Complete Resolution of a Large Hemorrhagic Lumbar Synovial Cyst Following Spinal Fusion Alone

Case Reports

. 2020 Dec 21;15(4):1085-1090.


doi: 10.4103/ajns.AJNS_366_20.


eCollection Oct-Dec 2020.

Affiliations

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Case Reports

Prasert Iampreechakul et al.


Asian J Neurosurg.


.

Abstract

The authors reported complete regression of a large hemorrhagic lumbar synovial cyst following posterior spinal fusion without direct cystic resection. A 64-year-old woman suffered from sudden onset of the left buttock pain radiating to the left leg after waking up in the morning following the previous history of a minor accident 2 months ago. Magnetic resonance imaging (MRI) of the lumbosacral spine showed a large extradural round mass originating from the left facet joint at the level of L3-L4. The mass was hyperintense on T1-weighted images and hypointense on T2-weighted images, probably compatible with hemorrhagic joint-related cyst. Surgical treatment was chosen for her because of persistent left radicular pain with no responding to medications. The patient underwent decompressive laminectomy, subtotal facetectomy, instrumented fusion, and only tissue biopsy due to severe adherence of the mass and dura. Histopathological examination was consistent with a hemorrhagic synovial cyst. The radicular pain completely disappeared after the surgery. Follow-up MRI of the lumbosacral spine obtained 6 months after the surgery demonstrated complete resolution of the hemorrhagic cyst. Complete resolution of hemorrhagic synovial cyst seems to correlate with subtotal facetectomy, probably resulting in leakage of cyst content and subsequent resorption of the cyst wall. In addition, hematoma within the synovial cyst may resolve spontaneously over time.


Keywords:

Hemorrhage; juxtafacet cyst; lumbar synovial cyst; spinal fusion; spontaneous resolution.

Conflict of interest statement

There are no conflicts of interest.

Figures


Figure 1


Figure 1

Magnetic resonance imaging of the lumbosacral spine. Sagittal T1-weighted (a), contrast-enhanced T1-weighted with fat suppression (b), T2-weighted (c), coronal T2-weighted (d), axial T1-weighted (e), and T2-weighted (f) images show a hypersignal T1 and hyposignal T2 epidural round mass, probably originating from the left facet joint, with mild enhancement at the level of L3–L4. This lesion displaces the thecal sac to the contralateral side and compresses left-sided spinal nerve roots


Figure 2


Figure 2

Microscopic examination of soft tissue from extradural spinal canal demonstrates fibroconnective tissue covering by synovial lining and hemosiderin-laden macrophages (H and E, ×400)


Figure 3


Figure 3

Anteroposterior (a) and lateral (b) views of plain radiography of the lumbosacral spine, obtained 3 days postoperation, demonstrate pedicle screw fixation at the level of L3–L4


Figure 4


Figure 4

Magnetic resonance imaging of the lumbar spine obtained 6 months following an operation. Sagittal T1-weighted (a), T2-weighted (b), coronal T2-weighted (c), axial T1-weighted (d), and T2-weighted (e) images confirm complete disappearance of the left hemorrhagic synovial cyst at the level of L3–L4

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