A rare cause of radiculopathy: facet joint synovial cyst protruding into the spinal canal

A 68-year-old female had a three-week history of severe low back pain radiating down the posterior left buttocks and left leg exacerbated by standing and walking. Lumbar spine MRI revealed cystic mass with similar intensity to cerebrospinal fluid located on dorsolateral left side of the sacral spinal canal inferior to the S1 pedicle. There was compression of left exiting S1 and traversing S2 nerve roots. Neurosurgery consult was requested to evaluate the cystic mass in the sacral spinal canal. After clinical evaluation, an unusually located synovial cyst was thought possible. Cyst contents were heterogeneous, suggestive of small hemorrhage and acute clinical history seemed reasonable. Left S1 and partial left S2 hemilaminectomy was performed and an epidural, partially hemorrhagic cyst was removed. There was no obvious connection to the ipsilateral L5-S1 facet joint. Pathology revealed synovial cyst, and the patient’s leg pain was improved postoperatively. This synovial cyst was unusual as it had no connection with the facet joint intraoperatively and its location in the sacral canal was uncommon.

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Microendoscopy-assisted extraforaminal lumbar interbody fusion for treating single-level spondylodesis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02313-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Motohide Shibayama ◽

Guang Hua Li ◽

Li Guo Zhu ◽

Zenya Ito ◽

Fujio Ito

Keyword(s):

Minimally Invasive ◽

Spinal Canal ◽

Interbody Fusion ◽

Facet Joint ◽

Clinical Results ◽

Invasive Technique ◽

Clinical Effects ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Single Level

Abstract Background Lumbar interbody fusion is a standard technique for treating degenerative lumbar disorders involving instability. Due to its invasiveness, a minimally invasive technique, extraforaminal lumbar interbody fusion (ELIF), was introduced. On surgically approaching posterolaterally, the posterior muscles and spinal canal are barely invaded. Despite its theoretical advantage, ELIF is technically demanding and has not been popularised. Therefore, we developed a microendoscopy-assisted ELIF (mELIF) technique which was designed to be safe and less invasive. Here, we aimed to report on the surgical technique and clinical results. Methods Using a posterolateral approach similar to that of lateral disc herniation surgery, a tubular retractor, 16 or 18 mm in diameter, was placed at the lateral aspect of the facet joint. The facet joint was partially excised, and the disc space was cleaned. A cage and local bone graft were inserted into the disc space. All disc-related procedures were performed under microendoscopy. The spinal canal was not invaded. Bilateral percutaneous screw-rod constructs were inserted and fixed. Results Fifty-five patients underwent the procedure. The Oswestry Disability Index and visual analogue scale scores greatly improved. Over 90% of the patients obtained excellent or good results based on Macnab’s criteria. There were neither major adverse clinical effects nor the need for additional surgery. Conclusions mELIF is minimally invasive because the spinal canal and posterior muscles are barely invaded. It produces good clinical results with fewer complications. This technique can be applied in most single-level spondylodesis cases, including those involving L5/S1 disorders.

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Single-level bilateral facet joint hypertrophy causing thoracic spinal canal stenosis

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2008.10.023 ◽

2009 ◽

Vol 16 (10) ◽

pp. 1363-1365 ◽

Cited By ~ 5

Author(s):

Andy Lim ◽

Paul D’Urso

Keyword(s):

Spinal Canal ◽

Facet Joint ◽

Spinal Canal Stenosis ◽

Single Level ◽

Canal Stenosis ◽

Thoracic Spinal

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The profile of the spinal column in subjects with lumbar developmental spinal stenosis

The Bone & Joint Journal ◽

10.1302/0301-620x.103b4.bjj-2020-1792.r1 ◽

2021 ◽

Vol 103-B (4) ◽

pp. 725-733

Author(s):

Marcus Kin Long Lai ◽

Prudence Wing Hang Cheung ◽

Dino Samartzis ◽

Jaro Karppinen ◽

Kenneth M. C. Cheung ◽

...

