Intraspinal synovial cysts: 10-year experience at the Ochsner Clinic

1999 ◽  
Vol 91 (2) ◽  
pp. 193-199 ◽  
Author(s):  
Jay U. Howington ◽  
Edward S. Connolly ◽  
Rand M. Voorhies
Keyword(s):  
Facet Joint ◽  
Signs And Symptoms ◽  
Cord Compression ◽  
Radicular Pain ◽  
Neurogenic Claudication ◽  
Content Type ◽  
Synovial Cysts ◽  
Operative Findings ◽  
Radiological Studies ◽  
Fine Print

Object. Although synovial cysts commonly involve the joints of the extremities, they are also found in the spinal canal. When symptomatic, they produce signs and symptoms consistent with nerve root and spinal cord compression. In this report the authors review the clinical presentations, radiological studies, and operative findings in 28 patients with intraspinal synovial cysts treated surgically at the Ochsner Clinic between 1988 and 1998. Methods. The medical records and radiological studies obtained in 28 patients (31 intraspinal synovial cysts) were analyzed. Twenty-nine (94%) of the cysts were located in the lumbar, one in the thoracic (T8–9), and one in the cervicothoracic (C7—T1) spine. Sixteen (57%) of the 28 patients presented with radicular pain. The remaining patients presented either with neurogenic claudication (25%) or with radicular pain and an associated neurological deficit (18%). Each cyst was located adjacent to a facet joint in which there was evidence of degenerative disease. Conclusions. Intraspinal synovial cysts are uncommon lesions most often found in the lumbar spine at the L4–5 level. They are invariably associated with facet degeneration and respond very well to surgical therapy.

Synovial cyst of spinal facet

1974 ◽  
Vol 41 (3) ◽  
pp. 372-376 ◽  
Author(s):  
Chun C. Kao ◽  
Stefan S. Winkler ◽  
J. H. Turner
Keyword(s):  
Facet Joint ◽  
Synovial Cyst ◽  
Cervical Disc ◽  
Content Type ◽  
Synovial Cysts ◽  
Extradural Cyst ◽  
Cervical Facet ◽  
Cervical Facet Joint ◽  
Herniated Cervical Disc ◽  
Fine Print

✓The authors report a case in which a true synovial cyst was found attached to a cervical facet joint. The differential diagnosis involving herniated cervical disc as well as other types of extradural cyst is discussed. The anatomically oriented term “juxta-facet cyst” is proposed to include both ganglion and synovial cysts seen in this area.

A myelographic variant in lumbar arachnoiditis

1972 ◽  
Vol 36 (4) ◽  
pp. 441-446 ◽  
Author(s):  
Randall W. Smith ◽  
John D. Loeser
Keyword(s):  
Radicular Pain ◽  
Operative Procedures ◽  
Nerve Roots ◽  
Content Type ◽  
Therapeutic Implications ◽  
Operative Findings ◽  
Fine Print

✓ A variant of lumbar arachnoiditis is described in patients undergoing rhizotomy for intractable radicular pain following multiple lumbar epidural operative procedures. The peculiar adhesions of the arachnoid, nerve roots, and dura are described and pictured. The slight myelographic abnormality seen in the presence of this kind of arachnoiditis, namely, lack of root sleeve visualization, is correlated with the gross operative findings and contrasted with the commonly recognized myelographic picture of lumbar arachnoiditis. Diagnostic and therapeutic implications are discussed.

Myelopathy due to epidural varicose veins of the cervicothoracic junction

1988 ◽  
Vol 69 (6) ◽  
pp. 940-941 ◽  
Author(s):  
Curtis A. Dickman ◽  
Joseph M. Zabramski ◽  
Volker K. H. Sonntag ◽  
Stephen Coons
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Varicose Veins ◽  
Signs And Symptoms ◽  
Cord Compression ◽  
Resonance Imaging ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Spinal Epidural ◽  
Fine Print

✓ A 30-year-old man presented with a subacute course of myelopathic signs and symptoms. Magnetic resonance imaging demonstrated an epidural mass lesion of the spinal canal at the cervicothoracic junction causing compression of the spinal cord. Laminectomy with resection of this lesion revealed a large varix with acute and chronic thrombus. Postoperatively, an improvement in neurological function occurred. Spinal epidural varicosities have been reported as an etiological factor in lumbar and sacral radiculopathies. This is the first reported case of spinal cord compression in association with spinal epidural varices. The diagnosis, pathophysiology, and management of this disorder are presented.

Radicular pain caused by synovial cyst: an underdiagnosed entity in the elderly?

2000 ◽  
Vol 92 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Dhany R. Charest ◽  
Brendan G. Kenny
Keyword(s):  
Preoperative Diagnosis ◽  
World Literature ◽  
The Elderly ◽  
Synovial Cyst ◽  
Radicular Pain ◽  
Age Group ◽  
Content Type ◽  
The World ◽  
Synovial Cysts ◽  
Fine Print

Object. Synovial cyst is a recognized but infrequent cause of nerve root or spinal canal compression. The authors undertook a review of 839 decompressive spinal procedures performed over a 5-year period. They found seven cases in which the symptoms were caused by synovial cysts. Methods. Six of these cases were in a subgroup of 80 patients who were older than 60 years of age, which represents 7.5% of the total for this age group. More than 200 cases of this abnormality have been reported in the world literature, but the incidence, prevalence, and natural history remain unknown. Conclusions. The authors propose that the incidence of synovial cysts may be more common than recognized in the elderly and suggest that preoperative diagnosis may help limit the extent of the surgical approach.

