Poster 67: Lumbar intraspinal synovial cyst: a case report

Abstract

Setting: Tertiary medical center physical medicine and rehabilitation unit. Patient: A 67-year-old woman with intractable right lower-extremity pain and paresthesias. Case Description: The patient presented with a 2 month-history of acute onset right buttock pain with radiation into calf and foot. She also had numbness and tingling in her right foot. There was no trauma or unusual activity, however, she had subtle right leg discomfort for many years prior to onset of pain. The patient had no subjective weakness or difficulty in bowel or bladder control. Neurologic examination revealed absent right ankle jerk and reduced sensation in S1 distribution. Motor strength was normal. Lumbar spine magnetic resonance imaging (MRI) revealed a juxta-facet intraspinal synovial cyst at the right L5-S1 level. This caused deformity and compression of the right S1 nerve root. There were also smaller extraspinal synovial cysts at L5-S1 level posteriorly. Assessment/Results: The patient underwent right L5 partial, inferior hemilaminectomy, L5-S1 medial facetectomy, foraminotomy of the S1 nerve root, and gross total resection of the L5-S1 level synovial cyst. Postoperatively, she reported relief of right lower-extremity pain for several hours. She then developed recurrence of right leg pain without weakness. MRI revealed hematoma formation at the operative bed. The hematoma was evacuated promptly, resulting in complete resolution of symptoms. Discussion: This case represents a classic presentation of a large intraspinal synovial cyst causing radiculopathy and outcome of surgical excision with the infrequent postoperative complication of hematoma. Conclusion: Intraspinal synovial cysts can cause intractable radicular pain. MRI studies are warranted for intractable radiculopathies.