Spinal Cyst Research Articles

Spontaneous resolution of synovial lumbar cyst presented with severe symptoms: a case report

IntroductionSpinal cysts have traditionally been treated with surgery since it was first described in 1950. However, there have been rare instances where these cysts have resolved on their own without the need for surgical intervention. Here, we discuss the 27th reported case of such spontaneous resolution in the medical literature and delve into the details of this unique case.Case presentationThis report details a rare case of a 58-year-old Middle Eastern female who suffered from severe radicular and lumbar pain. Radiological study showed the presence of a cyst in the lumbar column. Noninvasive treatment was chosen after ensuring that there were no other symptoms requiring surgery. The patient showed gradual improvement over the course of 12 months, after which the pain completely disappeared.DiscussionThe surgical approach is currently the main treatment for spinal cysts, but spontaneous resolution, despite its rarity, may be worth considering as a preferred therapeutic approach in the future. This avenue has not been thoroughly explored or studied. Due to the etiology of these cysts and their location within mobile joints, a longer period of conservative management including rest and physical therapy may play a pivotal role in promoting natural resolution.ConclusionConservative treatment of cysts should continue for at least 8 months, using painkillers and physical therapy without lumbar bracing. Surgery remains the most effective means of treatment to date. Further research is needed to validate and establish standardized treatment protocols.

Cysts of the ligamentum flavum are often linked to ischemic conditions: A morphological study.

"Cysts of the ligamentum flavum (cysts-LF)" is the term for non-neoplastic cystic lesion involving LF. The aim of the present study was to elucidate the histopathological characteristics and pathogenesis of "cysts-LF". Herein, we defined cysts-LF as spinal cysts containing degenerative LF components. From archival cases, we investigated 18 symptomatic cysts-LF surgically removed from 18 patients (13 males and five females; median age 68.5 years [range, 42-86 years]). The elastic fibers of LF components in the wall were separated and/or torn, and cyst walls were accompanied by chondroid metaplasia (17 cases), myxoid changes (13 cases), ossification (11 cases), amyloid deposits (14 cases), hemosiderosis (six cases), granular/smudgy calcification (four cases), synovial cell linings (three cases), and severe inflammatory infiltrates (one case). These histologic features of our cysts-LF were shared by previously reported "cysts-LF." Fourteen cysts-LF demonstrated vascular stenosis/occlusion, and eight showed thick hyalinized vessels, suggesting local circulatory insufficiency. Eight cases (44%) exhibited lipomembranous fat necrosis, accompanied by hyalinized vascular changes (p = 0.003). Ischemic conditions were observed in nearly half of the present cysts-LF, and may be one of the main contributing factors for the formation of cysts-LF, via degeneration and cystic changes in the LF.

Spinal neurenteric cysts: experience with 9 cases via an anterior cervical approach

OBJECTIVE Intraspinal cysts are uncommon, and the success rate of complete resection is still low for spinal neurenteric cysts (NCs). The aim of this study was to evaluate the efficacies of an anterior microscopic surgical approach in the treatment of ventral and ventrolateral subaxial cervical NCs (SCNCs). METHODS Between 2019 and 2022, 9 patients with NCs of the subaxial spine underwent an anterior microsurgical approach. Their clinical presentations, radiological features, operative findings, and follow-up data were retrospectively reviewed and analyzed. RESULTS All spinal cysts were intradural and extramedullary in origin. Five patients were first-time cases while 4 patients with recurrence underwent revision surgery. The most common clinical manifestation was pain (77.78%). One patient was found to have a concomitant disorder of Klippel-Feil syndrome. Microscopically confirmed gross-total resection was achieved in 8 patients (88.89%) based on clinical comparisons between pre- and postoperative MRI and intraoperative video. One patient had symptom recurrence 1 year after subtotal resection, while there was no evidence of recurrence during follow-up for the other patients. Dense adhesions within the spinal cord were observed in 8 patients (88.89%) intraoperatively. Most importantly, the surgical outcome was significantly improved in all patients, and the mean (± SE) Japanese Orthopaedic Association score increased from 11.33 ± 0.91 preoperatively to 16.22 ± 0.32 postoperatively (p = 0.008). CONCLUSIONS An anterior surgical approach was proven to be both safe and effective in treating the ventral or ventrolateral SCNCs. The authors believe that an anterior microsurgical approach should be considered as a useful approach especially in patients with ventral recurrent SCNCs. Its clinical efficacy compared with a posterior approach in ventral spinal cyst may be better as most of the neurenteric cysts are ventrally or ventrolaterally located.

