A 66-year-old male patient presented to the outpatient clinic with pain in the lower back, left leg and buttock associated with numbness. The patient had no past medical history or any other recent history of injury. The pain started 6 months ago and after three months of conservative management recommended by a community doctor, the pain progressively worsened.
Physical examination of the lumbar region was positive for Lasegue and Bragard testsm in addition to the left patellar reflex being absent. Moreover, both strength and sensitivity were preserved.
Radiographic imaging showed standing degenerative signs. Lumbar spine MRI also showed degenerative signs, associated with endplate osteophytes and signs of widespread dehydration of the discs in the absence of herniated discs. The posterior joints also showed important hypertrophic degenerative changes. Similarly, an image of intraspinal ganglion (11 mm) was identified at the level of L3-L4 which was influencing canal stenosis at the level, compressing and displacing the nerve roots. A cystic mass was further identified at the level of T1 and T2. The lesion originated from the level of L3-L4 facet joint and extended under the lamina of L3 and L4.
The findings were consistent with the diagnosis of Yuxta-articular facet cyst.
The pain worsened while sitting or climbing stairs and was relieved while in a standing position. The patient was advised surgical treatment, as conservativ. A left L3 hemilaminectomy, medial facetectomy, left ganglion excision and L3, L4 fusion was done. The patient had a satisfactory outcome of surgery.
Spine ganglions are grouped along with synovial cysts within the yuxta-articular facet cysts. The etiology is not known, however, it is generally associated with degenerative spinal disease or repeated trauma.
References
Symptomatic Yuxta-articular Facet Cyst: A Case Report https://clinmedjournals.org/articles/tcr/trauma-cases-and-reviews-tcr-1-023.php?jid=tcr
