Ganglion Cyst of the Posterior Longitudinal Ligament Causing Lumbar Radiculopathy

Abstract

J Korean Neurosurg Soc 47 : [298][299][300][301] 2010 Degenerated conditions such as herniated disc or spinal stenosis are common etiologies of lumbar radiculopathy. Less common etiologies include spinal extradural cyst such as synovial cysts and ganglion cysts. Ganglion cyst of the posterior longitudinal ligament (PLL) of the spine is a rare entity that can result in classical sciatica. Posterior longitudinal ligament cyst has no continuity with the facet joint and has no epithelial lining. Two young male patients presented with unilateral sciatica and were found to have intraspinal cystic lesions causing lumbar radiculopathy. Magnetic resonance imaging demonstrated rounded, cystic lesions (i.e., hypointense on T1-but hyperintense on T2-weighted images) adjacent to minimally dehydrated, nonherniated disc spaces in both cases. These patients underwent posterior decompression and cysts were excised, and their sciatic symptoms were completely resolved. Histological examination showed typical features of ganglion cysts in these cases.

Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts

“…1 Cysts in the posterior ligament are rare and have been reported only a few times in the literature. 8,18,22,49,50,52,59,65,70,94 They have only been found in the lumbar spine, and patients are significantly younger than those with juxtafacet cysts (mean 35 years vs 63 years; p < 0.001).…”

Bilateral Thoracic Ganglion Cyst : A Rare Case Report

“…They have similar clinical and radiographic features and are considered an extrusion of the synovium through a capsular defect from a degenerative or unstable facet joint. The ganglion/synovial cysts generally arise from facet joint but they may arise also from ligamentum flavum, posterior longitudinal ligament, annulus fibrosis and disc itself3,8,17). The majority of ganglion cysts in the lumbar spine occur at L4-L5 level and occasionally at L5-S1 and L3-L41,8,9,14).…”

“…The pathogenesis of ganglion cysts is the subject of considerable controversy in the literature, but the most accepted etiology is the herniation of synovial tissue and its content from the articular cavity through a defect in the wall of the articular capsule3). The possible causative factors include repetitive trauma, spondylolysthesis, facet artrosis, myxoid degeneration, proliferation of mesenchymal cells, and increased hyaluronidase production.…”

“…Ganglion cysts appear high signal intensity lesions with a fibrous capsule on T2 weighted image. In the differential diagnosis, extruded or sequestered disc fragment, cyst of the ligamentum flavum, perineural cyst, schwannoma, menengioma, metastasis, arachnoid cysts and rheumatoid pannus should be considered1,3,7).…”

Classification, mechanism and surgical treatments for spinal canal cysts

“…The ligamentum flavum cyst is regarded to be associated with microtrauma due to increased motion at a particular motion segment or segmental instability and local stress associated with degeneration at the level of occurrence. It's noted that patients with ligamentum flavum cysts have co-existence of facet joint degeneration, and incidence of degenerative spondylolisthesis at a range of 42 % and 65 % [5,6]. Pathologic ligamentum flavum cysts contain hemorrhage.…”