Evaluation and Treatment of Lumbar Spine Extradural Cysts: A Narrative Review.

The main objective was to describe the different types and characteristics of lumbar spine extradural cysts and their optimal treatment options with a focus on endoscopic technique.We searched Pubmed, EMBASE, Medline, and Google Scholar for articles published between 1967 and 2020 using the keywords "Spinal Cyst,""Extradural Cyst," and "Lumbar Cyst."The various anatomical and histological types of the extradural cysts with their presentations, etiologies, imaging, and optimal treatment with a focus on endoscopic techniques were reviewed from the articles. Lumbar spinal cysts are relatively rare pathologies that might cause radicular symptoms similar to lumbar disc herniation. Spinal extradural cysts are classified either histologically based on the cyst lining tissues (synovial cysts or non-synovial, ganglion cysts) or anatomicallybased on the structure of origin (epidural cysts, ligamentum flavum cysts, discal cysts, post-discectomy pseudocysts, posterior longitudinal ligament cysts, facet cysts). Surgical excision is the recommended treatment of symptomatic cysts with endoscopic techniques being a viable option. Extradural lumbar cysts can be identified based on their histological structure or depending on their structure of origin. Regardless of their classification, they could all give similar clinical findings, and the optimal treatment would be surgical excision with endoscopic technique being a viable option with a satisfactory outcome.

Full endoscopic resection of large bilateral synovial cysts in lumbar spine.

Synovial spinal cysts cause radiculopathy and back pain, with rare reports of cauda equina syndrome. Hypermobility and instability are cornerstones for synovial cyst formation. The incidence is around 5%, and data for bilateral cysts are lacking. Surgery is indicated after conservative measures fail. Recurrence is common and is potentially due to joint violation and destabilization from open surgery. This could be prevented via ultra-minimally invasive approaches. The authors present full endoscopic removal of bilateral synovial cysts in a patient with grade 1 stable spondylolisthesis and include a 360° view for confirmation of complete decompression. Postoperatively, the patient reported immediate pain relief. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23208.

An interdural spinal cyst in the cervicothoracic spine: a review and proposal for a revised classification of spinal meningeal cysts. Illustrative case.

Spinal cysts in the interdural space are extremely rare and are not included in the standard classification of spinal meningeal cysts. A 60-year-old female presented to our hospital with a spastic gait and numbness in both palms. Magnetic resonance imaging (MRI) revealed a spinal cyst from C4 to T4 compressing the spinal cord. Computed tomography myelography revealed a fistula at C4-5 and C5-6 that connected the cyst along the right C5 and C6 root sleeves. The cyst was located within the dura mater, and communication with the arachnoid space was achieved using a shunt tube. There was partial spastic gait amelioration after the procedure, but the patient experienced a relapse 2 months postoperation. A repeat procedure was performed without a shunt tube to allow greater communication between the cyst and the subarachnoid space. After this, marked improvement in gait function was observed, and MRI showed a significant reduction in cyst volume. Interdural spinal meningeal cysts are rare. When the interdural cyst cannot be removed entirely, surgery may be appropriate for providing a shunt tube or establishing communication between the cyst and arachnoid space to maintain the circulation of cerebrospinal fluid collected in the cyst cavity.

