Hemorrhage into a lumbar synovial cyst causing an acute cauda equina syndrome

Case report

Stephen B. Tatter M.D., Ph.D. 1 and G. Rees Cosgrove M.D., F.R.C.S.(C) 1
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  • 1 Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts
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✓ Juxtafacet cysts of the lumbar spine have been reported with increasing frequency but their pathogenesis remains obscure. These cysts most frequently present with back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms of spinal canal compromise. The authors report an unusual case of hemorrhage into a right L3–4 synovial cyst causing an acute cauda equina syndrome and describe its successful surgical treatment. The clinical, radiographic, and pathological features are discussed.

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Contributor Notes

Address reprint requests to: G. Rees Cosgrove, M.D., Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts 02114.
  • 1.

    Abrahams JJ, , Wood GW, & Eames FA, et al: CT-guided needle aspiration biopsy of an intraspinal synovial cyst (ganglion): case report and review of the literature. AJNR 9:398400, 1988 Abrahams JJ, Wood GW, Eames FA, et al: CT-guided needle aspiration biopsy of an intraspinal synovial cyst (ganglion): case report and review of the literature. AJNR 9:398–400, 1988

    • Search Google Scholar
    • Export Citation
  • 2.

    Azzam CJ: Midline lumbar ganglion/synovial cyst mimicking an epidural tumor: case report and review of pathogenesis. Neurosurgery 23:232234, 1988 Azzam CJ: Midline lumbar ganglion/synovial cyst mimicking an epidural tumor: case report and review of pathogenesis. Neurosurgery 23:232–234, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    Bjorkengren AG, , Kurz LT, & Resnick D, et al: Symptomatic intraspinal cysts: opacification and treatment by percutaneous injection. AJR 149:105107, 1987 Bjorkengren AG, Kurz LT, Resnick D, et al: Symptomatic intraspinal cysts: opacification and treatment by percutaneous injection. AJR 149:105–107, 1987

    • Search Google Scholar
    • Export Citation
  • 4.

    Brish A, & Payan HM: Lumbar intraspinal extradural ganglion cyst. J Neurol Neurosurg Psychiatry 35:771775, 1972 Brish A, Payan HM: Lumbar intraspinal extradural ganglion cyst. J Neurol Neurosurg Psychiatry 35:771–775, 1972

    • Search Google Scholar
    • Export Citation
  • 5.

    Brown RA, , Weiss JB, & Tomlinson IW, et al: Angiogenic factor from synovial fluid resembling that from tumours. Lancet 1:682685, 1980 Brown RA, Weiss JB, Tomlinson IW, et al: Angiogenic factor from synovial fluid resembling that from tumours. Lancet 1:682–685, 1980

    • Search Google Scholar
    • Export Citation
  • 6.

    Cameron SE, & Hanscom DA: Rapid development of a spinal synovial cyst. A case report. Spine 17:15281530, 1992 Cameron SE, Hanscom DA: Rapid development of a spinal synovial cyst. A case report. Spine 17:1528–1530, 1992

    • Search Google Scholar
    • Export Citation
  • 7.

    Eguchi K, , Migita K, & Nakashima M, et al: Fibroblast growth factors released by wounded endothelial cells stimulate proliferation of synovial cells. J Rheumatol 19:19251932, 1992 Eguchi K, Migita K, Nakashima M, et al: Fibroblast growth factors released by wounded endothelial cells stimulate proliferation of synovial cells. J Rheumatol 19:1925–1932, 1992

    • Search Google Scholar
    • Export Citation
  • 8.

    Eyster EF, & Scott WR: Lumbar synovial cysts: report of eleven cases. Neurosurgery 24:112115, 1989 Eyster EF, Scott WR: Lumbar synovial cysts: report of eleven cases. Neurosurgery 24:112–115, 1989

    • Search Google Scholar
    • Export Citation
  • 9.

    Franck JI, , King RB, & Petro GR, et al: A posttraumatic lumbar spinal synovial cyst. Case report. J Neurosurg 66:293296, 1987 Franck JI, King RB, Petro GR, et al: A posttraumatic lumbar spinal synovial cyst. Case report. J Neurosurg 66:293–296, 1987

    • Search Google Scholar
    • Export Citation
  • 10.

    Fritz P, , Klein C, & Mischlinski A, et al: Morphometric analysis of the angioarchitecture of the synovial membrane in rheumatoid arthritis and osteoarthritis. Zentralbl Pathol 138:128135, 1992 Fritz P, Klein C, Mischlinski A, et al: Morphometric analysis of the angioarchitecture of the synovial membrane in rheumatoid arthritis and osteoarthritis. Zentralbl Pathol 138:128–135, 1992

    • Search Google Scholar
    • Export Citation
  • 11.

    Heary RF, , Stellar S, & Fobben ES: Preoperative diagnosis of an extradural cyst arising from a spinal facet joint: case report. Neurosurgery 30:415418, 1992 Heary RF, Stellar S, Fobben ES: Preoperative diagnosis of an extradural cyst arising from a spinal facet joint: case report. Neurosurgery 30:415–418, 1992

    • Search Google Scholar
    • Export Citation
  • 12.

    Jabre A, , Shahbabian S, & Keller JT: Synovial cyst of the cervical spine. Neurosurgery 20:316318, 1987 Jabre A, Shahbabian S, Keller JT: Synovial cyst of the cervical spine. Neurosurgery 20:316–318, 1987

    • Search Google Scholar
    • Export Citation
  • 13.

    Jackson DE Jr, , Atlas SW, & Mani JR, et al: Intraspinal synovial cysts: MR imaging. Radiology 170:527530, 1989 Jackson DE Jr, Atlas SW, Mani JR, et al: Intraspinal synovial cysts: MR imaging. Radiology 170:527–530, 1989

    • Search Google Scholar
    • Export Citation
  • 14.

