Rapid spontaneous regression of a lumbar juxta-facet cyst

Necati Ucler¹, Sait Ozturk², Arif Gulkesen³, Metin Kaplan²,  
¹ Department of Neurosurgery, School of Medicine, Adiyaman University, Elazig, Turkey
² Department of Neurosurgery, School of Medicine, Firat University, Elazig, Turkey
³ Department of Physical Medicine and Rehabilitation, School of Medicine, Firat University, Elazig, Turkey

Correspondence Address:
Dr. Sait Ozturk
Firat Universitesi Hastanesi, Beyin Cerrahi Klinigi, 23119, Elazig
Turkey

Full Text

Sir,

The term “juxta-facet cyst” (JFC) refers to a cyst that arises from the zygapophyseal joint capsule of the spine. JFCs are typically found in the lumbar spine, most often at the L4-5 level.[1] The underlying etiology of the JFCs remains unclear. These cysts may be managed conservatively or removed surgically depending on the clinical scenario.[1],[2] In this report, we present an interesting case of rapid and spontaneous regression of a lumbar JFC.

A 36-year-old female patient presented with severe low back pain of acute onset that radiated down the posterior aspect of her right buttock and leg for 10 days. She complained of intermittent pain of similar nature in the past. The patient denied any history of trauma or other possible inciting factors. Neurological examination did not reveal any neurological deficit. Magnetic resonance imaging (MRI) of the lumbar spine revealed a cystic lesion of cerebrospinal fluid like intensity (T2 hyperintense-T1 hypointense) in the right dorsolateral side of the lumbar spinal canal inferior to the right L4 pedicle [Figure 1]. It was causing significant compression on the exiting L5 nerve root. A surgical excision of the lesion was planned considering the severe pain reported by the patient. During the preparation for the surgery, the patient reported a rapid resolution of her pain on the 2nd day of her admission. A repeat MRI of the lumbar spine, to our surprise, showed spontaneous regression of the cyst [Figure 2]. The patient was subsequently discharged and was pain free at a 3 month follow-up.{Figure 1}{Figure 2}

Synovial cysts were originally described by Baker to result from degenerative processes in a joint.[3] The most common explanation for the origin of these cysts, given that they are common in the lumbar spine, is a combination of stress from excessive loading and associated degeneration of the lumbar soft tissue.[3] Many of these epidural cysts are found at the L4-5 level, presumably due to a greater degree of motion at this level. Less frequent sites of involvement are the L5-S1 and L3-4 levels.[3] Excessive mobility of the involved joint appears to be an important precursor to the formation of these cysts. This notion is supported by the fact that the majority of synovial cysts are found at the L4–5 level, the most mobile lumbar vertebral segments.[2],[3] In addition, Howington et al., reported other plausible theories which include myxoid degeneration with cyst formation in collagen connective tissue, increased production of hyaluronic acid by fibroblasts in response to repeated stress, latent growth of a development rest of synovial tissue, or joint metaplasia.[4] Mattei et al., hypothesized that inflammation probably played an important role in the causation of these cysts.[5] Their view stemmed from the experience of resolution of a JFC in one of their patients treated by non-steroidal anti-inflammatory drug (NSAID) as well as similar evidences from the experimental data.[5]

The most widely reported form of treatment for symptomatic facet cysts is surgery, with the majority of the cases undergoing cyst decompression and/or excision. Rapid regression of the cyst in our patient within a short period of 2 days after admission remains surprising. This rapid and sudden regression could probably be due to cyst migration from the epidural region to the facet joint space, or due to rupture of the cyst due to repetitive microtrauma. While spontaneous regression following prolonged use of NSAIDs have been reported earlier, to the best of our knowledge, this is the first case of a lumbar juxta-facet cyst that underwent a rapid and spontaneous resolution.[5]

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Nil.

Conflicts of interest

There are no conflicts of interest.

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