Subaxial cervical synovial cyst presenting with myelopathy

1999 ◽  
Vol 90 (1) ◽  
pp. 141-144 ◽  
Author(s):  
Simon Cudlip ◽  
Francis Johnston ◽  
Henry Marsh
Keyword(s):  
Spinal Cord ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Facet Joints ◽  
Spinal Disease ◽  
Good Clinical Outcome ◽  
Content Type ◽  
Degenerative Spinal Disease ◽  
Synovial Cysts ◽  
Fine Print

✓ Synovial cysts occur infrequently in the spinal canal and are most often associated with degenerative facet joints. Despite the prevalence of degenerative spinal disease, symptomatic synovial cysts are extremely uncommon. There have been only two previously reported cases of subaxial degenerative synovial cysts of the cervical spine in patients who presented with a clinical picture of spinal cord compression. The authors report three additional patients treated for degenerative cervical synovial cysts who presented with myelopathy. In all three patients the cyst was successfully excised and a good clinical outcome achieved.

Posterior epidural migration of sequestered lumbar disc fragments

1999 ◽  
Vol 90 (2) ◽  
pp. 264-266 ◽  
Author(s):  
Pierre Robe ◽  
Didier Martin ◽  
Jacques Lenelle ◽  
Achille Stevenaert
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Contrast Material ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Content Type ◽  
Diagnostic Pitfalls ◽  
Fine Print

✓ The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.

Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: an initial experience

2000 ◽  
Vol 92 (5) ◽  
pp. 771-778 ◽  
Author(s):  
Peter A. Rasmussen ◽  
John Perl ◽  
John D. Barr ◽  
Georges Z. Markarian ◽  
Irene Katzan ◽  
...  
Keyword(s):  
Alternative Therapy ◽  
Signs And Symptoms ◽  
Antiplatelet Agents ◽  
Posterior Circulation ◽  
Occlusive Disease ◽  
Stent Insertion ◽  
Initial Experience ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Fine Print

Object. Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty.Methods. Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure.The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively.Conclusions. Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.

Chondroblastoma of the lumbar spine

2005 ◽  
Vol 2 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Raphaël Vialle ◽  
Antoine Feydy ◽  
Ludovic Rillardon ◽  
Carla Tohme-Noun ◽  
Philippe Anract ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Local Recurrence ◽  
Osteolytic Lesion ◽  
Radicular Pain ◽  
Appendicular Skeleton ◽  
Lumbar Region ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

Benign osteoblastoma of a thoracic vertebra

1980 ◽  
Vol 53 (5) ◽  
pp. 710-713 ◽  
Author(s):  
Nancy Epstein ◽  
Vallo Benjamin ◽  
Richard Pinto ◽  
Gleb Budzilovich
Keyword(s):  
Spinal Cord ◽  
Computerized Tomography ◽  
Residual Tumor ◽  
Cord Compression ◽  
Transthoracic Approach ◽  
Content Type ◽  
Benign Osteoblastoma ◽  
Posterior Laminectomy ◽  
Subtotal Removal ◽  
Fine Print

✓ A patient with osteoblastoma of the T-11 vertebral body presented with symptoms of spinal cord compression. Six weeks after an emergency laminectomy and subtotal removal, spinal computerized tomography disclosed residual tumor, which was totally removed via a combined anterior transthoracic approach and posterior laminectomy.

En bloc laminoplasty without dissection of paraspinal muscles

2005 ◽  
Vol 3 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Noboru Hosono ◽  
Hironobu Sakaura ◽  
Yoshihiro Mukai ◽  
Takahiro Ishii ◽  
Hideki Yoshikawa
Keyword(s):  
Ct Scanning ◽  
Cord Compression ◽  
Neck Muscle ◽  
Open Door ◽  
En Bloc ◽  
Cross Sectional ◽  
Content Type ◽  
Spinous Processes ◽  
Significant Difference ◽  
Fine Print

Object. Although conducting cervical laminoplasty in patients with multisegmental cord compression provides good neurological results, it is not without shortcomings, including C-5 palsy, axial neck pain, and undesirable radiologically detectable changes. Postoperative kyphosis and segmental instability can cause neurological problems and are believed mainly to result from neck muscle disruption. The authors developed a new laminoplasty technique, with the aim of preserving optimal muscle function. Methods. The present technique is a modification of unilateral open-door laminoplasty. By using an ultrasonic osteotome in small gaps of muscle bellies, a gutter is made without disrupting muscles, spinous processes, or their connections on the hinged side. Ceramic spacers are then positioned between elevated laminae and lateral masses at C-3, C-5, and C-7 on the opened side, which is exposed in a conventional manner. This new procedure was used to treat 37 consecutive patients with compression myelopathy. Postoperative computerized tomography (CT) scanning revealed a significant difference in a cross-sectional area of muscles between the hinged and opened side. The mean follow-up period was 40.2 months (range 24–54 months). Changes in alignment were observed in only one patient, and vertebral slippage developed in two. Performed at regular intervals, CT scanning demonstrated that the elevated laminae remained in situ throughout the study period. Conclusions. In using the present unilateral open-door laminoplasty technique, deep extensor muscles are left intact along with their junctions to spinous processes on the hinged side. Radiologically documented changes were minimal because the preserved muscles functioned normally immediately after the operation.

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