Radiologic Characteristics of Spinal Hemangioblastomas in von Hippel Lindau Disease as Guidance in Clinical Interventions

Hemangioblastomas in the central nervous system are the most common manifestation of von Hippel-Lindau (VHL) disease. Because the growth rate of hemangioblastomas is unpredictable, regular follow-up is mandatory, focusing on clinical symptoms and imaging of the central nervous system. However, clinical symptoms may be subtle and nonspecific, and data about the relationship between the radiologic findings and clinical symptoms are sparse. This study aims to evaluate if and how findings of magnetic resonance imaging (MRI) regarding spinal hemangioblastomas are associated with symptoms of VHL disease, with special attention to peritumoral edema and spinal cysts. Serial spinal MRI scans of 43 genetically or clinically established VHL patients with at least 2 years of follow-up were reevaluated to examine the volume, growth rate, and location of spinal hemangioblastomas and the presence, size, and growth rate of peritumoral edema and cysts. Findings were compared with clinical symptoms using the Fisher exact test. We observed a total of 77 spinal hemangioblastomas in 28 patients. Eight of the 28 patients showed peritumoral edema and spinal cysts, and 1 patient showed peritumoral edema without cyst formation; 6 of these 9 patients showed clinical symptoms. Both peritumoral edema and spinal cysts were associated with clinical symptoms (P= 0.023 and P= 0.011, respectively). The presence of peritumoral edema and/or spinal cysts shown on MRI in VHL patients with spinal hemangioblastomas is associated with symptoms in more than half of the patients and may alert the clinician to intensify clinical and radiologic surveillance.

Application of a New Gene-Cell Construct Based on the Olfactory Mucosa Escheating Cells Transduced with an Adenoviral Vector Encoding Mature BDNF in the Therapy of Spinal Cord Cysts.

A gene-cell construct based on rat olfactory mucosa ensheathing cells transduced with an adenoviral vector encoding a mature form of brain neurotrophic factor (mBDNF) was transplanted into post-traumatic cysts of rat spinal cord. Transplantation of the gene-cell construct improved motor activity of the hind limbs and reduced the size of cysts in some animals. However, comparison of the effects of transduced and non-transduced ensheathing cells revealed no significant differences. In parallel in vitro experiments, a decrease in the proliferation of transduced cells compared to non-transduced cells was observed. It is likely that mBDNF reduces proliferation of transduced cells, which can affect their efficiency. The therapeutic efficacy of the new gene-cell construct is most likely provided by the cellular component.

Brown-Séquard syndrome: An uncommon presentation of hydatid cyst

Primary spinal hydatid cyst account for 1% of all cases of hydatid disease. In Indian literature, few cases are reported. We report a case of 27-year-old immunocompetent Indian male patient presenting with brown sequard syndrome like presentation who later was diagnosed with extramedullary intradural multicystic large hydatid cyst. Following surgical removal of hydatid cyst, he was asymptomatic and was discharged on albendazole. There was no relapse in one year follow up. This case is being reported due to its rarity of occurence and presentation.

Study of the Therapeutic Efficiency of Transduced Olfactory Ensheathing Cells in Spinal Cord Cysts.

Posttraumatic spinal cord cysts are difficult to treat with medication and surgery. Gene-cell therapy is a promising area of treatment for such patients. However, optimal gene-cell construct for this therapy has not been developed. We investigated the therapeutic efficiency of human olfactory ensheathing cells (OECs) transduced by adenoviral vector encoding the mature form of brain-derived neurotrophic factor (mBDNF) in spinal cord cysts. The adenoviral vectors Ad5/35-CAG-mBDNF and Ad5/35-CAG-Fluc were constructed. Spinal cysts were modeled in female Wistar rats. We selected animals at the early and intermediate stages of recovery with scores to 13 according to the Basso, Beattie and Bresnahan (BBB) scale. The efficiency of therapy was evaluated by BBB tests. No cytotoxicity was detected using the Resazurin/AlamarBlue assay for both vectors at multiplicity of infection (MOIs) of 1, 5, and 25. There was an increase in the proliferation of cells treated with Ad5/35-CAG-mBDNF at MOIs of 5 and 25. The hind limb mobility after the transplantation of Ad5/35-CAG-mBDNF- and Ad5/35-CAG-Fluc-transduced human OECs and nontransduced OECs had approximately the same tendency to improve. Cyst reduction was observed with the transplantation of all the samples. Although Ad5/35-CAG-mBDNF-transduced OECs had high BDNF expression levels in vitro, these cells lacked positive effect in vivo because they did not exhibit significant effect concerning functional test when comparing the groups that received the same numbers of OECs. The therapeutic efficiency of transduced OECs appears to be due to the cell component. The autological and tissue-specific human OECs are promising for the personalized cell therapy. It is extremely important to test new gene-cell constructs based on these cells for further clinical use.

