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|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 4 | Page : 1684
Lumbar Synovial Cyst Causing Cauda Equina Syndrome
Khaled Hadhri, Mohamed Ben Salah, Mehdi Bellil
Department of Orthopedics and Traumatology, Spine Unit (UCV), Charles Nicolle's Hospital, Boulevard 9 Avril, Tunis, Tunisia
|Date of Submission||23-May-2020|
|Date of Decision||17-Aug-2020|
|Date of Acceptance||15-May-2021|
|Date of Web Publication||30-Aug-2022|
Department of Orthopedics and Traumatology, Spine Unit (UCV), Charles Nicolle's Hospital, Boulevard 9 Avril, Tunis - 1006
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hadhri K, Salah MB, Bellil M. Lumbar Synovial Cyst Causing Cauda Equina Syndrome. Neurol India 2022;70:1684
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. Patients with these lesions often present with radicular symptoms explained by nerve root compression or foraminal stenosis., Cauda equina syndrome is a very rare consequence of zygapophyseal cystic formation mainly described in association with hemorrhagic modification of the cyst.
|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.
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Conflicts of interest
There are no conflicts of interest.
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