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LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1684

Lumbar Synovial Cyst Causing Cauda Equina Syndrome


Department of Orthopedics and Traumatology, Spine Unit (UCV), Charles Nicolle's Hospital, Boulevard 9 Avril, Tunis, Tunisia

Date of Submission23-May-2020
Date of Decision17-Aug-2020
Date of Acceptance15-May-2021
Date of Web Publication30-Aug-2022

Correspondence Address:
Khaled Hadhri
Department of Orthopedics and Traumatology, Spine Unit (UCV), Charles Nicolle's Hospital, Boulevard 9 Avril, Tunis - 1006
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.355166

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How to cite this article:
Hadhri K, Salah MB, Bellil M. Lumbar Synovial Cyst Causing Cauda Equina Syndrome. Neurol India 2022;70:1684

How to cite this URL:
Hadhri K, Salah MB, Bellil M. Lumbar Synovial Cyst Causing Cauda Equina Syndrome. Neurol India [serial online] 2022 [cited 2022 Oct 2];70:1684. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1684/355166




Sir,

A 46-year-old female with a history of chronic low back pain and left radicular claudication presented with intermittent urinary and fecal incontinence evolving for 2 weeks associated with progressive weakness of the left lower limb and gait disturbance. Physical examination showed distal motor deficit to left tibialis anterior (3/5) and extensor hallucis longus muscle (1/5) with foot dorsal hypoesthesia, decrease of anal sphincter tone, and saddle area hypoesthesia. Axial T2-weighted magnetic resonance imaging (MRI) of the lumbar spine showed left zygapophyseal arthropathy at L4L5 level with hyperintense lesion developed into the spinal canal and complete mass effect on the dural sac corresponding to a juxtafacet synovial cyst [Figure 1]a. It was isointense compared to cerebrospinal fluid evoking the nonhemorrhagic character. T2-weighted short tau inversion recovery (STIR) sagittal reconstruction showed the cystic lesion centrally located into the spinal canal at the L4L5 level [Figure 1]b. Posterior decompression including facetectomy and cyst excision, which was continuous with the left facet joint, associated with posterior L4L5 arthrodesis achieved an immediate improvement of radicular pain and complete relief of urinary and fecal symptoms were observed at 6-months follow-up. The patient remained completely asymptomatic for 1 year postoperatively. Zygapophyseal synovial cysts are a common degenerative lesion mostly described in the lumbar spine as a consequence of dynamic instability.[1] Patients with these lesions often present with radicular symptoms explained by nerve root compression or foraminal stenosis.[1],[2] Cauda equina syndrome is a very rare consequence of zygapophyseal cystic formation mainly described in association with hemorrhagic modification of the cyst.[3]
Figure 1: (a) Axial T2-weighted MRI showing L4L5 left zygapophyseal arthropathy with hyperintense lesion developed into the spinal canal and complete mass effect on the dural sac. (b) T2-weighted STIR sagittal reconstruction showing the cystic lesion centrally located into the spinal canal at L4L5 level

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Nonoperative management could be an option for noncomplicated synovial cyst unlike association with cauda equina syndrome which indicates decompression surgery.[4]

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tillich M, Trummer M, Lindbichler F, Flaschka G. Symptomatic intraspinal synovial cysts of the lumbar spine: Correlation of MR and surgical findings. Neuroradiology 2001;43:1070-5.  Back to cited text no. 1
    
2.
Sze CI, Kindt G, Huffer WB, Chang M, Wang M, Kleinschmidt-DeMasters BK. Synovial excrescences and cysts of the spine: Clinicopathological features and contributions to spinal stenosis. Clin Neuropathol 2004;23:80-90.  Back to cited text no. 2
    
3.
Machino M, Yukawa Y, Ito K, Kanbara S, Kato F. Spontaneous hemorrhage in an upper lumbar synovial cyst causing subacute cauda equina syndrome. Orthopedics 2012;35:e1457-60.  Back to cited text no. 3
    
4.
Muir JJ, Pingree MJ, Moeschler SM. Acute cauda equina syndrome secondary to a lumbar synovial cyst. Pain Physician 2012;15:435-40.  Back to cited text no. 4
    


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