Multiple lumbar spinal inter-dural cysts

Abstract Introduction: Cysts of the spinal canal may be located in the extradural or intradural space. Distinct from these cysts, inter-dural spinal cysts form between the two layers of the spinal dura and contain fluid, including cerebrospinal fluid (CSF) and blood. Inter-dural spinal cysts are extremely rare. We recently encountered a patient presenting with a multiple lumbar spinal inter-dural cysts. Patient concerns: A 58-year-old woman presented with an acute onset of back pain radiating to her left leg. She had no history of surgery or trauma and no other medical illness. Her pain was not relieved by considerable attempts to control it through medication or physical therapy Diagnosis: The magnetic resonance imaging indicated multiple cystic lesions ventral and dorsal to the thecal sac at L2/3 which were compressing the roots of the cauda equina. The contents of the ventral lesion were relatively high signal on T2-weighted images and low-signal on T1-weighted images, suggesting a CSF. Additional magnetic resonsnce myelography was highly suggestive of multiple isolated cysts located in the inter-dural space, with a thin wall separated from the CSF. Interventions: The patient underwent total laminectomy of the 2nd to 3rd lumbar vertebral to expose the cyst. After midline dural incision, inner dural leaflet was found and we could have confirmed the exact position of the cyst was interdural space, and the inner dura was excised. We then retracted the rootlets to find another ventral cyst. A small incision was made in the inner dura overlying the ventral cyst and yellowish fluid was drained. Complete cyst fenestration and excision of the inner dural leaflet was performed. Outcomes: A histopathology report confirmed the cyst to be dura. The patient had complete resolution of symptoms and was asymptomatic 3 years after surgery. Conclusions: Inter-dural cysts occur very rarely. We report the first case of multiple lumbar spinal inter-dural cysts. Acknowledging inter-dural spinal cysts as a type of spinal meningeal cyst is imperative, as this will allow surgeons to avoid unnecessary dural breaches and associated complications.

Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft

Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft

Spinal Syrinx Due to Lipiodol-Induced Arachnoiditis

We present a case of a progressive symptomatic intramedullary cyst, diagnosed decades after Lipiodol injection. Lipiodol was originally administered intrathecally for the radiologic diagnosis of spinal masses. A link between the lesion and the history of Lipiodol injection was never suspected. Surgical exploration revealed a membrane above the lesion, separating the intradural space in a cranial and caudal compartment. On the level of the cyst, we identified glassy pearls containing a fatty liquid, compatible with Lipiodol deposits. We hypothesize that the syrinx is secondary to the impact of cerebrospinal fluid pulsations on the reactive membrane and that this membrane originated from an arachnoiditis caused by Lipiodol deposits. Lipiodol was indeed abandoned after it was found to cause arachnoiditis and neurologic sequelae. Despite the cessation of its usage, the causal role of Lipiodol in arachnoiditis and spinal cyst formation should still be considered, as symptoms may arise many years after Lipiodol administration.

Intradural Spinal Arachnoid Cyst in a Pediatric Patient: A Case Report

AbstractThe present case reports a 13-year-old patient with an intradural arachnoid cyst, which manifested itself with a sudden loss of strength and sensitivity in the lower and upper limbs and a severe pain in the cervical and thoracic region. On examination, a lesion displayed as an intradural hematoma; however, a laminotomy was performed and it was realized that the lesion was an arachnoid spinal cyst of the cervical-dorsal spine.

