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LETTER TO EDITOR
Year : 2008  |  Volume : 56  |  Issue : 1  |  Page : 96-97

Posterior longitudinal ligament cyst as a rare cause of lumbosacral radiculopathy with positive straight leg raising test


Department of Neurological Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu, India

Date of Acceptance12-Jun-2007

Correspondence Address:
Vedantam Rajshekhar
Department of Neurological Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.39330

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How to cite this article:
Biji B, Moorthy RK, Rajshekhar V. Posterior longitudinal ligament cyst as a rare cause of lumbosacral radiculopathy with positive straight leg raising test. Neurol India 2008;56:96-7

How to cite this URL:
Biji B, Moorthy RK, Rajshekhar V. Posterior longitudinal ligament cyst as a rare cause of lumbosacral radiculopathy with positive straight leg raising test. Neurol India [serial online] 2008 [cited 2022 Sep 27];56:96-7. Available from: https://www.neurologyindia.com/text.asp?2008/56/1/96/39330


Sir,

A 26-year-old male presented with low back pain radiating to the right calf for six months. Neurological examination revealed diminished right ankle jerk and positive straight leg raising test (SLRT). The MRI of the lumbosacral spine [Figure - 1] showed an extradural ventrally placed lesion at the level of L5-S1 disc on the right side. He underwent fenestration at the right L5-S1 interlaminar space and excision of the cyst. The right S1 root appeared stretched by a cystic lesion that was within the layers of PLL, had a translucent wall, contained clear fluid and was not communicating with the disc space, facetal joint, dural tube or the nerve root sheath. The annulus fibrosus was intact and the disc space was not entered into. Histopathology of the cyst wall showed fibro-collagenous connective tissue and adipose tissue. Postoperatively there was resolution of the radicular pain and at 10 months follow-up he was asymptomatic with no neurological deficits.

When a patient presents with unilateral lumbosacral radiculopathy with a positive SLRT, the commonest diagnosis considered is that of an extruded lumbar disc. In a systematic review, Rebain et al. have commented that although the SLRT is considered to be a reliable clinical test for diagnosing lumbar disc herniation in a patient with low back pain, its specificity is only 0.4. [1] Hence other pathologies like extradural intraspinal cysts, neurofibromas or schwannomas, metastatic lesions or an epidural vein causing root compression should be considered in the presence of radiculopathy with a positive SLRT. [2],[3],[4],[5],[6]

Extradural intraspinal cysts are a rare cause of lumbosacral radiculopathy, of which seven cases in English literature have been reported secondary to posterior longitudinal ligament (PLL) cyst, the details of which are summarized in [Table - 1]. [2],[3],[4],[5],[6] As was seen in our patient, PLL cysts have been described to have a broad base to the PLL in the anterior epidural space without connection to the dural tube, facetal joint, intervertebral disc and nerve root. [2],[3],[4],[5],[6] On imaging, they are located behind a vertebral body adjacent to the disc space. Degeneration of the adjacent disc, [2],[3],[5] as was seen in our case and contrast enhancement of the cyst wall [2],[3],[5],[6] has been reported. Marshman et al. have summarized the various clinical, radiological and pathological features of PLL cysts and have concluded that they are a distinct entity from disc cysts. [5] It is interesting to note that all patients reported in the literature, including our patient, were young males.

In a patient presenting with unilateral lumbosacral radiculopathy with a positive SLRT, when a disc prolapse is not visualized in the MRI, a careful search for an associated cystic lesion should be made, lest it be missed. Identification of a PLL cyst and its excision without entering the adjacent disc space results in a good clinical outcome.

 
  References Top

1.Rebain R, Baxter GD, McDonough S. A systematic review of the passive straight leg raising test as a diagnostic aid for low back pain (1989 to 2000). Spine 2002;27:E388-95.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Baba H, Furusawa N, Maezawa Y, Uchida K, Kokubo Y, Imura S, et al. Ganglion cyst of the posterior longitudinal ligament causing lumbar radiculopathy: Case report. Spinal Cord 1997;35:632-5.  Back to cited text no. 2  [PUBMED]  
3.Le Breton C, Garreau de Luobresse C, Awky J, Khalil A, Sibony M, Judet T, et al. L5 radicular pain related to a cystic lesion of the posterior longitudinal ligament. Eur Radiol 2000;10:1812-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Lin RM, Wey KL, Tzeng CC. Gas-containing "ganglion" cyst of lumbar posterior longitudinal ligament at L3. Case report. Spine 1993;18:2528-32.  Back to cited text no. 4    
5.Marshman LA, Benjamin JC, David KM, King A, Chawda SJ. "Disc cysts" and "posterior longitudinal ligament ganglion cysts": Synonymous entities? Report of three cases and literature review. Neurosurgery 2005;57:E818.  Back to cited text no. 5    
6.Miscusi M, Gilioli E, Faccioli F, Bricolo A. Posterior longitudinal ligament cyst causing radiculopathy. Case illustration. J Neurosurg 2002;97:399.  Back to cited text no. 6    


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This article has been cited by
1 Full-Endoscopic Resection of a Recurrent Posterior Longitudinal Ligament Cyst: Technical Note
Alexandre Simonin, Jade Philippe, Jean-Yves Fournier
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[Pubmed] | [DOI]



 

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