Lumbar intraspinal synovial cyst with urine incontinence: A case report and review of the literature

Yıl 2013, , 546 - 549, 01.12.2013

Yahya Turan Tevfik Yılmaz Cüneyt Göçmez Kağan Kamaşak Salih Hattapoğlu Adnan Ceviz

https://doi.org/10.5799/ahinjs.01.2013.04.0345

Öz

Synovial cysts are rarely observed in cases with epidural compressive syndromes. They are intraspinal lesions that may mimic disc hernias by causing radicular symptoms. A 28-year-old female patient presented with radicular complaints such as back pain for 6 months, urinary incontinence for 1 month, and progressive right leg pain and numbness for the last 2 weeks. Physical examination revealed weakness (4/5) in gastrocnemius muscle, right L5-S1 hypoesthesia, and urinary incontinence. On magnetic resonance imaging, an intraspinal cyst was seen at the level of L5-S1. The patient was operated with bilateral L5 hemipartial laminectomy, foraminotomy, and cyst excision. Her symptoms, especially urinary incontinence, regressed at the early postoperative period and completely disappeared together with normal motor and sensory examination findings at the control visit at 1 year. J Clin Exp Invest 2013; 4 (4): 546-549

Anahtar Kelimeler

Synovial cyst, lumbar spine, intraspinal steroids, spinal surgery, urine incontinence

Lumbar intraspinal synovial cyst with urine incontinence: A case report and review of the literature

Öz

Sinovyal kistler epidural kompresif sendromları olan olgularda nadiren görülmektedir. Radiküler semptomlarla disk hernilerini taklit edebilen intraspinal lezyonlardır. Yirmi sekiz yaşında bayan hasta, altı aydır süren bel ağrısı, bir aydır idrar kaçırma ve son iki haftadır giderek artan sağ bacak ağrısı ve uyuşma gibi radiküler şikayetlerle başvurdu. Fizik muayenesinde; gastrokinemius kasında güç kaybı (4/5), sağ L5,S1 hipoestezisi ve idrar inkontinansı tespit edildi. Manyetik rezonans görüntülemede, L5-S1 seviyesinde intraspinal kist görüldü. Olguya bilateral L5 hemiparsiyel laminektomi, foraminotomi ve kist eksizyonu yapıldı. Hastanın özellikle idrar inkontinansı olmak üzere postoperatif erken dönemde şikayetleri geriledi, bir yıl sonraki kontrol muayenesinde hiç bir şikayetinin olmadığı, motor ve duyu kaybının da tamamen düzeldiği gözlendi.

Anahtar Kelimeler

Sinoviyal kist, lomber vertebra, intraspinal steroid, spinal cerrahi, idrar inkontinansı

Kaynakça

• Tillich M, M Trummer, Lindbichler F, Flaschka G. Symp- tomatic intraspinal synovial cysts of the lumbar spine: correlation of MR and surgical findings. Neuroradiol- ogy 2001;43:1070-1075.
• Shah RV, Lutz GE. Lumbar intraspinal synovial cysts: conservative management and review of the world’s literature. Spine J 2003;3:479-488.
• Stoodley MA, Jones NR, Scott G. Cervical and thoracic juxtafacet cysts causing neurologic deficits. Spine 2000;25:970-973.
• Kao CC, Uihlein A, Bickel WH, Soule EH. Lumbar intraspinal extradural ganglion cyst. J Neurosurg 1968;29:168-172.
• Yamamoto A, Nishiura, Handa H, Kondo A. Ganglion cyst in the ligamentum flavum of the cervical spine causing myelopathy: report of two cases. Surg Neurol 2001;56:390-395.
• Hsu K Y, Zucherman JF, Shea WJ, Jeffrey RA. Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment. Spine 1995;20:80-89.
• Trummer M, G Flaschka, M Tillich, et al. Eustacchio. Diagnosis and surgical management of intraspinal sy- novial cysts: report of 19 cases. J Neurol Neurosurg Psychiatry 2001;70:74-77.
• Kono K, H Nakamura, Y Inoue, et al. Yamada. Intra- spinal extradural cysts communicating with adjacent herniated disks: imaging characteristics and possible pathogenesis. AJNR Am J Neuroradiol 1999;20:1373- 1377.
• Yuh WT, J M Drew, J N Weinstein, et al. Intraspinal synovial cysts. Magnetic resonance evaluation. Spine (Phila Pa 1976) 1991;16:740-745.
• Apostolaki E, Davies AM, Evans N, Cassar-Pullicino VN. MR imaging of lumbar facet joint synovial cysts. Eur Radiol 2000;10:615-623.
• Boviatsis E J, Stavrinou LC, Kouyialis AT, et al. Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature re- view. Eur Spine J 2008;17:831-837.
• Mun JH, Lee RS, Lim C, et al. Intraspinal ganglion cyst. Chonnam Med J 2012;48:183-184.
• Kemaloglu S, Nas K, Gur A, et al. Synovial cyst at the intervertebral foramina causing lumbar radiculopathy. Spinal Cord 2001;39:399-401.