Intraspinal ganglion cyst

Abstract

The pathogenesis of juxtafacet cysts is closely related to degenerative instability of the lumbar spine and degenerative changes in the ligamentum flavum and the facet joint. A 56-year-old man presented with severe right thigh pain and numbness for 1 month after a laminar fracture of the L4 spine. Magnetic resonance imaging revealed a heterogenous cystic mass surrounding the facet joint between the fourth and fifth lumbar vertebrae on the right side. Conservative therapy was unsuccessful and the lesion was removed by surgical decompression alone without fusion. The histological examination showed a fragmented, cystic wall-like structure composed of myxoid degenerative tissue without lining epithelium. Here we present this case of a ganglion cyst that appeared to be associated with facet joint instability.

Keywords: Ganglion cysts; Spine; Synovial cyst.

FIG. 1

Preoperative images of the lumbar spine. Preoperative sagittal (A) and axial (B) magnetic resonance images show a large, round, mass-like lesion with heterogeneous signal intensity on the T2-weighted image. The right facet joint shows fluid accumulation (B, upper arrow). Laminar fracture close to the L4-5 facet joint is also seen (B, lower arrow). A preoperative computed tomography scan of the lumbar spine at the L-5 level shows a laminar fracture close to the L4-5 facet joint on the right side (arrow).

FIG. 2

Postoperative images of the lumbar spine. Eight months later, the previously noted lesion is not seen on the postoperative follow-up magnetic resonance image.