Haemorrhagic Lumbar Juxtafacet Cyst with Ligamentum Flavum Involvement

Abstract

Juxtafacet cysts are an uncommon cause of radiculopathy. They occur most frequently in the lumbar region, and their distribution across the spine correlates with mobility. Haemorrhagic complications are rare and may occur in the absence of any provocation, although there is some association with anticoagulation and trauma. We present a case of acute radiculopathy due to an L5/S1 juxtafacet cyst with unprovoked haemorrhage which was found to extend into ligamentum flavum. The patient underwent uncomplicated microscope assisted decompression with excellent results. The demographics, presentation, aetiology, and management of juxtafacet cysts are discussed.

Ligamentum flavum cyst: An uncommon but recognizable and surgically correctable category of juxtafacet cyst

“…The distribution of juxtafacet cysts correlates with mobility and the incidence of degenerative changes, with over 50% occurring at L4-L5 and the remainder mostly found at L5-S1 and L3-L4. These cysts are unusual in the cervical spine and even rarer in the dorsal spine [12] . There are no pertinent clinical symptoms; however, the spinal canal can impinge upon and displace neural structures and can lead to neurologic symptoms.…”

“…Differential diagnosis on imaging between ligamentum flavum cysts and synovial cysts is useful for surgical planning, as the latter is more difficult to resect, necessitating facet joint exploration [15] . Owing to the lack of data, there are no prospective randomized controlled trials for the management of lumbar juxtafacet cysts [12] . Conservative therapy appears to be less promising, and most conservative therapies have been proven to be temporary and have an unreliable short-term outcome.…”

Ligamentum Flavum Cyst With Acute Onset Motor Deficit: A Literature Review and Case Series

“…2,5 They are found mostly in the most mobile and degenerative segments of the spine, with almost more than half of ligamentum flavum cysts found in the lumbar spine at the L4-L5 level and the remainder at L5-S1 and L3-L4. 6 Most often, they are diagnosed during surgery, but if looked at closely, they can be diagnosed preoperatively by magnetic resonance imaging (MRI). 7 The symptoms produced by ligamentum flavum cysts depend on their location, size, and rate of growth.…”

“…7 The symptoms produced by ligamentum flavum cysts depend on their location, size, and rate of growth. 6 Only a few cases of their association with neurologic deficits have been documented in the literature to date, and acute onset of weakness is even rarer. Various treatment modalities, including conservative methods such as analgesics, braces, physiotherapy, steroid injections, and even repeated aspiration of cysts, have been attempted for symptomatic ligamentum flavum cysts with less favorable results.…”

“…Various treatment modalities, including conservative methods such as analgesics, braces, physiotherapy, steroid injections, and even repeated aspiration of cysts, have been attempted for symptomatic ligamentum flavum cysts with less favorable results. 6 Surgical resection of the cyst along with the affected ligamentum flavum removal is advised when they cause neurological symptoms or intractable pain. 8,9 We present our experience with 3 cases of ligamentum flavum cysts that developed an acute onset of neurologic deficit.…”