Complete resolution of a large hemorrhagic lumbar synovial cyst following spinal fusion alone

Prasert Iampreechakul; Punjama Lertbutsayanukul; Samasuk Thammachantha

doi:10.4103/ajns.AJNS_366_20

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 1085-1090
DOI: 10.4103/ajns.AJNS_366_20

Case Report

Complete resolution of a large hemorrhagic lumbar synovial cyst following spinal fusion alone

Authors

Prasert Iampreechakul

Department of Neurosurgery, Prasat Neurological Institute, Bangkok
Punjama Lertbutsayanukul

¹Department of Neuroradiology, Prasat Neurological Institute, Bangkok
Samasuk Thammachantha

²Department of Pathology, Prasat Neurological Institute, Bangkok

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.

Key-words:

Hemorrhage - juxtafacet cyst - lumbar synovial cyst - spinal fusion - spontaneous resolution

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Referenzen

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