    Kao CC, , Uihlein A, & Bickel WH, et al: Lumbar intraspinal extradural ganglion cyst. J Neurosurg 29:168172, 1968 Kao CC, Uihlein A, Bickel WH, et al: Lumbar intraspinal extradural ganglion cyst. J Neurosurg 29:168–172, 1968

    • Search Google Scholar
    • Export Citation
  • 15.

    Kao CC, , Winkler SS, & Turner JH: Synovial cyst of spinal facet. Case report. J Neurosurg 41:372376, 1974 Kao CC, Winkler SS, Turner JH: Synovial cyst of spinal facet. Case report. J Neurosurg 41:372–376, 1974

    • Search Google Scholar
    • Export Citation
  • 16.

    Kjerulf TD, , Terry DW Jr, & Boubelik RJ: Lumbar synovial or ganglion cysts. Neurosurgery 19:415420, 1986 Kjerulf TD, Terry DW Jr, Boubelik RJ: Lumbar synovial or ganglion cysts. Neurosurgery 19:415–420, 1986

    • Search Google Scholar
    • Export Citation
  • 17.

    Koch AE, , Polverini PJ, & Kunkel SL, et al: Interleukin-8 as a macrophage-derived mediator of angiogenesis. Science 258:17981801, 1992 Koch AE, Polverini PJ, Kunkel SL, et al: Interleukin-8 as a macrophage-derived mediator of angiogenesis. Science 258:1798–1801, 1992

    • Search Google Scholar
    • Export Citation
  • 18.

    Liu SS, , Williams KD, & Drayer BP, et al: Synovial cysts of the lumbosacral spine: diagnosis by MR imaging. AJR 154:163166, 1990 Liu SS, Williams KD, Drayer BP, et al: Synovial cysts of the lumbosacral spine: diagnosis by MR imaging. AJR 154:163–166, 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Maresca L, , Meland NB, & Maresca C, et al: Ganglion cyst of the spinal canal. Case report. J Neurosurg 57:140142, 1982 Maresca L, Meland NB, Maresca C, et al: Ganglion cyst of the spinal canal. Case report. J Neurosurg 57:140–142, 1982

    • Search Google Scholar
    • Export Citation
  • 20.

    Mercader J, , Muñoz-Gomez J, & Cardenal C: Intraspinal synovial cyst: diagnosis by CT. Follow-up and spontaneous remission. Neuroradiology 27:346348, 1985 Mercader J, Muñoz-Gomez J, Cardenal C: Intraspinal synovial cyst: diagnosis by CT. Follow-up and spontaneous remission. Neuroradiology 27:346–348, 1985

    • Search Google Scholar
    • Export Citation
  • 21.

    Munz M, , Tampieri D, & Robitaille Y, et al: Spinal synovial cyst: case report using magnetic resonance imaging. Surg Neurol 34:431434, 1990 Munz M, Tampieri D, Robitaille Y, et al: Spinal synovial cyst: case report using magnetic resonance imaging. Surg Neurol 34:431–434, 1990

    • Search Google Scholar
    • Export Citation
  • 22.

    Onofrio BM, & Mih AD: Synovial cysts of the spine. Neurosurgery 22:642647, 1988 Onofrio BM, Mih AD: Synovial cysts of the spine. Neurosurgery 22:642–647, 1988

    • Search Google Scholar
    • Export Citation
  • 23.

    Pendleton B, , Carl B, & Pollay M: Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery 13:322326, 1983 Pendleton B, Carl B, Pollay M: Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery 13:322–326, 1983

    • Search Google Scholar
    • Export Citation
  • 24.

    Reust P, , Wendling D, & Lagier R, et al: Degenerative spondylolisthesis, synovial cyst of the zygapophyseal joints, and sciatic syndrome: report of two cases and review of the literature. Arthritis Rheum 31:288294, 1988 Reust P, Wendling D, Lagier R, et al: Degenerative spondylolisthesis, synovial cyst of the zygapophyseal joints, and sciatic syndrome: report of two cases and review of the literature. Arthritis Rheum 31:288–294, 1988

    • Search Google Scholar
    • Export Citation
  • 25.

    Silbergleit R, , Gebarski SS, & Brunberg JA, et al: Lumbar synovial cysts: correlation of myelographic, CT, MR, and pathologic findings. AJNR 11:777779, 1990 Silbergleit R, Gebarski SS, Brunberg JA, et al: Lumbar synovial cysts: correlation of myelographic, CT, MR, and pathologic findings. AJNR 11:777–779, 1990

    • Search Google Scholar
    • Export Citation
  • 26.

    Titelbaum DS, , Rhodes CH, & Brooks JS, et al: Pigmented villonodular synovitis of a lumbar facet joint. AJNR 13:164166, 1992 Titelbaum DS, Rhodes CH, Brooks JS, et al: Pigmented villonodular synovitis of a lumbar facet joint. AJNR 13:164–166, 1992

    • Search Google Scholar
    • Export Citation
  • 27.

    Vernet O, , Fankhauser H, & Schnyder P, et al: Cyst of the ligamentum flavum: report of six cases. Neurosurgery 29:277283, 1991 Vernet O, Fankhauser H, Schnyder P, et al: Cyst of the ligamentum flavum: report of six cases. Neurosurgery 29:277–283, 1991

    • Search Google Scholar
    • Export Citation
  • 28.

    Wilkinson LS, & Edwards JC: Microvascular distribution in normal human synovium. J Anat 167:129136, 1989 Wilkinson LS, Edwards JC: Microvascular distribution in normal human synovium. J Anat 167:129–136, 1989

    • Search Google Scholar
    • Export Citation

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