Intradural Invasion of Lumbar Synovial Cyst

Bae, Jun Seok; Lee, Sang-Ho; Kim, Jin-Sung; Myung, Sung Hui; Paeng, Sung Suk

doi:10.2176/nmc.52.234

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…23,24 However, juxtafacet cysts can arise anywhere adjacent to the facet joints, and cause intra-or extraforaminal nerve compression; 24,40,43,64,92 even intradural cysts have been reported. 9,89 Just as disc herniation can occur far lateral to the foramen, 58 synovial cysts can cause far-lateral nerve impairment as well. 56,74 Interestingly, in a radiological survey of patients with symptomatic lumbar cysts, Doyle and Merrilees 21 observed 3 times more cysts posterior, and therefore outside the spinal canal, than anterior to the facet joint.…”

Section: Location Of Cystmentioning

confidence: 99%

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

Bruder

Cattani

Geßler

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVESynovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery.METHODSA total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors’ department were analyzed. Medical reports with regard to signs and symptoms, operative findings, complications, and short-term outcome were reviewed. Assessment of long-term outcome was performed with a standardized telephone questionnaire based on the Oswestry Disability Index (ODI). Furthermore, patients were questioned about persisting pain, symptoms, and further operative procedures, if any. Subjective satisfaction was classified as excellent, good, fair, or poor based on the Macnab classification.RESULTSThe approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation.CONCLUSIONSSurgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion.

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Section: Location Of Cystmentioning

confidence: 99%

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

Bruder

Cattani

Geßler

et al. 2017

Journal of Neurosurgery: Spine

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“…Several case reports have been published on "intradural synovial cysts" (IDSCs). [8][9][10][11][12][13][14][15][16][17][18][19] A review of these reports showed that dural penetration of the extradural cyst most frequently occurs at the craniovertebral junction. Neurological symptoms had been caused by direct compression of the spinal cord, brain stem, or hypoglossal nerve.…”

Section: Introductionmentioning

confidence: 99%

Atlantoaxial Intradural Synovial Cyst Mimicking an Extradural Lesion Adjacent to a Retro-odontoid Pseudotumor: A Case Report

MORIGUCHI¹,

FUKUNAGA²,

Ninomiya³

et al. 2022

NMC Case Report Journal

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Atlantoaxial synovial cysts can very rarely penetrate the dura mater into the thecal sac and cause direct neural compression. Several case reports have been available on "intradural synovial cysts" (IDSCs). In this study, we report on a case with an atlantoaxial IDSC mimicking an extradural lesion. A 90-year-old man was diagnosed with a cystic lesion located laterally to the atlantoaxial joint adjacent to the retro-odontoid pseudotumor (ROP) causing cervical spinal cord compression. Thus, surgical removal was planned. On preoperative examination, the cyst, which had a two-layer structure showing a T2-isointense small mass inside a T2-hyperintense lesion, was thought to be located in the extradural region. However, operative findings showed that the cyst was located inside the dura mater. Histopathological examination suggested a synovial cyst. No recurrence of the cyst was observed until the latest follow-up after 3 years, and the ROP decreased in size. Almost all IDSCs reported previously were observed in the medial site of the atlantoaxial joint. In our case, however, the cyst was observed adjacent to the posteromedial site of the right atlantoaxial joint and the ROP, mimicking an extradural lesion. We had no knowledge regarding the IDSC before the surgery and assumed an extradural lesion. Albeit rare, the existence of such a condition should be considered.

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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%

“…There are reports of spontaneous cyst regression as well as regression after anti-inflammatory drug treatment with Cox-2 inhibitors. 7,12 There are also reports showing that cysts can lead to cauda equina syndrome and have deleterious outcomes for patients. 7 There is no need to treat asymptomatic cysts and a conservative treatment can be applied in symptomatic small cysts without neurological deficits in our opinion.…”

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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Intradural Invasion of Lumbar Synovial Cyst

Cited by 5 publications

References 27 publications

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

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

Atlantoaxial Intradural Synovial Cyst Mimicking an Extradural Lesion Adjacent to a Retro-odontoid Pseudotumor: A Case Report

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

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