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Badra M, Najjar E, Wardani H, Jamaleddine Y, Daccache E, Ezzeddine H, Moucharafieh R. Evaluation and Treatment of Lumbar Spine Extradural Cysts: A Narrative Review. Cureus 2024; 16:e60604. [PMID: 38894794 PMCID: PMC11185196 DOI: 10.7759/cureus.60604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
The main objective was to describe the different types and characteristics of lumbar spine extradural cysts and their optimal treatment options with a focus on endoscopic technique. We searched Pubmed, EMBASE, Medline, and Google Scholar for articles published between 1967 and 2020 using the keywords "Spinal Cyst," "Extradural Cyst," and "Lumbar Cyst." The various anatomical and histological types of the extradural cysts with their presentations, etiologies, imaging, and optimal treatment with a focus on endoscopic techniques were reviewed from the articles. Lumbar spinal cysts are relatively rare pathologies that might cause radicular symptoms similar to lumbar disc herniation. Spinal extradural cysts are classified either histologically based on the cyst lining tissues (synovial cysts or non-synovial, ganglion cysts) or anatomically based on the structure of origin (epidural cysts, ligamentum flavum cysts, discal cysts, post-discectomy pseudocysts, posterior longitudinal ligament cysts, facet cysts). Surgical excision is the recommended treatment of symptomatic cysts with endoscopic techniques being a viable option. Extradural lumbar cysts can be identified based on their histological structure or depending on their structure of origin. Regardless of their classification, they could all give similar clinical findings, and the optimal treatment would be surgical excision with endoscopic technique being a viable option with a satisfactory outcome.
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Affiliation(s)
- Mohammad Badra
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center, Johns Hopkins International, Beirut, LBN
| | - Elie Najjar
- Department of Orthopedics, Center for Spinal Studies and Surgery (CSSS) Queen's Medical Centee, Nottingham University Hospitals, Nottingham, GBR
| | - Hassan Wardani
- Department of Orthopedic Surgery, Faculty of Medicine, Lebanese University, Beirut, LBN
| | - Youssef Jamaleddine
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, LBN
| | - Elio Daccache
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, LBN
| | - Hady Ezzeddine
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
| | - Ramzi Moucharafieh
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
- Department of Orthopedics and Traumatology, Clemenceau Medical Center, Johns Hopkins International, Beirut, LBN
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Rana S, Pradhan A, Casaos J, Mozaffari K, Ghodrati F, Sugimoto B, Yang I, Nagasawa DT. Lumbar spinal ganglion cyst: A systematic review with case illustration. J Neurol Sci 2023; 445:120539. [PMID: 36638603 DOI: 10.1016/j.jns.2022.120539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Ganglion cysts are benign soft tissue lesions found in joints, most commonly wrists. The incidence for juxtafacet cysts, the condition under which spinal ganglion cysts are categorized, is between 0.06% and 5.8%. Spinal ganglion cysts often arise in the most mobile segment of the lumbar spine, L4-L5. Patients commonly present with pain, radiculopathy, and weakness. Conservative management is used, but surgical resection is the most common treatment modality. We aim to review the literature and present a rare case of an L2-L3 situated spinal ganglion cyst, treated with maximal safe resection. METHODS A systematic review of literature was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were queried using Boolean operators and search terms, "spinal ganglion cyst, lumbar ganglion cyst, and lumbar juxtafacet cyst". Presentation, surgical management, and postoperative course of a 29-year-old male with an L2-L3 spinal ganglion cyst are also described. RESULTS The search yielded 824 articles; 23 met inclusion criteria. These papers consisted of 27 spinal ganglion cyst cases with disaggregated patient data. 63.0% of patients were male, and 53.4 years (range: 23-86) was the average age at presentation. Mean symptom duration was 1.9 years (range: 3 days-12 years). 70.4% of patients reported complete symptom resolution. 14.8% of cases noted neural foramen involvement. CONCLUSIONS Spinal ganglion cysts are benign lesions typically presenting with radiculopathy. Maximal safe resection is an effective treatment modality with low complication rates. Future studies are needed to understand if neural foramen involvement leads to increased symptom severity.
