Degenerative spondylolisthesis, synovial cyst of the zygapophyseal joints, and sciatic syndrome: report of two cases and review of the literature

Abstract

Two cases of sciatica secondary to nerve root compression by a "synovial cyst" of a zygapophyseal joint are described. In light of these 2 cases and on reviewing the literature, it appears that zygapophyseal joint osteoarthritis with degenerative (or articular) spondylolisthesis can be a predisposing factor to the formation of such synovial expansions and, consequently, the cause of nerve root compression. The coexistence of a lumbar degenerative spondylolisthesis with a radicular syndrome should therefore encourage early investigation by computed tomography scan, so that conservative treatment would not be unnecessarily prolonged.The most common cause of sciatic pain is nerve root compression secondary to disc herniation, but nerve root compression can be caused by other structures, and computed tomography (CT) scanning may reveal, and can often differentiate, them. It appears that capsulosynovial expansions of the zygapophyseal joints occur with relative frequency. Most often, the expansions are related to zygapophyseal joint osteoarthritis (OA), which in some cases, is also responsible for an anterior displacement of the upper vertebrae (degenerative spondylolisthesis). We describe here 2 typical cases, with documentation by CT scan, neurosurgery, and histologic examination.CASE REPORTS Patient 1. The patient, a 77-year-old female homemaker, was hospitalized because of a 1-month history of left-sided lumbosciatic pain that had no precise radicular radiation. The pain was not aggravated by coughing or defecating and was not accompanied by paresthesias. There was no history of preceding tpauma. Since 1974, this patient had been treated with levodopa because of Parkinson's disease. In 1982, she experienced a transitory cerebrovascular accident.Physical examination findings indicated that the patient's general state of health was good. She presented with an acute vertebral syndrome, mostly on the left side. Pain limited dorsolumbar mobility in all 4 directions, particularly in extension, which was almost impossible. Results of the neurologic examination were entirely normal, including the absence of Las8gue's sign. The laboratory test results were normal.Standard films of the lumbar spine showed a first-degree degenerative spondylolisthesis of L4 on L5, in connection with a severe L4-L5 zygapophyseal joint OA. In addition, there was advanced disc degeneration of L5-S 1 , showing a "vacuum phenomenon" (Figure 1).

MR imaging of lumbar facet joint synovial cysts

“…7 c). Acute onset sciatica can be due to acute haemorrhage into the LFSC [17,20]. In this situation MR imaging may show evidence of subacute breakdown products of blood within the LFSC (Fig.…”

“…Spontaneous resolution also occurs (Fig. 7 d) [38], and cyst rupture has been cited as an explanation for this [1,17,49]. Conversely, progressive symptoms have been described in association with increasing cyst size [18,54].…”

“…Facet joint injection with steroid and long-acting anaesthetic can provide temporary or prolonged pain relief [6,17,34,54,56,57,58] which may be of value in patients unfit for surgery. Indirect aspiration via the facet joint can be effective, whereas direct aspiration under fluoroscopic guidance has been successful [57,59].…”

“…The literature indicates a minor female preponderance of 53 % with an age range of 16±81 years (mean age 57 years) [1,2,5,6,7,8,9,10,11,12,13,14,15,16,17]. A review of 26 published cases showed a female predominance of 66 % [17].…”

Synovial Cysts of the Lumbar Spine

“…Several studies have reported that LSCs may occur in association with trauma, 3) rheumatoid arthritis, 29) and degenerative disorders of the spine in older individuals, 13) contributing to attendant degenerative spondylolisthesis. 33) LSCs may project from the anterior or posterior aspect of the facet joints, protruding internal or external, respectively, to the spinal canal, 19) and diameter may range between 3 to 30 mm. 35) Accordingly, some surveys on their prevalence, based on computed tomography (CT) or magnetic resonance (MR) imaging of the lumbar spine in a symptomatic population, revealed that LSCs are responsible for neurological complaints only in …”