Lumbar nerve root compression by synovial cysts of the ligamentum flavum

Abdullah, Adel F.; Chambers, Robert; Daut, Dennis P.

doi:10.3171/jns.1984.60.3.0617

Cited by 99 publications

(48 citation statements)

References 15 publications

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“…In previously reported cases, cysts of the ligamentum flavum were at L4-L5 and L5-S1 level [1,3,4,10,18,23]; cervical localization has seldom been described [11]. Neuroimaging is helpful in diagnosing cervical cyst of the ligamentum flavum.…”

Section: Discussionmentioning

confidence: 92%

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report

et al. 2005

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IntroductionCysts of the ligamentum flavum are rare lesions that are most frequently located in the lumbar spine [1 -4, 21, 23], the cervical localization is unusual [11]. Most of the intraspinal degenerative cysts are juxta-articular (synovial and ganglion) cysts, and have a similar radiologic appearance [8,12,15,16,20]. We report the unique neuroimaging and pathological findings obtained in a patient with a cyst of the ligamentum flavum in the cervical region associated with a C7-T1 subluxation. This report, to our information, is the first of its kind. Case reportThis 66-year-old woman presented with a 1-year history of progressive gait disturbance with lower extremity fatigue. Clinical examination revealed marked spastic paraparesis and difficulty in performing fine motor tasks with the left hand as well as loss of penmanship of the right hand. MRI revealed a T2-hyperintense cystic lesion with a hypointense tail in the anterolateral part of the left lamina of C7 (Fig. 1a), associated with a C7-T1 anterolisthesis (Fig. 1b). The patient underwent a C7-T1 hemilaminectomy and a hypertrophied, partially calcified ligamentum was resected. A round, yellowish cyst of about 1 cm in diameter filled with gelatinous fluid was found in the internal aspect of the ligamentum flavum; it was adherent to the duramater but dissection was achieved easily. There was no communication between the lumen of the cyst and the joint capsule. Pathological examination of the cyst revealed myxoid and pseudocystic degeneration of the ligamentum flavum without a synovial layer (Fig. 2). A postoperative dynamic X-ray revealed no spinal instability with resolution of the cervicothoracic subluxation. The patient's myelopathy Abstract A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patient's myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. Association between degenerative intraspinal cysts and listhesis is discussed. To our knowledge, this is the first case of cyst of the ligamentum flavum associated with cervical subluxation.

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Section: Discussionmentioning

confidence: 92%

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report

et al. 2005

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“…18,28) The overall prevalence of anterior and posterior facet joint cysts are 2.3% and 7.3%, respectively, and back pain is the primary symptom for cysts located posterior to the facet joint, possibly because the ligamentum flavum (LF) acts as a mechanical barrier against the formation of anterior cysts. 7) Synovial cysts within the lumbar spinal canal are usually classified as synovial cyst, ganglion cyst, posterior longitudinal ligament (PLL) cyst, or LF cyst based on their location, 9) origin, 1,34) and pathologic features. 14) Cystic lesion located on the internal and posterolateral side of the spinal canal, continuous with the facet joints, and lined with epithelial tissue is classified as synovial cyst.…”

Section: Introductionmentioning

confidence: 99%

“…28,29) Cystic lesion located at the periarticular area but lacking epithelial lining and continuity with the synovial cavity is classified as ganglion cyst. 28) Cystic lesion embedded in the inner surface of the LF with no epithelial lining or continuity with the facet joint synovium is classified as LF cyst, 1,34) and cystic lesion located in the PLL with the same properties is classified as PLL cyst. 21) These lesions usually present with common symptoms of radiculopathy, neurogenic claudication, myelopathy, neurological deficit, and even cauda equina syndrome.…”

Section: Introductionmentioning

confidence: 99%

“…18,25) Synovial cysts may adhere any tissue in the spinal canal, so surgeons must be alert to cerebrospinal fluid fistula at the end of operation. 1,13,18) Larger cyst is more likely to adhere to the dura mater. 18) One of our patients with synovial cyst suffered recurrence of symptoms 1 year later, and another with LF cyst had adherence of the cyst wall to the dura mater during exploration.…”

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“…The pathogenesis of LF and PLL cysts is not yet understood, but may involve myxomatous degeneration of the connective tissue and accumulation of viscous myxoid material. 1) The loading exerted by degenerated intervertebral disk on the PLL may also be a factor in the development of PLL cyst. 6) All these hypotheses involve chronic degenerative facet joint disease or lumbar disk disease.…”

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Lumbar Synovial Cysts: Experience With Nine Cases

Ayberk

Ozveren

Gok

et al. 2008

Neurol. Med. Chir.(Tokyo)

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Nine patients treated surgically for lumbar spinal synovial cyst were reviewed. Four patients had synovial, two had ganglion, one had posterior longitudinal ligament, and two had ligamentum flavum cyst. Synovial cysts had a single layer of epithelial cells in the inner layer of the cyst with continuity with the facet joint. Ganglion cyst had no continuity with the facet joint and epithelial lining was present in one and absent in one case. Posterior longitudinal ligament and ligamentum flavum cysts had no continuity with the facet joint and no epithelial lining. Magnetic resonance imaging showed the cysts better than computed tomography. All patients treated for nerve root compression or lumbar spinal canal narrowing. One patient suffered recurrence 1 year later and was reoperated. Operative results were excellent in six and good in three patients. Lumbar spinal synovial cysts should be considered in differential diagnosis of lumbar radiculopathy/neurogenic claudication and is surgically treatable.

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

Reust

Wendling

Lagier

et al. 1988

Arthritis & Rheumatism

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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).

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Lumbar nerve root compression by synovial cysts of the ligamentum flavum

Abstract: Synovial cysts of the ligamentum flavum, measuring 1 cm in diameter, caused compression of the lumbar nerve roots in four patients. The authors discuss the association of these cysts with advanced focal spondylosis, and speculate on their etiology.

Cited by 99 publications

References 15 publications

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report

Lumbar Synovial Cysts: Experience With Nine Cases

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

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