Reversible cause of back pain and sciatica in rheumatoid arthritis: An apophyseal joint cyst

Jacob, Janel R.; Weisman, Michael H.; Mink, Jerrold H.; Metzger, Allan L.; Feldman, Gary R.; Dorfman, Howard D.; Blinderman, Elliott E.; Resnick, Donald

doi:10.1002/art.1780290320

Cited by 27 publications

(18 citation statements)

References 13 publications

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“…The literature cites various outcomes in the surgical and nonsurgical care of symptomatic synovial cyst patients to include facet joint arthrography, 27 steroid injection into the apophyseal joint, 28 and direct puncture of the cyst. 29,30 Spontaneous resolution of synovial cyst has been reported.…”

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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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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“…The most common cause reported is degenerative facet joint disease with hypertrophy and herniation of synovium through a tear of the capsule. Rarely, cysts have been observed to develop secondary to rheumatoid arthritis 2,6,8,9) . However, there have been no cases reported in association with AS; although Vergne et al 10) considered the possibility of this association.…”

Section: Discussionmentioning

confidence: 99%

“…Most intraspinal synovial cysts are located in the lower lumbar spine, where the greatest degree of movement is present 4) . In rare cases, they have also been described with inflammatory changes of the facet joints in association with rheumatoid arthritis and undifferentiated spondyloarthropathy 2,3,6) . However, there has been no report of intraspinal synovial cysts associated with ankylosing spondylitis (AS).…”

Section: Introductionmentioning

confidence: 99%

Foraminal Synovial Cyst Associated with Ankylosing Spondylitis

Kim

2011

J Korean Neurosurg Soc

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54ted to our institute with severe back pain and right thigh pain. Five years previously, he developed severe back pain after a light fall and the magnetic resonance imaging (MRI) revealed a fresh compression fracture at L1. The patient was diagnosed with AS at that time and underwent percutaneous vertebroplasty (Fig. 1). The lowest T-score on DEXA bone mineral density was -3.57 at that time. The patient presented with only mild back discomfort after the vertebroplasty. However, the back and thigh pain progressively worsened without any history of trauma for one month before re-admission. Ambulation was very limited and the patient was then admitted to the hospital again. On physical examination, there was no motor weakness but there was decreased sensation to pinprick in the right L2 dermatome. The results of the straight leg raising test and femoral stretch test were negative. Simple radiographs showed severe degenerative changes, spondylosis, aggravated kyphosis and a stress fracture through the ossified posterior segment, below the prior vertebroplasty ( Fig. 2A). Computed tomography scanning confirmed the stress fracture (Fig. 2B). The MRI revealed a right foraminal cystic mass at the L2-L3 level with effacement of the nerve root (Fig. 3). The cyst's interior signal was isointense with the cerebrospinal fluid on T1-weighted images and hyperintense on T2-weighted sequences. Administration of gadolinium resulted in little enhancement of the cyst's wall. A right L2-L3 total facetectomy and posterolateral fusion were performed to remove the lesion (Fig. 4). During surgery, a 1.6 cm cystic le- INTRODUCTIONSynovial cysts usually develop from the synovial capsule of the facet joints. Although their etiology is unclear, facet joint arthropathy and underlying spinal instability are known to be associated with the formation of synovial cysts and worsening symptoms 1,7) . Most intraspinal synovial cysts are located in the lower lumbar spine, where the greatest degree of movement is present 4) . In rare cases, they have also been described with inflammatory changes of the facet joints in association with rheumatoid arthritis and undifferentiated spondyloarthropathy 2,3,6) . However, there has been no report of intraspinal synovial cysts associated with ankylosing spondylitis (AS). We report a patient who developed a radiculopathy caused by foraminal synovial cyst associated with AS accompanying posterior element fracture. CASE REPORTA 55-year-old man with a five year history of AS was admit-J Korean Neurosurg Soc 50 : 54-56, 2011 10.3340/jkns.2011.50.1.54 Copyright © 2011 The Korean Neurosurgical Society Ankylosing spondylitis (AS) is frequently associated with inflammatory lesions of the spine and continuous fatigue stress fractures; however, an association with an intraspinal synovial cyst has not been previously reported. A 55-year-old man with a five year history of AS who presented with back pain and a right radiculopathy was admitted to the hospital. Five years previously, he underwent a percutaneous vertebrop...

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“…Percutaneous techniques ranging from percutaneous aspiration 28,[43][44][45] to facet joint puncture and intraarticular/epidural steroid injection 14,34,36,38,39,46 have been described in the literature.…”

Section: Conservative Treatmentmentioning

confidence: 99%

“…38 Owing to segmental instability and concomitant spondylolisthesis, the need for fusion is quite high.…”

Section: Surgical Therapymentioning

confidence: 99%

Microsurgical Treatment of Juxta Facet Cysts of the Lumbar Spine

Deinsberger

Kinn

Ungersböck

2006

Journal of Spinal Disorders &Amp; Techniques

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Conservative therapy does not adequately improve symptoms in patients with intraspinal juxta facet cysts and radicular signs. Juxta facet cysts can be treated effectively with a minimally invasive microsurgical approach. This may be of particular significance when the cysts are associated with spondylolisthesis, minimizing the risk of instability and the need for fusion. In a selected group of patients with persistent low back pain, fusion may become necessary to improve symptoms.

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Reversible cause of back pain and sciatica in rheumatoid arthritis: An apophyseal joint cyst

Cited by 27 publications

References 13 publications

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

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

Foraminal Synovial Cyst Associated with Ankylosing Spondylitis

Microsurgical Treatment of Juxta Facet Cysts of the Lumbar Spine

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