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NEUROIMAGE
Year : 2011  |  Volume : 59  |  Issue : 2  |  Page : 315-316

Completely calcified lumbar synovial cyst


Department of Neurosurgery, RUSH University Medical Center, Chicago, IL, USA

Date of Web Publication7-Apr-2011

Correspondence Address:
Manish K Kasliwal
Department of Neurosurgery, Suite 1115, RUSH University Medical Center, Chicago, IL 60612
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.79173

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How to cite this article:
Kasliwal MK, Deutsch H. Completely calcified lumbar synovial cyst. Neurol India 2011;59:315-6

How to cite this URL:
Kasliwal MK, Deutsch H. Completely calcified lumbar synovial cyst. Neurol India [serial online] 2011 [cited 2019 Aug 20];59:315-6. Available from: http://www.neurologyindia.com/text.asp?2011/59/2/315/79173


A 56-year-old woman presented with back pain of 3 years duration and magnetic resonance imaging (MRI) of spine done at the onset of symptoms showed degenerative changes in the lumbosacral spine [Figure 1]. A repeat MRI of lumbosacral spine performed for the recent worsening of symptoms, and development of right lumbar radiculopathy, showed a space occupying lesion, iso-hypointense lesion on T1W and hypointense on T2W image sequences with no obvious contrast enhancement. In addition, there were degenerative changes of the spine [Figure 2]. Computed tomography (CT) scan of the lumbosacral spine revealed a 1.5 Χ 1.5 rounded well-delineated completely calcified lesion abutting the right L4−5 facet joint with facet arthropathy [Figure 3]. A diagnosis of a completely calcified degenerative synovial cyst was made and surgical excision of the same with L4−5 fusion was performed.
Figure 1: Sagittal (left) and axial (right) T2W lumbosacral spine MRI at initial presentation showing degenerative changes in the lumbosacral with no evidence of any space occupying lesion

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Figure 2: Axial T1W (left), T2W (middle), and sagittal post contrast (right) MRI showing an extradural space occupying lesion (white arrow) hypointense on both T1 and T2 weighted MRI with no obvious contrast enhancement

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Figure 3: Bony window of axial (left), coronal (middle), and sagittal (right) CT scan of the lumbosacral spine showing a well-defined rounded calcified lesion located dorsally in the spinal canal abutting the right L4−5 facet joint with evidence of facet arthropathy (white arrow)

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Synovial cysts possibly develop due to degenerative changes in the spine; most common pathogenesis being osteoarthritis of facet joint, degenerative spondylosis and/or spondylolisthesis with resulting weakening of the joint capsule and resultant cyst formation. [1] These can be asymptomatic or may present with back pain or radiculopathy. Moreover, the development of synovial cyst superimposed on symptomatic degenerative spine disease can result in development of radicular symptoms. The imaging appearance on MRI facilitates the preoperative diagnosis more than 90% of times and is considered the investigative modality of choice. [2] Hypointensity on T1W and hyperintensity on T2W images is quite characteristic of synovial cyst. [1],[2] Factors affecting variability of the MR appearance include proteinaceous concentration of the fluid, presence or absence of blood, calcification, and gas (vacuum phenomenon) in the spinal canal. [1] CT is of value in illustrating indirect findings such as marginal calcifications, gas formation, or bone erosion of the adjacent lamina. [3] Though calcification can occur in synovial cyst; marginal calcification remains most common giving rise to characteristic hypointense rim on T2W MRI. [1],[2] A completely calcified synovial cyst is very rare and can be deceptive on MR imaging due to total signal loss as happened in the present case showing as hypointense mass on T1 and T2 weighted images which can be very well appreciated on a CT. [4] Completely calcified synovial cyst can be misdiagnosed as spinal bony tumor, tumor calcinosis, or calcified ligamentum flavum. [5] The presence of degenerative changes in the spine especially in the adjacent facet can help diagnosing the lesion as synovial cyst. Treatment options for spinal synovial cysts can be nonsurgical or surgical. [6] Considering the rarity of spontaneous resolution and poor outcomes with other conservative measures, there has been a reasonable agreement on the need of surgery for symptomatic synovial cysts; [4],[6] the extent of surgery and the need of concomitant fusion remain controversial, however.

 
  References Top

1.Boviatsis EJ, Staurinou LC, Kouyialis AT, Gavra MM, Stavrinou PC, Themistokleous M, et al. Spinal synovial cysts: Pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. Eur Spine J 2008;17:831-7.   Back to cited text no. 1
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2.Apostolaki E, Davies AM, Evans N, Cassar-Pullicino VN. MR imaging of lumbar facet joint synovial cysts. Eur Radiol 2000;10:615-23.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Fardon DF, Simmons JD. Gas-filled intraspinal synovial cyst. A case report. Spine (Phila Pa 1976) 1989;14:127-9.  Back to cited text no. 3
    
4.Almefty R, Arnautoviæ KI, Webber BL. Multilevel bilateral calcified thoracic spinal synovial cysts. J Neurosurg Spine 2008;8:473-7.  Back to cited text no. 4
    
5.Miyakoshi N, Shimada Y, Kasukawa Y, Ando S. Progressive myelopathy due to idiopathic intraspinal tumoral calcinosis of the cervical spine. Case report. J Neurosurg Spine 2007;7:362-5.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Shah RV, Lutz GE. Lumbar intraspinal synovial cysts: Conservative management and review of the world's literature. Spine J 2003;3:479-88.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Giant, Completely Calcified Lumbar Juxtafacet Cyst: Report of an Unusual Case
Kevin T. Huang,Timothy R. Owens,Teresa S. Wang,Jessica R. Moreno,Jacob H. Bagley,Carlos A. Bagley
Global Spine Journal. 2014; 4(3): 175
[Pubmed] | [DOI]



 

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