluoroscopically guided, contrast-enhanced, percutaneous facet cyst distention and rupture followed by an intra-articular facet joint injection of 1 cc kenalog and 1 cc of 1% lidocaine. Seventeen of the patients also received a transforaminal epidural steroid injection just before facet cyst rupture. Telephone follow-up was conducted on all patients. RESULTS Excellent long-term (average follow-up 1 y; range, 6-24 mo) pain relief was achieved in 23 (72%) of 32 patients undergoing facet cyst rupture. Twelve patients (37.5%) had synovial cyst recurrence and 11 chose to undergo repeat rupture, which resulted in 5 patients (45%) obtaining complete relief of symptoms and 6 patients (55%) requiring surgical intervention for cyst removal. Fisher exact test demonstrated that all patients who did not have a cyst recurrence were a success and obtained complete relief of symptoms (p<.0002). Patients who underwent a repeat rupture had a 50% chance of a successful outcome. There was no statistical significance between a successful outcome and level of facet cyst rupture, the presence of spondylolisthesis, sex, age, or having a transforaminal epidural steroid injection at the time of the procedure. Wilcoxon signed-rank test demonstrated that the difference in Numerical Pain Rating Scale and Roland-Morris Disability Questionnaire scores before and after the procedure was statistically significant (p<.0001). No complications were reported. CONCLUSIONS Fluoroscopic percutaneous Z-joint cyst rupture appears to be a safe and effective minimally invasive treatment option. This procedure should be considered before surgical intervention.
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Affiliation(s)
- Tracy L Allen
- Physiatry Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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