Article

Rapid, Symptomatic Enlargement of a Lumbar Juxtafacet Cyst

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Abstract

A case is reported in which a 45-year-old man developed cauda equina syndrome caused by enlargement of an L4-L5 juxtafacet cyst diagnosed 4 months earlier. To highlight the short interval that can elapse between the discovery of a juxtafacet cyst and its remarkable progression. Although juxtafacet cysts are acquired lesions, how long they take to develop remains unclear. Hemorrhage is a well-known cause of rapid or even dramatic cyst enlargement. This is the first report providing magnetic resonance imaging evidence of rapid, remarkable enlargement of a nonhemorrhagic juxtafacet cyst. The patient underwent conservative treatment for an L4-L5 right juxtafacet cyst diagnosed by magnetic resonance imaging during evaluation of posttraumatic lower back pain. Four months later, the patient presented with severe pain radiating down the right lateral leg, urinary retention, and impaired dorsal flexion of the right foot. Repeat magnetic resonance imaging showed the cyst now markedly enlarged and occupying almost the entire width of the canal. The cyst was removed, and the patient's symptoms abated. At 15 months after surgery, he is symptom-free. Juxtafacet cyst may occasionally enlarge and cause severe symptoms within months.

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... Le scanner permet d'évoquer le diagnostic devant la découverte d'une masse intracanalaire au contact d'une articulation interapophysaire postérieure arthrosique, le kyste peut être de contenu habituellement liquidien, plus rarement hémorragique , calcique , ou aérique, la calcification isolée de la paroi facilite la mise en évidence du kyste, en rapport avec des dépôts pariétales de calcium ou d'hémosidérine , la détection du kyste est difficile quand le kyste est hydrique et sans calcifications pariétales (5). ...
... Increasing prevalence on imaging suggests that the majority of these cysts resolve or remain asymptomatic, and there are reports of spontaneous resolutions of these cysts 42) . However, synovial cysts may also undergo rapid enlargement through both hemorrhagic as well as nonhemorrhagic mechanisms causing acute cauda equina syndrome 18,43) . ...
Article
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Intraspinal synovial cysts are infrequent causes of back and radicular leg pain. Commonly associated with degenerative spinal disease, the majority of synovial cysts appear in the lumbar spine. Rarely, intracystic hemorrhage can occur through an unclear mechanism. Similarly rare, cysts may also become migratory. The pathogenesis of hemorrhagic synovial cysts remains uncertain and their potential for migration also remains unclear. A 36 year-old male presented to the clinic with 5 months of back pain and leg pain that began after a work-related injury. An initial MRI obtained by another surgeon 3 month prior demonstrated an epidural cystic mass with T1 hypointensity and T2 hyperintensity at L2-L3. With worsening pain, the patient came to our clinic for a second opinion. A second MRI demonstrated resolution of the L2-L3 epidural cystic mass and formation of a new epidural cystic mass at L3-L4 causing compression of the thecal sac. The patient subsequently underwent decompressive hemilaminectomy with cyst removal. We present a case of two lumbar synovial cysts, separated over time and a vertebral level and giving the appearance of a single, migratory cyst. This is the first case of an "occult migratory" synovial cyst with repeat MR imaging capturing spontaneous resolution of the initial cyst and formation of a hemorrhagic cyst one level below. We also present a summary of the 44 cases of hemorrhagic synovial cysts reported in the literature and propose a mechanism that may account for the hemorrhagic and migratory progression in some patients.
... A lumbar juxtafacet cyst might remain asymptomatic for years until it gradually reaches a size that can cause root radiculopathy. Rapid expansion of a synovial cyst causing severe symptoms is a rare possibility (20). On the other hand, spontaneous regression of these cysts is not unusual (27). ...
Article
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Hemorrhagic synovial cyst is rarely reported. They mostly occur in the lumbar region with acute intractable radiculopathy that is the result of sudden increase in the cyst’s volume with hematoma. Bleeding in the cyst is the result of spontaneous rupture of fragile neoangiogenic vessels of the cyst’s wall, although their rupture in traumatic events and anticoagulant therapy has so been reported. With careful review of the literature we could find only 34 reported cases in the past. Herein we will present a new case where hemorrhage in a L4-L5 synovial cyst resulted in cauda equina syndrome. Our case and those described in the literature will be reviewed and analysed in terms of clinical picture, age, gender, site of affection. However, since the MR features of hematoma varies in different stages of the evolution of the clot, we will stress on MR picture of hemorrhagic synovial cysts in detail, and their ideal management will also be discussed.
... [1][2][3] Moreover, some patients are reported in whom intracystic bleeding causes the rapid growth of cysts, producing an occupation of the spinal canal space, severely compressing nerves. [4][5][6][7] However, spinal subdural hematomas (SSDH) are very rare pathological entities. They occur mostly in the thoracic to thoracolumbar region, and cause rapid progressing nerve palsy in the acute phase, 8,9 or similarly produce spinal canal stenosis leading to symptoms of nerve irritation in the chronic phase. ...
Article
Context: We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. Findings: A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5-S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. Conclusion: We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions.
... This event is responsible of the acute symptomatology, consisting of neurological deficits and/or intractable painful symptoms [2, 7]. Hemorrhagic presentation can be favored by anticoagulation therapy, trauma, disc herniation or by the presence of a vascular anomaly [2, 7, 9, 10]. It has also been hypothesized that the presence of neoangiogenesis in the cyst walls might be the cause of the bleeding. ...
Article
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Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and/or progressive symptoms of spinal canal compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage into synovial cysts have been reported in the literature.
Chapter
Facet joints are a major source of neck and low-back pain. Facet joint syndrome is defined as a constellation of symptoms that result in diffuse pain that does not fit a clear nerve root pattern (e.g. not sciatica). Both cervical and lumbar facet syndromes have been described (Cavanaugh et al. 2006).
Chapter
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Article
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Article
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Article
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Article
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Article
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Article
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Article
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The lumbar intraspinal synovial cyst is an uncommon cause of low-back pain or "sciatica." However it is important to recognize these cysts so that correct surgical management is offered to the patient. Intraspinal synovial cysts can be accurately diagnosed by computed tomography (CT). The authors report ten cases of lumbar intraspinal synovial cysts (LISC) that highlight the clinical and radiologic features.
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Article
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Article
A patient with posttraumatic lumbar radicular paresthesias is presented. The preoperative diagnosis of an epidural synovial cyst was considered. At surgery, an epidural synovial microcystic mass was found emanating from a distracted L4-5 facet joint and dissecting into the layers of the ligamentum flavum. A brief review of the condition is presented.
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Juxtafacet cysts of the lumbar spine have been reported with increasing frequency but their pathogenesis remains obscure. These cysts most frequently present with back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms of spinal canal compromise. The authors report an unusual case of hemorrhage into a right L3-4 synovial cyst causing an acute cauda equina syndrome and describe its successful surgical treatment. The clinical, radiographic, and pathological features are discussed.
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Article
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