Keyword(s):

Logistic Regression ◽

Spinal Stenosis ◽

Vertebral Body ◽

Spinal Canal ◽

Facet Joint ◽

Spinal Column ◽

Stepwise Logistic Regression ◽

Diagnostic Study ◽

Vertebral Canal ◽

Dural Sac

Aims The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort. Methods This was a radiological analysis of 2,387 participants who underwent L1-S1 MRI. Means and ranges were calculated for age, sex, BMI, and MRI measurements. Anteroposterior (AP) vertebral canal diameters were used to differentiate those with DSS from controls. Other imaging parameters included vertebral body dimensions, spinal canal dimensions, disc degeneration scores, and facet joint orientation. Mann-Whitney U and chi-squared tests were conducted to search for measurement differences between those with DSS and controls. In order to identify possible associations between DSS and MRI parameters, those who were statistically significant in the univariate binary logistic regression were included in a multivariate stepwise logistic regression after adjusting for demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported where appropriate. Results Axial AP vertebral canal diameter (p < 0.001), interpedicular distance (p < 0.001), AP dural sac diameter (p < 0.001), lamina angle (p < 0.001), and sagittal mid-vertebral body height (p < 0.001) were significantly different between those identified as having DSS and controls. Narrower interpedicular distance (OR 0.745 (95% CI 0.618 to 0.900); p = 0.002) and AP dural sac diameter (OR 0.506 (95% CI 0.400 to 0.641); p < 0.001) were associated with DSS. Lamina angle (OR 1.127 (95% CI 1.045 to 1.214); p = 0.002) and right facet joint angulation (OR 0.022 (95% CI 0.002 to 0.247); p = 0.002) were also associated with DSS. No association was observed between disc parameters and DSS. Conclusion From this large-scale cohort, the canal size is found to be independent of body stature. Other than spinal canal dimensions, abnormal orientations of lamina angle and facet joint angulation may also be a result of developmental variations, leading to increased likelihood of DSS. Other skeletal parameters are spared. There was no relationship between DSS and soft tissue changes of the spinal column, which suggests that DSS is a unique result of bony maldevelopment. These findings require validation in other ethnicities and populations. Level of Evidence: I (diagnostic study) Cite this article: Bone Joint J 2021;103-B(4):725–733.

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Posterior Epidural Migration of Sequestrated Lumbar Disc Fragments Into the Bilateral Facet Joints

Neurosurgery ◽

10.1227/neu.0b013e3182245b21 ◽

2011 ◽

Vol 69 (5) ◽

pp. E1148-E1151 ◽

Cited By ~ 5

Author(s):

Tzuu-Yuan Huang ◽

Kung-Shing Lee ◽

Tai-Hsin Tsai ◽

Yu-Feng Su ◽

Shiuh-Lin Hwang

Keyword(s):

Differential Diagnosis ◽

Facet Joint ◽

Lumbar Disc ◽

Synovial Cyst ◽

Leg Pain ◽

Hybrid Technique ◽

Facet Joints ◽

Disc Disease ◽

First Case ◽

Rod System

Abstract BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc fragment is usually found in rostral, caudal, or lateral directions. Posterior epidural migration is very rare. We report the first case with posterior epidural migration and sequestration into bilateral facet joints of a free disc fragment. CLINICAL PRESENTATION A 78-year-old female presented with low back pain and right leg pain. Plain radiographs showed lumbar spondylolisthesis. Magnetic resonance imaging revealed a posterior epidural mass and intrafacet mass, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion in the left L3-4 facet joint had rim enhancement, whereas the right one was not contrasted after gadolinium injection. Preoperative differential diagnosis included abscess, tumor, hematoma, or synovial cyst. An interbody cage fusion at L3-4 and L4-5 for spondylolisthesis was performed, and a hybrid technique was applied with the Dynesys flexible rod system at L3-S1 for multisegment degenerative disc disease. The lesion proved to be an epidural disc fragment with sequestration into bilateral facet joints. CONCLUSION A free disc fragment should be considered in the differential diagnosis of posterior epidural lesions, and even in the facet joint.

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