; Facet cyst haematoma in the lumbar spine: a report of four cases
Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Facet cyst haematoma in the lumbar spine: a report of four cases

VIEWS: 18 PAGES: 6

We present 4 cases of facet cyst haematoma in the ligamentum flavum of the lumbar spine. All patients presented with a one-to-3-month history of back pain or numbness in the legs, and sudden neurological deterioration. One also developed cauda equina syndrome and another developed radiculopathy. In all cases, magnetic resonance imaging showed a mass with high signal intensity on both T1- and T2-weighted images. Facet arthrography and computed tomography revealed communication between the mass and the neighbouring facet joint. The haematomas were removed en bloc with the ligamentum flavum. They were surrounded by the ligament and contained degenerated and lacerated elastic fibres but no synovial lining cells. Facet cyst haematoma is so-named because of bleeding from tissue adjacent to the facet joint into a pre-existing facet cyst. [PUBLICATION ABSTRACT]

More Info
  • pg 1
									Journal of Orthopaedic Surgery 2009;17(1):80-4




Facet cyst haematoma in the lumbar spine: a
report of four cases
N Miyatake,1 T Aizawa,1 H Hyodo,2 H Sasaki,2 T Kusakabe,1 T Sato2
1
    Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
2
    Department of Orthopaedic Surgery, Sendai Orthopaedic Hospital, Sendai, Japan




                                                             Key words: cysts; hematoma; hemorrhage; ligamentum
                                                             flavum; zygapophyseal joint
ABSTRACT

We present 4 cases of facet cyst haematoma in the            INTRODUCTION
ligamentum flavum of the lumbar spine. All patients
presented with a one-to-3-month history of back pain         Haematoma in a pre-existing juxta-facet cyst can
or numbness in the legs, and sudden neurological             compress nerve roots or dura mater and cause
deterioration. One also developed cauda equina               radiculopathy or cauda equina syndrome. 32 such
syndrome and another developed radiculopathy.                cases have been reported as a haemorrhagic cyst,
In all cases, magnetic resonance imaging showed              haemorrhagic lumbar synovial cyst, or haemorrhage
a mass with high signal intensity on both T1- and            into a synovial cyst,1–23 depending on the histological
T2-weighted images. Facet arthrography and                   findings such as synovial lining cells in the cyst wall.
computed tomography revealed communication                   Such terminologies are confusing because some cysts
between the mass and the neighbouring facet joint.           have features of both synovial and non-synovial
The haematomas were removed en bloc with the                 cysts.24,25 In 46 patients with juxta-facet cysts, none had
ligamentum flavum. They were surrounded by the               synovial cells but all had the communicating channel
ligament and contained degenerated and lacerated             between the cyst and the neighbouring facet joint.
elastic fibres but no synovial lining cells. Facet cyst      Thus, they should all be called simply ‘facet cysts’.25
haematoma is so-named because of bleeding from                   We present 4 cases of facet cyst haematoma in the
tissue adjacent to the facet joint into a pre-existing       lumbar spine and discuss their possible pathogenesis.
facet cyst.                                                  Magnetic resonance imaging (MRI), facet joint




Address correspondence and reprint requests to: Dr Tetsuro Sato, Department of Orthopaedic Surgery, Sendai Orthopaedic
Hospital, 24 Higashidori, Izai, Wakabayashi-ku, Sendai 984-0038, Japan. E-mail: te-sato@sendaiseikei.or.jp
Vol. 17 No. 1, April 2009                                                        Facet cyst haematoma in the lumbar spine   81


                                                         Table 1
                                          Clinical and radiological presentation

 Features                            Case 1                  Case 2               Case 3                 Case 4
 Sex/age (years)                     M/86                    M/56                 M/57                   M/84
 Initial symptom/duration (months)   Bilateral leg           Bilateral buttock    Right posterior leg    Low back pain/2
                                     numbness/3              pain/1               pain/3
 Cause of exacerbation               Walking                 Waking up            Picking up heavy box   No
 Preoperative acute-on-chronic       Bilateral calf          Bilateral leg        Right posterior leg    Right posterolateral
 symptom/duration (months)           numbness/1              weakness/4 days      pain/2                 leg pain/1
 Location/level                      Posterior/L1–L2         Posterior/L4–L5      Posterolateral/L5–S    Posterolateral/L4–L5
 Facet joint degeneration according  Grade 3                 Grade 3            
								
To top