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Affiliation(s)
- Shivam Rana
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Anjali Pradhan
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Joshua Casaos
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Khashayar Mozaffari
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Farinaz Ghodrati
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Brianna Sugimoto
- Achieve Brain & Spine, Santa Monica, CA, United States of America
| | - Isaac Yang
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Department of Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States of America; Department of Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, United States of America; Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, United States of America; Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America.
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Simonin A, Philippe J, Fournier JY. Full-Endoscopic Resection of a Recurrent Posterior Longitudinal Ligament Cyst: Technical Note. World Neurosurg 2021; 153:2-5. [PMID: 34062301 DOI: 10.1016/j.wneu.2021.05.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Posterior longitudinal ligament cysts are very rare lesions and do not usually recur. Microscopic resection is commonly performed. The aim of this article was to report a case of recurrent posterior longitudinal ligament cyst that benefited from full-endoscopic resection. METHODS We used the 25° endoscope of the RIWOspine set for interlaminar approach. A step-by-step description of the surgical technique was presented. RESULTS Clinical evolution was favorable. The patient remained pain-free 1 month after surgery, and postoperative magnetic resonance imaging showed complete resection of the cyst. CONCLUSIONS Endoscopy is a safe and feasible approach for posterior longitudinal ligament cysts, including unusual recurrent cases.
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Affiliation(s)
| | - Jade Philippe
- Department of Neurosurgery, Hôpital de Sion, Sion, Switzerland
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Velagapudi L, Matias CM, Elia C, Stolzenberg D, Largoza G, Feld R, Curtis M, Harrop JS. Spinal ganglion cyst presenting with radiculopathy: diagnostic challenges and differential. Spinal Cord Ser Cases 2021; 7:6. [PMID: 33468998 DOI: 10.1038/s41394-020-00373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Ganglion cysts are benign soft tissue lesions, usually arising from periarticular connective tissue. These are very rarely reported in the spine, but when seen can cause radiculopathy or myelopathy. CASE PRESENTATION A 68-year-old female patient presented with worsening radiculopathy and right foot drop and imaging noted a right L5-S1 foraminal mass. The lesion was gross totally resected. Histological analysis revealed myxoid degeneration and inflammation, without a synovial lining, consistent with ganglion cyst. DISCUSSION While uncommon, intra-foraminal ganglion cysts can be distinguished from synovial cysts through imaging and histology and are typically amenable to surgical resection. Greater knowledge and insight about differentiating ganglion versus synovial cyst may prevent resection of facet joints and prevent a fusion procedure.
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Affiliation(s)
- Lohit Velagapudi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Caio M Matias
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Elia
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Stolzenberg
- Rothman Orthopedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Garrett Largoza
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rick Feld
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Curtis
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
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Cultrera F, Nuzzi D, Panzacchi R, Cataldi ML, Lofrese G. A proposal of degenerative anterior epidural cysts of the lumbar spine. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bruder M, Cattani A, Gessler F, Droste C, Setzer M, Seifert V, Marquardt G. Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts. J Neurosurg Spine 2017; 27:256-267. [PMID: 28686146 DOI: 10.3171/2016.12.spine16756] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Synovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery. METHODS A total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors' department were analyzed. Medical reports with regard to signs and symptoms, operative findings, complications, and short-term outcome were reviewed. Assessment of long-term outcome was performed with a standardized telephone questionnaire based on the Oswestry Disability Index (ODI). Furthermore, patients were questioned about persisting pain, symptoms, and further operative procedures, if any. Subjective satisfaction was classified as excellent, good, fair, or poor based on the Macnab classification. RESULTS The approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation. CONCLUSIONS Surgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion.
