Lumbar Intraforaminal Synovial Cyst in Young Adulthood: Case Report and Review of the Literature

Kalevski, Svetoslav; Haritonov, Dimitar; Peev, Nikolay

doi:10.1055/s-0034-1370694

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…The rate of CSF leakage in Literature ranges from 3.1% to 12.66%. 18,19 Leakage of CSF carries the risk for wound healing problems, longer hospital stay and may lead to further surgical procedures. Moreover, Kothe et al 14 revealed a potential inferior outcome in terms of low back pain after 12 months in the case of dural leakage.…”

Section: Discussionmentioning

confidence: 99%

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Resection of Lumbar Spinal Facet Joint Cysts and Cerebrospinal Fluid Leakage

Schmidt

Setzer²,

Seifert³

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Intraspinal facet joint cysts can lead to nerve root compression symptoms with severe discomfort and disability. Permanent improvement can be achieved by surgical resection of the cyst. However, cerebrospinal fluid (CSF) leakage is a common problem in resection of facet joint cyst. The aim of the study was to investigate the frequency of CSF leak after resection of a joint cyst and to determine predictive factors.Methods: A total of 176 consecutive patients underwent surgery for lumbar spinal facet joint cyst in our institution between 1997 and 2018. Patients with a CSF leak were compared with patients without a CSF leak (control group).Results: CSF leakage occurred in 14 patients (8.0%) In 2 of the cases (14.3%), the CSF leak was recognized only postoperatively, in 12 cases (85.7%), the CSF leak was detected intraoperatively. Despite intraoperative dura repair, 4 of these 12 patients (33.3%) presented with CSF leakage postoperatively. Altogether 6 patients had postoperative CSF leakage. Compared with patients without CSF leak, there were no differences in preoperative symptoms, surgical technique, complications, or postoperative findings. Adhesion of the cyst to the dura mater was present in all 14 patients with CSF leakage (100%), but only 61.7% of the control group (P < 0.005). All patients in the CSF leak group showed an improvement of their preoperative symptoms. Conclusions:The rate of CSF leakage in resection of spinal facet joint cyst was 8% in the present study. The occurrence of a CSF leakage was independent of clinical factors, level, or side of the cyst, but significantly correlated to dural adhesion of the cyst. Since neither clinical recovery nor recurrence rates do depend on complete removal of the cyst, aggressive resection of dural adherend parts of the cyst wall should be avoided to prevent CSF leakage.

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Section: Discussionmentioning

confidence: 99%

“…This is concordant to the literature. The rate of CSF leakage in Literature ranges from 3.1% to 12.66% 18,19…”

Section: Discussionmentioning

confidence: 99%

Resection of Lumbar Spinal Facet Joint Cysts and Cerebrospinal Fluid Leakage

Schmidt

Setzer²,

Seifert³

et al. 2022

Clinical Spine Surgery: A Spine Publication

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“…FJ synovial cysts as a cause of LBP with radicular symptoms is an uncommon finding. The overall incidence of anterior facet synovial cysts is reported to be 2.3% [4]. The incidence of facet joint synovial cysts is increasing due to greater availability of imaging modalities such as MRI and an increase in the aging population.…”

Section: Discussionmentioning

confidence: 99%

“…LSC are thought to form when facet joint (FJ) degeneration allows for fluid build-up in the joint, which escapes the joint capsule and forms cysts in the synovium [2] [3] [4] [5] [6]. Symptomatic LSC are most often found posterior and lateral to the dural sac, anterior to the FJ [6].…”

Section: Introductionmentioning

confidence: 99%

Improvement in Radicular Symptoms but Continued Facet Arthropathy and Axial Back Pain Following Rupture of a Facet Joint Synovial Cyst

Kratz¹,

Buck²,

Cramer³

2018

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Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient's low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient's radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.

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“…4,10 However, there are reports of spontaneous regression of such cysts, 7,11 as well as intradural invasion 12 or spontaneous hemorrhage causing a cauda equina syndrome or bilateral foot drop. 13,14 The clinical symptoms can differ and are difficult to predict.…”

Section: Introductionmentioning

confidence: 99%

Intraspinal Lumbar Juxtaarticular Cyst Treatment through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome

Kursumovic

Bostelmann

Gollwitzer

et al. 2016

Clinics and Practice

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Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years).Fifteen of twenty procedures were successful and cyst rupture was confirmed by CT-scans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.

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Lumbar Intraforaminal Synovial Cyst in Young Adulthood: Case Report and Review of the Literature

Cited by 9 publications

References 30 publications

Resection of Lumbar Spinal Facet Joint Cysts and Cerebrospinal Fluid Leakage

Resection of Lumbar Spinal Facet Joint Cysts and Cerebrospinal Fluid Leakage

Improvement in Radicular Symptoms but Continued Facet Arthropathy and Axial Back Pain Following Rupture of a Facet Joint Synovial Cyst

Intraspinal Lumbar Juxtaarticular Cyst Treatment through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome

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