Hypertrophic Synovitis of the Facet Joint Causing Root Pain

2008 ◽  
Vol 1 ◽  
pp. CMAMD.S411
Author(s):  
Koichi Iwatsuki ◽  
Toshiki Yoshimine ◽  
Masanori Aoki ◽  
Kazuhiro Yoshimura
Keyword(s):  
Facet Joint ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Leg Pain ◽  
Facet Joints ◽  
Resonance Imaging ◽  
Disc Disease ◽  
Articular Surfaces ◽  
Synovial Cysts ◽  
Magnetic Resonance Imaging Mri

Osteoarthritic changes in the facet joints are common in the presence of degenerative disc disease. Changes in the joint capsule accompany changes in the articular surfaces. Intraspinal synovial cysts that cause radicular pain, cauda equina syndrome, and myelopathy have been reported; however, there have been few reports in orthopedic or neurosurgical literature regarding hypertrophic synovitis of the facet joint presenting as an incidental para-articular mass. Here, we report a case of hypertrophic synovitis causing root pain. We describe the case of a 65-year-old man suffering from right sciatica and right leg pain in the L5 nerve-root dermatome for 1 year; magnetic resonance imaging (MRI) revealed an enhanced mass around the L4–5 facet joint. We investigated this mass pathologically. After right medial facetectomy, the symptoms resolved. Pathological investigation revealed this mass was hypertrophic synovitis. Hypertrophic synovitis of the facet joint might cause root pain.

scholarly journals Minimally invasive CT guided treatment of intraspinal synovial cyst

2014 ◽  
Vol 48 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Sergeja Kozar ◽  
Miran Jeromel
Keyword(s):  
Synovial Cyst ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Low Back ◽  
Facet Joints ◽  
Resonance Imaging ◽  
Ct Guided ◽  
Synovial Cysts ◽  
Magnetic Resonance Imaging Mri

Abstract Background. Intraspinal synovial cysts of vertebral facet joints are uncommon cause of radicular pain as well as neurological deficits. They can be managed both conservatively and surgically. Case report. A 77-year old polymorbid patient presented with bilateral low back pain which worsened during the course of time and did not respond to the conservative treatment. A diagnosis of intraspinal synovial cyst was made using the magnetic resonance imaging (MRI). Percutaneous computed tomography (CT) guided injection with installation of local anesthetic together with corticosteroid and rupture of the cyst was successfully used. A month after the procedure his pain improved, the usage of analgesics diminished and his over-all quality of life improved. Conclusions. Percutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

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

Neurosurgery ◽  
2011 ◽  
Vol 69 (5) ◽  
pp. E1148-E1151 ◽  
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.

scholarly journals Small L4 ventral root schwannoma with acute onset of radicular pain: A case report

2021 ◽  
Vol 12 ◽  
pp. 293
Author(s):  
Hiroya Shimauchi-Ohtaki ◽  
Junya Hanakita ◽  
Toshiyuki Takahashi ◽  
Manabu Minami ◽  
Ryo Kanematsu ◽  
...  
Keyword(s):  
Cauda Equina ◽  
Radicular Pain ◽  
Acute Onset ◽  
Ventral Root ◽  
Leg Pain ◽  
Resonance Imaging ◽  
Tumor Removal ◽  
Nerve Roots ◽  
Decompressive Laminectomy ◽  
Acute Radiculopathy

Background: Patients with cauda equina schwannomas usually present with slowly progressive radiculopathy. Herein, we describe a 34-year-old male who presented with acute radiculopathy attributed to a small L4 ventral root schwannoma. Case Description: A 34-year-old male suddenly developed left leg pain. Magnetic resonance imaging (with/without contrast) revealed a small intradural mass lesion involving the L4 nerve root that was enhanced with contrast (size: 9 × 12 × 12 mm). The computed tomography myelogram revealed that the tumor had originated from the L4 ventral root and compressed the dorsal root in the lateral recess. Following a decompressive laminectomy for tumor removal, the patient’s radicular pain improved. The histological diagnosis was consistent with a schwannoma. Conclusion: Small cauda equina schwannomas involving ventral nerve roots can cause acute radiculopathy readily relieved with decompressive laminectomies for tumor excision.