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Affiliation(s)
- Markus Bruder
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Christian Droste
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
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Tai PA, Li TC. Lumbar Intradural Ganglion Cyst. World Neurosurg 2016; 88:691.e1-691.e4. [DOI: 10.1016/j.wneu.2015.11.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 12/01/2022]
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Kizilay Z, Yilmaz A, Gurcan S, Berber O, Ozsunar Y, Eliyatkın N. A ganglion cyst derived from a synovial cyst: A case report. Neurol Neurochir Pol 2015; 49:436-40. [PMID: 26652879 DOI: 10.1016/j.pjnns.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/03/2015] [Accepted: 08/07/2015] [Indexed: 11/29/2022]
Abstract
The synovial and ganglion cysts originating from the facet joint have been named under the name of the Juxtafacet cyst by the several researchers. They put forward that the synovial cyst originated from the synovial joint. But, they failed to clarify the pathophysiology of the formation of the ganglion cyst. In this case report, we reported a 67-year-old male patient was referred to the emergency from another center with the complaint of a left leg pain and weakness in the left foot and patient was treated with microchirurgical technique. His patological examination was evaluated a ganglion cyst. We have discussed and explained the pathophysiology of the formation of a ganglion cyst derivered from a synovial cyst. And separately, we have presented the spinal cysts by grouping them under a new classification called a cystic formation of the soft tissue attachments of the mobile spine as well as dividing them into sub-groups.
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Affiliation(s)
- Zahir Kizilay
- Adnan Menderes University Medicine Faculty Neurosurgery Department, Aytepe-Aydin, Turkey.
| | - Ali Yilmaz
- Adnan Menderes University Medicine Faculty Neurosurgery Department, Aytepe-Aydin, Turkey.
| | - Sevilay Gurcan
- Adnan Menderes University Medicine Faculty, Pathology Department, Aytepe-Aydin, Turkey.
| | - Osman Berber
- Adnan Menderes University Medicine Faculty Neurosurgery Department, Aytepe-Aydin, Turkey.
| | - Yelda Ozsunar
- Adnan Menderes University Medicine Faculty, Radiology Department, Aytepe-Aydin, Turkey.
| | - Nuket Eliyatkın
- Adnan Menderes University Medicine Faculty and Basic Oncology PhDc, Institute of Oncology, Dokuz Eylul University, Aytepe-Aydin, Turkey.
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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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Hyung-Jun K, Dae-Yong K, Tae-Ho K, Ho-Sang P, Jae-Sung K, Jae-Won J, Jung-Kil L. Lumbar discal cyst causing bilateral radiculopathy. Surg Neurol Int 2011; 2:21. [PMID: 21427789 PMCID: PMC3050063 DOI: 10.4103/2152-7806.77026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Accepted: 01/03/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Discal cyst is a rare lesion that can result in clinical symptoms typical of disc herniation manifesting as a unilateral single nerve root lesion. To the best of the authors' knowledge, this is the first reported case of discal cyst resulting in bilateral radiculopathy. CASE DESCRIPTION A 48-year-old female presented with bilateral sciatica and neurogenic claudication for 3 months. Magnetic resonance imaging revealed an extradural cystic lesion compressing the ventral aspect of the thecal sac at the level of the L3-L4 intervertebral disc. The lesion showed low and high signal intensities on T1- and T2-weighted images, respectively. Total excision of the cyst was achieved after a left hemipartial laminectomy of L3, and an obvious communication with the disc space was found. Bilateral sciatica was immediately resolved after surgery, and was sustained at the two-year follow-up. The histological diagnosis was consistent with a discal cyst. CONCLUSIONS Although a discal cyst is extremely rare, the possibility of a discal cyst should be considered in differential diagnosis of patients with radiculopathy, particularly when encountering any extradural mass lesion ventral to the thecal sac. Surgical resection is the most employed therapeutic method for symptomatic lumbar discal cysts.
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Affiliation(s)
- Kwak Hyung-Jun
- Department of Neurosurgery, Dong Gwang Ju Woori Hospital, Gwangju, Korea
| | - Kim Dae-Yong
- Department of Neurosurgery, Dong Gwang Ju Woori Hospital, Gwangju, Korea
| | - Kim Tae-Ho
- Department of Neurosurgery, Gwang Ju Woori Hospital, Gwangju, Korea
| | - Park Ho-Sang
- Department of Neurosurgery, Gwang Ju Woori Hospital, Gwangju, Korea
| | - Kim Jae-Sung
- Department of Neurosurgery, Gwang Ju Woori Hospital, Gwangju, Korea
| | - Jang Jae-Won
- Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea
| | - Lee Jung-Kil
- Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea
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