A ganglion cyst derivered from a synovial cyst: A case report (original) (raw)
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Lumbar Intraspinal Synovial and Ganglion Cysts (Facet Cysts)
Spine, 1995
Study Design. This study analyzed the clinical his tory, physical examination, diagnostic studies, and op erative and histoiogic findings in 19 patients with lum bar intraspinal synovial and ganglion facet cysts evaluated and treated over a 10-year period. Objectives. The results were correlated to provide a greater understanding of the nature of lumbar facet cysts and rationale for conservative or surgical treat ments. Summary of Background Data. The 19 patients in cluded 13 women and 6 men ranging in age from 38 to 70 years. 84,4% of the patients presented with radicular pain. 26.3% had significant motor deficit. 68.4% of the "T^ei cysts were found at L4-i'l^, 21.1% at L5-S1, 5.2% at 1.1-L2, and 5.2% at L2-L3. Their clinical pictures, im aging studies, and surgical and histoiogic findings were correlated in a retrospective fashion. Methods. The clinical history and findings on physi cal examination, standard radiography, myelography, computed tomography-myelography, facet anhrography, post-facet arthrography, magnetic resonance imag ing with and without contrast, and computed tomogra phy scans were reviewed. Results. Bilobed cysts were found on both dorsal and ventral lispecis of the involved facet joints within and outside of the spinal canal on facet arthrography. computed tomography, magnetic resonance imaging, and at the time of surgery in more than 60% of the pa tients. Significant facet degeneration was found in 75% of standard radiographs, and in all of the magnetic res onance imaging and computed tomography scans, in six patients, syniptoms improved with rest, medication, and bracing, Epidural corticosteroid injections provided short-term relief in three out of four patients. Facet cor ticosteroid injections provided good relief in one, par tial relief in one, and no relief in one patient. Surgical decompression in eight patients resulted in three excel lent, four good, and one fair outcome. Conclusions. Most of the lumbar intraspinal facet cysts were associated with significantly degenerated facet joints. Patients with intraspinal facet cysts may respond to conservative treatments if there is no signifi cant neurologic deficit. Surgical decompression and removal of large facet cysts usually are successful in l-roin ".St. .Vlary's .Spmc Center, San Franci.seo, Calilornia, .ind fDc
Objective: To determine the changes to a synovial cyst following symptomatic resolution utilizing a conservative treatment protocol. Clinical Features: A 76-year-old female had a 6-month history of pain in the right buttock, posterior thigh, calf, ankle and foot and dysaesthesia in the right L5 dermatome. Intervention and Outcome: Following a short course of conservative chiropractic management, the patient's symptoms resolved and was subsequently discharged. At 6 months post-discharge she remained asymptomatic and was re-imaged using the same MR imaging parameters. Comparison of both sets of images revealed little change in the appearance of the lesion. Conclusion: MR imaging is the gold standard for radiological diagnosis of lumbar synovial cysts. Surgical intervention remains the most commonly employed management protocol with good outcomes and few deleterious effects. However, there is a growing body of evidence for symptomatic relief using less invasive protocols, including chiropractic (as in this case) and physical therapy. This study was conducted to consider the correlation between symptomatology and radiological findings. This is the first reported case of MR imaging appearances of a lumbar facet synovial cyst pre-and post-successful conservative management resulting in symptomatic resolution.
Symptomatic ganglion cyst of ligamentum flavum as a late complication of lumbar fixation
Neurologia i Neurochirurgia Polska, 2012
We report the case of a 72-year-old man who underwent surgery for a mobile spondylolisthesis L4-L5. Six months later, magnetic resonance imaging revealed an extradural cyst of the ligamentum flavum at L5-S1, which was then removed. Histological examination revealed a ganglion cyst of the ligamentum flavum. Cyst formation could be explained primarily according to the natural history of chronic degenerative disease of spine elements. Nevertheless, we could also consider the cyst formation as demonstrative of an adjacent segment syndrome: hypermobility of the L5-S1 segment just below three fixed vertebral segments would have triggered the mechanical stress necessary for L5-S1 ligamentum flavum degeneration.