Agreement between magnetic resonance imaging, myelography, and surgery for detecting recurrent, thoracolumbar intervertebral disc extrusion in dogs

2013 ◽  
Vol 26 (01) ◽  
pp. 12-18 ◽  
Author(s):  
B. A. Brisson ◽  
S. G. Nykamp ◽  
D. Reynolds
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Intervertebral Disc ◽  
Interobserver Agreement ◽  
Surgical Decompression ◽  
Diagnostic Methods ◽  
Resonance Imaging ◽  
Disc Disease ◽  
Recurrent Lesion ◽  
Magnetic Resonance Imaging Mri

Summary Objectives: Although magnetic resonance imaging (MRI) is reported to be superior to myelography to determine the location and site of first time disc herniation, comparison of these diagnostic methods in cases of recurrent intervertebral disc disease (IVD) herniation after a first surgery has not been evaluated. The objective was to compare the diagnostic accuracy of MRI and myelography in a series of dogs undergoing repeat surgical decompression for recurrent IVD extrusion when compared to the gold standard of surgery. Methods: Ten dogs with recurrent IVD herniation underwent MRI and myelography followed by surgical decompression. Three observers reviewed the images to determine the site and side of the first surgery and the recurrent lesion. Agreement was determined by calculating a kappa (κ) score. Results: Substantial interobserver agreement was noted for recurrent lesion site using MRI and myelography (κ = 0.77 vs. 0.73) and when comparing MRI and myelography to the reported surgical site (κ = 0.73 vs. 0.67). Interobserver agreement was greater with MRI for circumferential location compared to myelography (κ = 0.76 vs. 0.43), similar to what was found when comparing to surgical side (κ = 0.82 vs. 0.49). The previous surgical site in this study had no effect on ability to identify the new lesion. Clinical significance: Despite the limitations of MRI, there was greater agreement between observers using MRI for both the recurrent and first lesion.

scholarly journals A Rare Case of Thoracic Pyogenic Facet Joint Infection

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Tomoyuki Setoue ◽  
Jun-ichiro Nakamura
Keyword(s):  
Epidural Abscess ◽  
Facet Joint ◽  
Joint Infection ◽  
Severe Infection ◽  
Resonance Imaging ◽  
Decompressive Laminectomy ◽  
Common Complaint ◽  
Neurologic Impairment ◽  
Magnetic Resonance Imaging Mri ◽  
Paraspinal Abscess

Pyogenic facet joint infection is a rare but severe infection. The most common complaint on presentation is pain followed by fever, then neurologic impairment. While the lumbar spine is involved in the vast majority of cases presented in the literature, the case presented here occurred in the thoracic spine. The patient was a 48-year-old immune-competent female who presented with left back pain. Magnetic resonance imaging (MRI) indicated a facet effusion, paraspinal abscess, and epidural abscess in the level of 9th-11th thoracic vertebra. On the 6th day of treatment, she presented a neurological disorder and underwent decompressive laminectomy and surgical debridement. We observed immediate improvement as a result of the surgery.

Comparison of spinal magnetic resonance imaging and myelography in cancer patients.

1987 ◽  
Vol 5 (10) ◽  
pp. 1663-1669 ◽  
Author(s):  
C Hagenau ◽  
W Grosh ◽  
M Currie ◽  
R G Wiley
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cancer Patients ◽  
Imaging Modality ◽  
Radicular Pain ◽  
Surface Coil ◽  
Resonance Imaging ◽  
Spinal Magnetic Resonance Imaging ◽  
Clinically Significant ◽  
Magnetic Resonance Imaging Mri

Spinal involvement by systemic malignancy is common, and often leads to extradural compression of the spinal cord and/or nerve roots by metastases. Rapid, anatomically accurate diagnosis is essential to the successful management of these patients. We compared spinal magnetic resonance imaging (MRI) with conventional myelography in a series of 31 cancer patients being evaluated for myelopathy (N = 10), or back/radicular pain (N = 21). All patients were evaluated between April 1985 and July 1986, and underwent both studies within ten days of each other (median, two days). MRI was performed on a 0.5 Tesla Technicare unit with a body surface coil, and results compared with standard contrast myelography. All studies were reviewed separately and in a "blinded" fashion. MRI and myelography were comparable in detecting large lesions that produced complete subarachnoid block (five of ten patients with myelopathy, three of twenty-one patients with back/radicular pain). In 19 of 31 patients, smaller but clinically significant extradural lesions were found. In nine of 19 cases, these lesions were demonstrated equally well by both modalities; in nine of 19 cases, these lesions were demonstrated by myelography alone; in one of 19, a lesion was demonstrated by MRI alone. Given our current technology, myelography appeared superior to MRI as a single imaging modality. However, MRI may be an alternative in patients where total myelography is technically impossible or unusually hazardous.

