Lumbar L4-L5 ganglion cyst with hemicauda equina syndrome. Report of a case and review of the literature

Abstract

Mostly associated with degenerative facet joints and spondylolisthesis, symptomatic lumbar juxta facet cysts - ganglion and synovial cysts are uncommon lesions of the spine. They can mimic herniated discs, causing low back pain, radiculopathy or even cauda equina syndrome; also some of them are associated with spinal instability. Referring to a case with hemicauda equina syndrome where microsurgical decompression was performed with very good result; alternative treatment solutions are discussed: conservative therapy for symptomatic lesions is often unsuccessful, spinal fusion should be made for those cases with spinal instability, although there are reports of spontaneous resolution of these cysts as well as the symptoms associated with them.

Lumbar Facet Cyst Causing Incomplete Cauda Equina Syndrome: A Case Report and Review of Literature

“…3,[6][7][8] Facet cysts can cause cauda equine syndrome due to hemorrhage within synovial cyst or rapidly expanding cysts. 2,4,9 Nonsurgical management in the form of rest, analgesics, and spinal exercises and epidural steroids have been generally unsatisfactory, 3,6,13 although there is a few reports of spontaneous regression of facet cysts. [14][15][16] Percutaneous rupture of the cyst has been shown to have a high recurrence rate.…”

“…3,[6][7][8] Cauda equina syndrome may occur due to hemorrhage into the cyst 2,4 or rapid expansion of a cyst. 9 In this report, we would like to present the occurrence of incomplete cauda equine syndrome resulting from a facet synovial cyst in a 65-year-old woman who presented with weakness in both lower limbs, difficulty in walking, and saddle anesthesia. The symptoms resolved following a posterior decompression, cyst excision, and instrumented fusion surgery.…”