Published online Dec 16, 2013. doi: 10.12998/wjcc.v1.i9.285
Revised: November 5, 2013
Accepted: November 18, 2013
Published online: December 16, 2013
Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. This article summarizes the clinical presentation, radiographic appearance, and management of three intraspinal, midline facet cysts. Three patients with symptomatic midline intraspinal facet cysts were retrospectively reviewed. Documented clinical visits, operative notes, histopathology reports, and imaging findings were investigated for each patient. One patient presented with neurogenic claudication while two patients developed partial, subacute cauda equina syndrome. All 3 patients initially responded favorably to lumbar decompression and midline cyst resection; however, one patient required surgical stabilization 8 mo later. Following the three case presentations, we performed a thorough literature search in order to identify articles describing intraspinal cystic lesions in lateral or midline locations. Midline intraspinal facet cysts represent an uncommon cause of lumbar stenosis and thecal sac compression. Such entities should enter the differential diagnosis of midline posterior cystic lesions. Midline cysts causing thecal sac compression respond favorably to lumbar surgical decompression and cyst resection. Though laminectomy is a commonly performed operation, stabilization may be required in cases of spondylolisthesis or instability.
Core tip: Midline, intraspinal cysts arise from facet joint degeneration. The lesions represent an important and often over-looked cause of back pain and other neurological symptoms. Radiographic identification of the fluid-filled sacs is particularly important in the setting of cauda equina syndrome, in which immediate surgical intervention is required in order to address the compressive lesion. Although the treatment of choice is a spinal decompression and resection, posterior fusions may prevent cyst recurrence.