scholarly journals An unusual case of unilateral limb hypertrophy: Lipoma of sacral roots

2012 ◽  
Vol 03 (01) ◽  
pp. 89-92 ◽  
Author(s):  
Archana B Netto ◽  
Sanjib Sinha ◽  
Arun B Taly ◽  
Chandrajit Prasad ◽  
A Mahadevan ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Unusual Case ◽  
Tethered Cord ◽  
Leg Pain ◽  
Lumbosacral Spine ◽  
Resonance Imaging ◽  
Chronic Denervation ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Progressive Enlargement

ABSTRACTWe report an unusual case of unilateral limb pseudo hypertrophy in a 21-year-old lady who developed progressive enlargement of the right calf followed by thigh in association with chronic leg pain. Magnetic resonance imaging (MRI) of the affected limb confirmed enlargement of various muscles. Electromyography revealed neurogenic features consistent with S1 radiculopathy. MRI of the lumbosacral spine showed tethered cord with a lipoma infiltrating multiple sacral roots. Our case illustrates that muscular pseudo hypertrophy may follow chronic denervation as a consequence of spinal neural compressive disease. The various mechanisms postulated for this distinct condition are outlined.

scholarly journals Optimal Cut-Off Value of the Superior Articular Process Area as a Morphological Parameter to Predict Lumbar Foraminal Stenosis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Tae-Ha Lim ◽  
Soo Il Choi ◽  
Hyung Rae Cho ◽  
Keum Nae Kang ◽  
Chang Joon Rhyu ◽  
...  
Keyword(s):  
Facet Joint ◽  
Control Group ◽  
Foraminal Stenosis ◽  
Morphological Parameter ◽  
Resonance Imaging ◽  
Cross Sectional ◽  
Lumbar Foraminal Stenosis ◽  
Articular Process ◽  
Magnetic Resonance Imaging Mri ◽  
Bone Margin

Background. We devised a new morphological parameter called the superior articular process area (SAPA) to evaluate the connection between lumbar foraminal stenosis (LFS) and the superior articular process. Objective. We hypothesized that the SAPA is an important morphologic parameter in the diagnosis of LFS. Methods. All patients over 60 years of age were included. Data regarding the SAPA were collected from 137 patients with LFS. A total of 167 control subjects underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. We analyzed the cross-sectional area of the bone margin of the superior articular process at the level of L4-L5 facet joint in the axial plane. Results. The average SAPA was 96.3±13.6 mm2 in the control group and 128.1±17.2 mm2 in the LFS group. The LFS group was found to have significantly higher levels of SAPA (p<0.001) in comparison to the control group. In the LFS group, the optimal cut-off value was 112.1 mm2, with 84.4% sensitivity, 83.9% specificity, and AUC of 0.94 (95% CI: 0.91–0.96). Conclusions. Higher SAPA values were associated with a higher possibility of LFS. These results are important in the evaluation of patients with LFS.

scholarly journals Black disc disease: a commentary

2002 ◽  
Vol 13 (2) ◽  
pp. 1-4 ◽  
Author(s):  
Setti S. Rengachary ◽  
Raju S. V. Balabhadra
Keyword(s):  
Magnetic Resonance Imaging ◽  
Radicular Pain ◽  
Clinical Syndrome ◽  
Allograft Bone ◽  
Disease Entity ◽  
Resonance Imaging ◽  
Disc Disease ◽  
Black Disc ◽  
Surgical Options ◽  
Anterior Column Support

Internal disc disruption associated with axial back pain but not radicular pain is a disease entity that was recognized about two decades ago as a disorder that could potentially be treated by spinal fusion. In this article the authors describe the clinical syndrome, magnetic resonance imaging and discography findings of pathophysiological pain generation, and the available surgical options. Based on the current understanding of this disease entity, the optimum surgical procedure entails radical discectomy, anterior column support, adequate amounts of auto- or allograft bone, bone extenders and enhancers, and rigid stabilization of the motion segment.

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