Pigmented villonodular synovitis originating from the lumbar facet joint: a case report

Abstract

The authors successfully treated a rare case of pigmented villonodular synovitis (PVNS) that originated from the lumbar facet joint (L4-5). A 43-year-old man presented with a complaint of left severe sciatica causing difficulty in walking. Magnetic resonance imaging (MRI) demonstrated an extradural mass on the left side at L4 and the mass compressed the dural tube and was continuous with the left L4-5 facet joint. A computed tomography myelogram revealed an extradural defect of contrast medium at the L4 level and an erosion of the L4 lamina. A total synovectomy with unilateral osteoplastic laminectomy was performed. The histological findings were a diagnosis of PVNS. The patient's symptoms resolved completely and the MRI at postoperative 3 years demonstrated no recurrence of PVNS. It is important to totally remove the synovium, which is the origin of PVNS in order to prevent the recurrence. We think that our procedure is reasonable and adequate for lumbar PVNS.Keywords Pigmented villonodular synovitis Á Lumbar spine Á Synovectomy Á Juxtafacet cyst Á Laminoplasty Pigmented villonodular synovitis (PVNS) is a slowly progressive mass lesion that arises in association with villous or nodular overgrowth in the synovial membranes of tendon sheaths, joints and bursae [12,14,31]. The etiology of PVNS remains controversial but degenerative change and trauma have been implicated [1, 2, 6, 9, 11-14, 20, 31]. It is well known that PVNS occurs in young individuals and affects the appendicular skeleton, particularly the knee and hip joints [2,9,16,18,19,22,23,28]. The occurrence of PVNS in the axial skeleton is quite rare and there have been few reports of PVNS of the lumbar spine; specifically, only 18 cases are found in the English literature [4,7,8,10,16,21,23,24,26,27,30,31]. There have been no reports focusing on surgical treatment for PVNS although it is important that the synovium is totally removed to prevent the recurrence [5]. We successfully treated a case of PVNS that originated from the lumbar facet joint (L4-5) using total synovectomy with unilateral osteoplastic laminectomy. Case reportA 43-year-old man presented with a 2-year history of low back pain and he had undergone conservative medical treatment with a diagnosis of L5 spondylolysis. He consulted us with a complaint of left severe sciatica causing difficulty in walking for 3 weeks. He had no obvious history of trauma. Neurological examination revealed normal deep tendon reflexes in the lower legs bilaterally (patellar tendon reflex and Achilles tendon reflex) and a negative result upon performing the straight leg raising test. There were no sensory disturbances, motor weakness or urinary incontinence. Plain lumbar spine radiographs showed spondylolysis and anterolisthesis of L5. Magnetic resonance imaging (MRI) demonstrated an extradural mass on the left side at L4. This mass lesion showed mixed high and iso-intensity on T1-weighted imaging, and mixed high and

Tenosynovial Giant Cell Tumor of the Cervical Spine: Case Report and Review of the Literature

“…Giant cell tumors affect patients in the third and fourth decades of life. TGCT is often asymptomatic or painful with a history of minor antecedent trauma; some contend that trauma is related to its pathogenesis [ 5 ]. In this patient’s case, management was complicated by the coexistence of traumatic cervical fractures, and she underwent two operations for definitive management: the first for stabilization and pathologic diagnosis and the second to accomplish gross total resection.…”

“…Maximal resection in diffuse subtypes offers the best chance for reducing recurrence (7.7% recurrence rate) [ 20 ]. Some have emphasized the need to remove the entire synovium to prevent recurrence [ 5 ]. Giant cell tumors are radiosensitive, and radiation is generally recommended for subtotal resection; however, its role is controversial [ 9 , 10 ].…”

Desmoid Type Fibromatosis in the Facet Joint of Lumbar Spine: Case Report and Review of Literature

“…PVNS usually involves the knee and hip joint. Involvement of the facet joint by PVNS with bony erosion of the adjacent lamina is rarely reported (21, 22). These tumors cannot be differentiated by imaging findings alone.…”

Villonodular synovitis of the lumbar spine: Case report of a rare pathology

“…Pigmented villonodular synovitis is an uncommon condition, distinguished by synovial proliferation associated with a hemosiderin deposition in the affected joint 7 . Calcifications are not featured to this pathology 8 . PVNS is mainly associated with monoarticular manifestations of lower extremities.…”