APPLICATION OF NEUROTROPHIC FACTORS BDNF AND NT-3 IN CELL THERAPY OF EXPERIMENTAL POSTTRAUMATIC SPINAL CORD CYSTS

The experimental post-traumatic spinal cord cysts were modeled. It has been shown that NT-3 enhances the effectiveness of the use of human olfactory ensheathing cells in the treatment of experimental spinal cord cysts.

Влияние трансплантации обкладочных клеток обонятельной выстилки на изменение размеров посттравматических кист спинного мозга

Влияние трансплантации обкладочных клеток обонятельной выстилки на изменение размеров посттравматических кист спинного мозга

The Mechanism of the Effect of Exercise Training on the Morphology of Neurons in the Caudate Putamen of the Mice

The purpose of this article is to study the effect of exercise training on neuronal morphology of somatosensory regions and caudate putamen in the cerebral cortex of mice. In this paper, 20 female mice of Kunming species and 20 mice were paired and randomly assigned to the exercise group and the control group. The exercise group mice performed physical activities. After 8 weeks of exercise training on the exercise treadmill, in a quiet state, tissue sections of the somatosensory area of the cerebral cortex were prepared and HE stained. The changes in tissue morphology were observed under an optical microscope and cell counts were performed. The mice were sacrificed during sexual maturity and senescence, and seven morphological parameters in the frontal cortex neurons of two types of mice were measured by cytomorphometry. The test was used to compare the differences between the parameters of different groups. To a certain extent, it can promote the increase of 12% in the nucleolus of canine pyramidal cells in the sensory area of the cerebral cortex of the white mice, and the increase in the density of the spinal cyst spines in the middle pyramidal cells of the sixth layer and the middle astrocytes of the caudal shell. The conclusion shows that proper exercise can increase the activity of neurons in the caudate putamen of the rat brain, which is beneficial to the transmission of neurons and the release of transmitters, and promotes the function of the brain.

Inter-dural spinal cyst with acute thoracic compressive myelopathy: anatomical aspects of spinal dura, case report and literature review

Introduction Inter-dural juxta-facet spinal cysts occur rarely. They form as part of the degenerative spinal disease process and can be misdiagnosed as synovial cysts or ganglion cysts. We report the case of a thoracic inter-dural juxta-facet spinal cyst causing acute compressive thoracic myelopathy. Methods The data was collected retrospectively from patient records. The literature review was performed in PubMed. Results We report a case of symptomatic inter-dural juxta-facet thoracic spinal cyst. The literature review showed a variety of different spinal cysts including arachnoid cyst, discal cyst, ganglion cyst, epidermoid cyst and synovial cysts. Micro-instability and repeated microtrauma associated with degenerative changes are most likely contributors to its formation. Asymptomatic cysts can show spontaneous resolution. When symptomatic, they can be managed with surgical excision with good patient outcome. Conclusion Inter-dural spinal cysts can be diagnosed and surgically excised to produce excellent post-operative outcome. High pre-operative index of suspicion of this diagnosis together with good understanding of the intraoperative anatomy are essential to avoid inadvertent dural breach.

A Rare Presentation of Primary Hydatid Cyst in an Adolescent – A Case Report

The aim of this case study was to report a very uncommon and rarely seen, but serious condition, involving spine. Hydatid cyst is caused by Echinococcus granulosus mainly. It is rarely found in spine, lumbar spine is least commonly involved in spine. A 14 years old boy with lower back pain radiating to both lower limbs observed in the hospital. Associated with progressive weakness and sensory deficit in both lower limbs investigations showed a space occupying lytic lesion extending from L3-S1 with cystic nature, showing nerve root compression at L3, L4 and L5. Managed with excision of cyst through posterior approach to lumbar spine and stabilized with posterior spinal instrumentation L2-L5 and S2AI screw. Hydatid cyst in lumbar spine should be considered as differential diagnosis of cystic lesions of spine. Treatment of hydatid cyst in spine is primarily removal of lesion. Postoperatively the patient improved, mobilized on first post-operative day and has been complication free in one-week follow up.

Spinal hydatic cyst

Spinal hydatic cyst