Lumbar hemorrhagic synovial cysts: diagnosis, pathogenesis, and treatment. Report of 3 cases

Ramieri, Alessandro; Domenicucci, Maurizio; Seferi, Arsen; Paolini, Sergio; Petrozza, Vincenzo; Delfini, Roberto

doi:10.1016/j.surneu.2005.07.073

Cited by 45 publications

(60 citation statements)

References 30 publications

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“…From the literature reviewed, out of 499 cases, 258 (52.5%) had back pain, 303 (61.7%) and 116 (23.6%) had painful radiculopathy and neurogenic claudication, respectively, 183 (37.2%) had motor deficits, 187 (38%) had sensory loss and 175 (35.2%) demonstrated reflex disturbances. Radicular pain with acute onset may be associated with intracystic hemorrage and can be a result of both acute cyst distention or compression of a nervous element [32,36]. Symptoms may simulate a herniated nucleus pulposus, lumbar stenosis or facet joint syndrome, all of which are more common [2,13,28].…”

Section: Discussionmentioning

confidence: 99%

Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review

et al. 2008

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This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Although the relevant reports in the international literature are increasing, the controversy about conservative versus surgical treatment and the need for concomitant fusion still exists. Data from seven patients (age range 58-69 years, mean age 61 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concomitant local pathology, treatment and results of treatment were recorded. A follow-up of at least 6 months (range 6-48 months) was conducted and results were noted. All patients had back pain, while five also experienced unilateral radicular leg pain and one had bilateral leg pain. One patient had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. No fusion was performed. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. Review of the literature revealed a trend towards surgery, as this is correlated to a more favorable outcome compared with conservative treatment. Fusion should be performed on a case-by-case basis only. Surgery is a safe and effective treatment choice in this increasingly appearing ailment. A prospective, randomized trial should clarify issues under debate.

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Section: Discussionmentioning

confidence: 99%

Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review

et al. 2008

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“…40) Hemorrhage within the LSC may cause rapid increase in the cyst volume, and initiate acute back and radicular pain, or may dramatically increase existing pain, as demonstrated by the 24 cases of hemorrhagic LSC so far reported. 16,32) The higher incidence at L4-5 (82%), the level of greatest spinal motion, and the association with spondylolisthesis (40%) support the involvement of underlying spinal instability in formation of the cyst and worsening of the symptoms. 23) While many authors have considered that there is no clinical relevance to differentiating between true synovial cysts and pseudo-cysts, as presentations, treatments, and prognoses are identical, 36) the distinction is important from a histopathological perspective, and may be helpful in understanding LSC etiology.…”

Section: Discussionmentioning

confidence: 89%

“…10) Low back pain or radiculopathy are often the only clinical findings (85%), less frequently patients complain about motor deficits (27%), and lastly the onset with cauda equina syndrome is rare (13%), 26) as well as intracystic hemorrhage with only 24 cases described. 16,32) Diagnosis can be made by arthrography, CT, or MR imaging. The characteristic aspect is a regularly shaped extradural mass, and gas within the cyst may be present and is thought to originate from the vacuum cleft of the contiguous degenerated lumbar facet joint.…”

Section: Discussionmentioning

confidence: 99%

Synovial Cysts of the Lumbar Spine

Ganau

Ennas

Bellisano

et al. 2013

Neurol. Med. Chir.(Tokyo)

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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.

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“…35 Surgically excised cysts in 23 patients with untreatable radicular pain and/or neurological deficits showed hemorrhage considered to be caused by the rupture of fragile neoangiogenic vessels. 36 Acute onset of radicular symptoms has been reported following hemorrhage into lumbar synovial cysts after trauma or in cases of spinal instability. 37 The bright facet sign is a term given to the presence of high signal within the facet articulations (bright facet response) on fast spin echo T2-weighted images.…”

Section: Discussionmentioning

confidence: 99%

Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report

Cox

2012

Journal of Chiropractic Medicine

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Introduction: The purpose of this study is to report the findings resulting from chiropractic care using flexion distraction spinal manipulation for a patient with low back and radicular pain due to spinal stenosis caused by a synovial cyst. Case Report: A 75-year-old man presented with low back pain radiating to the right anterior thigh and down the left posterior leg of 3 years' duration. Physical and imaging examinations showed a synovial cyst-induced spinal stenosis at the right L3-L4 level and bilateral L4-L5 spinal stenosis. Intervention and Outcomes: Flexion distraction spinal manipulation and physiological therapeutics were applied at the levels of stenosis. After 4 visits, the patient noted total absence of the right and left lower extremity pain and no adverse reaction to treatment. After 3 months of treatment and 16 visits, his low back and buttock pain were minimal; and he had no leg pain. Conclusion: Lumbar synovial cyst and stenosis-generated low back and radicular pain was 80% relieved in a 75-year-old man following Cox flexion distraction spinal manipulation.

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Lumbar hemorrhagic synovial cysts: diagnosis, pathogenesis, and treatment. Report of 3 cases

Cited by 45 publications

References 30 publications

Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review

Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review

Synovial Cysts of the Lumbar Spine

Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report

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