Spinal ganglion cyst presenting with radiculopathy: diagnostic challenges and differential

Abstract

Introduction: Ganglion cysts are benign soft tissue lesions, usually arising from periarticular connective tissue. These are very rarely reported in the spine, but when seen can cause radiculopathy or myelopathy.

Case presentation: A 68-year-old female patient presented with worsening radiculopathy and right foot drop and imaging noted a right L5-S1 foraminal mass. The lesion was gross totally resected. Histological analysis revealed myxoid degeneration and inflammation, without a synovial lining, consistent with ganglion cyst.

Discussion: While uncommon, intra-foraminal ganglion cysts can be distinguished from synovial cysts through imaging and histology and are typically amenable to surgical resection. Greater knowledge and insight about differentiating ganglion versus synovial cyst may prevent resection of facet joints and prevent a fusion procedure.

Fig. 1. Axial MRI imaging.

A lesion (arrow) in the right L5–S1 foramen, hypointense on T1 weighted image (A), and hyperintense on T2 weighted image (B) is seen.

Fig. 2. Sagittal MRI imaging.

Parasagittal T2 weighted image showing lesion (solid line arrow) compressing L5 nerve root (dash dot arrow) in the in foramen.

Fig. 3. Intaoperative ultrasound imaging.

Intraoperative ultrasound (A) confirmed the lesion seen on MRI (solid line arrow) just dorsal to the nerve root (dash dot arrow). Color Doppler demonstrated no internal vascular flow (B) and following resection, ultrasound demonstrated the mass was completely removed (C).

Fig. 4. Lesion gross appearance.

A solid lesion was fully resected en bloc.

Fig. 5. Histologic examination of the ganglion cyst reveals a fibroconnective tissue wall (triangle) with area of mural reactive chronic inflammation (arrow), and myxoid degeneration that leads to cyst formation (star).

Hematoxylin and eosin stain, original magnification ×100.