Intraspinal Epidural Hematoma Caused By Acupuncture Mimicking An Intraspinal Synovial Cyst: A Case Report

Background Intraspinal hematoma is a rare complication of acupuncture. A few cases of subdural hematoma or epidural hematoma have been reported, with most of them in a fusiform shape, making the hematomas easy to identify on magnetic resonance imaging (MRI) scans. Case presentation A 49-year-old man presented with back pain that radiated into his lower limb that had appeared during acupuncture of his back. After admission, MRI was performed and indicated an L5/S1 intraspinal mass that had an oval shape, resembling an intraspinal cyst. The patient underwent surgery to remove the mass, which was confirmed to be a hematoma. Conclusion Intraspinal hematomas appear with various intensity signals and shapes on MRI, making its differential diagnosis difficult. A carefully medical history review (to determine if the pain derives from a puncture-type treatment or an injury) and surgical exploration may be helpful for identifying this condition.

Bronchogenic Intraspinal Cyst-A Rare Case of Spinal Cystic Space Occupying Lesion

A 55 year old female patient presented with progressive back pain of 6 month duration,aggravated on lying down, associated with weakness and numbness of the bothlower limbs for since 4 months. On neurological examination, the tone was foundincreased in both the lower limbs with a subjective power of grade 3/5 in both thelower limbs. Ankle and knee jerks were brisk with hypoaesthesia below D12dermatomes bilaterally, plantars were extensor. A clinical diagnosis of involvement ofD9 spinal level lesion was made. Magnetic resonance imaging (MRI) of the dorsolumbarspine showed an intraduralextramedullary ventrally placed lesion at the D8–D9 vertebral level with significant compression of the spinal cord [Figure 1, 2, 3]. Thelesion appeared hyperintense on T2W image with no contrast enhancement and withsignificant compression and shifting of the cord to the left. After preoperative routinehematological investigations, she underwent operation by laminectomy of D8–D9vertebrae and total excision of the cystic lesion was performed [Figure 4, 5]. Histologicalexamination revealed respiratory type pseudostratified ciliated columnar cells and apathological diagnosis of bronchogenic cyst was rendered [Figure 6]. The patient hadan uneventful postoperative period with subjective improvement of her symptomswith reduced spasticity & improvement of motor grade to 4/5 in both lower limbs. Bang. J Neurosurgery 2020; 9(2): 146-150

Spontaneous regression of extradural intraspinal cysts in a dog: a case report

Background Extradural intraspinal cysts are fluid accumulations that appear to be associated with increased motion at vertebral joints. Case presentation We report the spontaneous regression of lumbar and lumbosacral cysts (presumably synovial cysts) and the unusual occurrence of an S1–2 extradural intraspinal cyst in a dog. The dog presented with lumbosacral pain. Six extradural intraspinal cysts were observed on high-field magnetic resonance imaging from L5–6 to S1-S2. The cysts between L5–6 and L7-S1 ranged from 0.12 to 0.44cm2 at their largest area. The largest cyst was located at S1–2 (left), measuring 0.84 cm2 at its largest view. The dog was medically managed. A follow-up magnetic resonance imaging scan was obtained 3.5 years after the first imaging. All cysts except the one at S1–2 had reduced in size. Mean reduction in size was 59.6% (35–81%). Conclusions In summary, we report a case with multiple extradural intraspinal cysts that underwent spontaneous regression of all but one cyst during a 3.5-year follow-up period. Whether this is a single occurrence, or is part of the natural history of these cysts in the lumbosacral region of dogs, remains to be established. Spontaneous regression of intraspinal cysts had not been described in dogs.

Bone morphogenetic protein–induced inflammatory cyst formation after lumbar fusion causing nerve root compression

Bone morphogenetic protein (BMP) has been reported to cause early inflammatory changes, ectopic bony formation, adjacent level fusion, radiculitis, and osteolysis. The authors describe the case of a patient who developed inflammatory fibroblastic cyst formation around the BMP sponge after a lumbar fusion, resulting in compressive lumbar radiculopathy. A 70-year-old woman presented with left L-4 and L-5 radiculopathy caused by a Grade I spondylolisthesis with a left herniated disc at L4–5. She underwent a minimally invasive transforaminal lumbar interbody fusion with BMP packed into the interbody cage at L4–5. Her neurological symptoms resolved immediately postoperatively. Six weeks later, the patient developed recurrence of radiculopathy. Radiological imaging demonstrated an intraspinal cyst with a fluid-fluid level causing compression of the left L-4 and L-5 nerve roots. Reexpoloration of the fusion was performed, and a cyst arising from the posterior aspect of the cage was found to compress the axilla of the left L-4 nerve root and the shoulder of the L-5 nerve root. The cyst was decompressed, and the wall was partially excised. A collagen BMP sponge was found within the cyst and was removed. Postoperatively, the patient's radiculopathy resolved and she went on to achieve interbody fusion. Bone morphogenetic protein can be associated with inflammatory cyst formation resulting in neural compression. Spine surgeons should be aware of this complication in addition to the other reported BMP-related complications.

Presentation and progression of a disc cyst in a pediatric patient

Disc cysts are rare intraspinal extradural lesions that communicate with the intervertebral disc and can mimic the symptoms of acute lumbar disc herniation. Initially reported in the Japanese-language literature as a new entity (discal cyst), there are few documented cases in North America, and only 1 prior case in the pediatric population. The authors present the case of a 16-year-old girl with an intervertebral disc cyst causing lumbar radiculopathy that progressed despite conservative treatment. All medical records, imaging studies, intraoperative findings, and pertinent literature were reviewed. Serial preoperative MR imaging revealed enlargement of the intraspinal cyst at the L4–5 level, resulting in compression of the right L-5 nerve root. Enlargement of the cyst occurred over a 4-month period despite conservative treatment with physical therapy and corticosteroid injections. Microsurgical discectomy and excision of the cyst resulted in complete resolution of the preoperative radiculopathy. An intervertebral disc cyst is a rare entity in the adult population and exceedingly rare in the pediatric population but should remain in the differential diagnosis of any intraspinal extradural mass. The authors hypothesize that there exists a spectrum of this entity that may not be responsive to conservative therapy. Cyst excision alone or in conjunction with microsurgical discectomy is safe and effective in treating radiculopathy caused by disc cysts.