Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Clin Cases. Dec 16, 2013; 1(9): 285-289
Published online Dec 16, 2013. doi: 10.12998/wjcc.v1.i9.285
Midline synovial and ganglion cysts causing neurogenic claudication
Jonathan Pindrik, Mohamed Macki, Mohamad Bydon, Zahra Maleki, Ali Bydon
Jonathan Pindrik, Mohamed Macki, Mohamad Bydon, Ali Bydon, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Zahra Maleki, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Author contributions: Pindrik J designed and wrote the report; Macki M and Bydon M assisted in the composition of the manuscript; Maleki Z provided the pathological images and histopathological interpretations; Bydon A was the attending physician of all three patients, conceived the manuscript concept and oversaw the work on the project.
Correspondence to: Ali Bydon, MD, Associate Professor, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, United States.
Telephone: +1-443-2874934 Fax: +1-410-5023399
Received: September 17, 2013
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.

Keywords: Midline, Synovial, Ganglion, Intraspinal, Cyst, Neurogenic, Claudication, Laminectomy, Facet

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.