Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2020; 11(1): 68-75
Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.68
Rapid spontaneous resolution of lumbar ganglion cysts: A case report
Vito Chiarella, Alessandro Ramieri, Marco Giugliano, Maurizio Domenicucci
Vito Chiarella, Marco Giugliano, Maurizio Domenicucci, Department of Neurological and Psychiatric, Sapienza University of Rome, Rome 00185, Italy
Alessandro Ramieri, Orthopaedic Division, Don Gnocchi Foundation, Milan 20148, Italy
Author contributions: Domenicucci M and Ramieri A designed research; Ramieri A and Chiarella V performed research; Chiarella V and Giugliano M contributed analytic tools; Chiarella V and Ramieri A analyzed data; Ramieri A and Chiarella V wrote the paper.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Alessandro Ramieri, MD, PhD, Research Fellow, Surgeon, Orthopaedic Division, Don Gnocchi Foundation Onlus Milan Italy, Maresciallo Caviglia 30, Rome 00100, Italy. alexramieri@libero.it
Received: May 20, 2019
Peer-review started: May 26, 2019
First decision: August 31, 2019
Revised: September 23, 2019
Accepted: October 27, 2019
Article in press: October 27, 2019
Published online: January 18, 2020
Processing time: 202 Days and 17.9 Hours
Abstract
BACKGROUND

To discuss the rare event of spontaneous resolution of a lumbar ganglion cyst, a personal case report and 25 cases culled from the literature were described in detail. We focused on demographic, classification, clinical and radiological findings, treatment, outcome and radiological resolution.

CASE SUMMARY

A 51-year-old man presented to our observation with complaints of low back and right leg pain. Lumbar magnetic resonance imaging (MRI). showed a L4-L5 ganglion cyst. The patient was referred to medical therapy and bracing. After 4 wk, he showed a complete resolution of pain. The complete spontaneous resolution of the cyst was demonstrated by the followed-up MRI.

CONCLUSION

Spontaneous resolution of lumbar ganglion is very rare and only 26 cases, including ours, were reported in literature. Different degrees of biomechanical impairment seem to play a fundamental role in the pathogenesis. Related symptoms are essentially represented by low back and/or radicular pain, without significant neurological disorders. Anti-inflammatory drugs, light unloading exercises and brace could be recommended to administrated pain and decrease facet loads. Mean time for clinical improvement was 7 mo, while MRI disappearance occurred in an average time of 11 mo. Therefore, surgery should be applied when conservative treatment, prolonged at least 6 mo, fails.

Keywords: Lumbar ganglion cyst, Spontaneous resolution, Conservative treatment, Radiological disappearance, Case report

Core tip: Our paper is an original study that analyzes in detail and for the first time, on the basis of a personal observation, the clinical and radiological scenario related to the rare spontaneous resolution of a lumbar ganglion cyst. The term “ganglion cyst” was used according to the recent our morphological classification. Discussing natural history and biomechanical features of this pathology, we propose some recommendations that could be adopted in cases with a propensity to spontaneous resolution.