Abstract
Degenerative changes in the lumbar spine can be followed by cystic changes. Most reported intraspinal cysts are ganglion or synovial cysts. Ligamentum flavum pseudocyst, as a cystic lesion in the lumbar spine, is a rare and unusual cause of neurologic signs and symptoms and is usually seen in elderly persons (due to degenerative changes). They are preferentially located in the lower lumbar region, while cervical localization is rare. Complete removal of the cyst leads to excellent results and seems to preclude recurrence. We report the case of a right-sided ligamentum flavum cyst occurring at L3–L4 level in a 70-year-old woman, which was surgically removed with excellent postoperative results and complete resolution of symptoms. In addition, we discuss and review reports in the literature.
Highlights
Degenerative changes in the lumbar spine can be followed by cystic changes
We report the case of a right-sided ligamentum flavum cyst occurring at L3–L4 level in a 70-year-old woman, which was surgically removed with excellent postoperative results and complete resolution of symptoms
Magnetic resonance imaging revealed at L3–L4 level a right-sided voluminous epidural cystic lesion, 10 mm in diameter, which was hypointense on T1-weighted images and hyperintense on T2-weighted images and its wall was enhanced with contrast material
Summary
A 70-year-old woman presented with 5-year history of gradually developing gait disturbance as well as pain in the lumbar area, buttock, and right leg, the right knee, involving mostly the L4 distribution. In the meantime an artificial knee joint was implanted with inadequate recovery of the pain. Reflexes were hypoactive in both legs with right-sided patellar reflex loss. Magnetic resonance imaging revealed at L3–L4 level a right-sided voluminous epidural cystic lesion, 10 mm in diameter, which was hypointense on T1-weighted images and hyperintense on T2-weighted images and its wall was enhanced with contrast material. The mass was surgically resected together with the hypertrophied ligamentum flavum after partial L3–L4 hemilaminectomy (Fig. 1). There was no connection between the cyst and the facet joint. Pathological examination of the cyst revealed myxoid and pseudocystic degeneration of the ligamentum
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