Spinal lumbar synovial cysts. Diagnosis and management challenge
European Spine Journal, 2006
Sophisticated and newer imaging capabilities have resulted in increased reporting and treatment options of spinal lumbar synovial cysts (LSS). Most of the patients with lumbar cysts tend to be in their sixth decade of life with a slight female predominance. The incidence of LSS is thought to be less than 0.5% of the general symptomatic population. They may be asymptomatic and found incidentally or the epidural growth of cysts into the spinal canal can cause compression of neural structures and hence associated clinical symptoms. Most of the symptomatic LSS patients present with radicular pain and neurological deficits. Spinal synovial cysts are commonly found at L4-5 level, the site of maximum mobility. They may be unilateral or bilateral and at one or multilevel. MRI is considered the tool of choice for its diagnosis. The etiology of LSS is still unclear, but underlying spinal instability, facet joint arthropathy and degenerative spondylolisthesis has a strong association for worsening symptoms and formation of spinal cysts. Synovial cysts resistant to conservative therapy should be treated surgically. Resection and decompression with or without fusion and instrumentation remains an appropriate option. Synovial cysts may recur following surgery. The optimal approach for patients with juxtafacet LSS remains unclear. The best surgical treatment option for each particular individual should be tailored depending upon the symptoms, radiological findings and other co morbidities.
Synovial cysts of the lumbar spine
Neurologia i Neurochirurgia Polska, 2012
Symptomatic lumbar synovial cysts (LSCs) are a rare cause of degenerative narrowing of the spinal canal, with thecal sac or nerve root compression. True synovial cysts have a thick wall lined by synovial cells, containing granulation tissue, numerous histiocytes, and giant cells. In contrast, pseudo-cysts lack specialized epithelium, have a collagenous capsule filled with myxoid material, and may be classified into ganglion cysts, originating from periarticular fibrous tissues, and ligamentous cysts, arising from the ligamentum flavum or even from the posterior longitudinal ligament. Here we present the surgical series of the Chair of Neurosurgery at the University of Cagliari (Italy) including a total of 17 LSCs. Surgical technique consisted of facet sparing excision of LSC, achieved by simple hemilaminectomy/laminectomy, and diagnosis was always confirmed by histological specimen examination, which detected the typical synovial epithelium, the intracystic presence of hemosiderin, histiocytes, and calcifications. Further immunohistochemical investigation revealed positive staining for cytokeratin: CK5, CK6, and AE1/AE3. Clinically, our cohort experienced rapid and complete resolution of symptoms, without perioperative complications, or recurrence of cysts or vertebral instability at a median follow up of 28 months, when the MacNab score was generally excellent. A review of the literature, retrieving articles published from 1973, collected a total of 101 articles concerning all the cases of LSC scientifically described to date. Both clinical and histological findings described in our study support the theory of degenerative microtraumatic pathogenesis of synovial cysts.
Coincidental Lesions that have been seen in Patients with Lumbar Discopathy at Spinal MR Examination
Medical Science and Discovery, 2018
Pre-diagnosis of Lumbar Discopathy and radiological examination of 613 patients whom Lumbar MRI applied have been assessed in the present study. The scrutiny on MRI has been carried out by musculoskeletal radiologists who are well experienced in the field of spinal lumbar MRI. The coincidental finding has been defined as any abnormal finding included in the imaging field which was not associated with the main complaint. Vertebral hemangioma, tarlov cyst, Renal cyst, schmorl nodule, liver cyst were included in the study. Imaging data were obtained by the same MR Device (Avanto 1.
Spontaneous resolution of symptomatic lumbar synovial cyst
Journal of Surgical Case Reports, 2016
Lumbar synovial cyst arises from the facet joint and can lead to back pain, radiculopathy, neurogenic claudication or even cauda equina syndrome. Although most surgeons would consider surgery to be the treatment of choice, the natural history of the disease process remains unknown and uncertainty still exists regarding optimal management of this controversial entity. We illustrate a case of large L5/S1 synovial cyst for which surgery was initially planned. However, it resolved spontaneously without any treatment. We also provide a brief literature review regarding conservative, surgical and minimally invasive management of symptomatic lumbar synovial cyst with special reference to patient outcome.