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A rare cause of low back pain: intraspinal synovial cyst containing gas
Accepted Manuscript Title: A rare cause of low back pain; intraspinal synovial cyst containing gas Author: Hakan Cebeci, Ali Fuat Tekin, Mesut Sivri, Ali Sami Kıvrak PII: DOI: Reference:
S1529-9430(16)00284-9 http://dx.doi.org/doi: 10.1016/j.spinee.2016.01.175 SPINEE 56837
To appear in:
The Spine Journal
Please cite this article as: Hakan Cebeci, Ali Fuat Tekin, Mesut Sivri, Ali Sami Kıvrak, A rare cause of low back pain; intraspinal synovial cyst containing gas, The Spine Journal (2016), http://dx.doi.org/doi: 10.1016/j.spinee.2016.01.175. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
A rare cause of low back pain; intraspinal synovial cyst containing gas
2
Hakan Cebeci, MD, Specialist, Department of Radiology, Selcuk University Faculty of
3
Medicine, Konya, Turkey
4
Ali Fuat Tekin, MD, Assistant, Department of Radiology, Konya Research and Education
5
Hospital, Konya, Turkey.
6
Mesut Sivri, MD, Assistant , Department of Radiology, Selcuk University Faculty of
7
Medicine, Konya, Turkey
8
Ali Sami Kıvrak, MD, Associate Professor, Department of Radiology, Selcuk University
9
Faculty of Medicine, Konya, Turkey
10 11 12
Corresponding author:
13
Hakan Cebeci, MD, Specialist
14
Department of Radiology, Selcuk University Faculty of Medicine,
15
Konya, Turkey, 42075
16
Phone: +90 332 224 38 00 Fax: +90 332 224 38 00
17
E mail: [email protected]
18
The Authors declare that there is no conflict of interest.
19
Running Title: Intraspinal synovial cyst containing gas
20
Keywords: back pain; intraspinal; synovial cyst.
21
Page 1 of 3
22
A rare cause of low back pain; intraspinal synovial cyst containing gas
23
A 55-year-old female patient was admitted to our clinic with low back pain radiating to
24
left lower extremity, over a period of three months. On physical examination,
25
flattening of lumbar lordosis, thirty degrees of rotation limitation to the left side and
26
hypoesthesia on the area innervated by left L4 spinal nerve were determined. L4-5
27
degenerative disc disease was on top of definitive diagnosis according to the
28
physical examination. Magnetic resonance imaging of lumbar spine revealed spinal
29
extradural well defined nodular lesion (on the left paracentral area at the level of L4-5
30
intervertebral disc), with the size of 9x5 mm. The lesion was hyperintense with
31
peripherally hypointense rim on T2 weighted images and hypointense on T1
32
weighted images (Fig 1a, b). Enhancement was not demonstrated after intravenous
33
gadolinium
34
demonstrated encapsulated cystic lesion containing gas and vacuum phenomenon
35
on left facet joint (Fig 2a). The lesion was located medially to left facet joint with
36
compression to thecal sac (Fig 2b). Lumbar intraspinal synovial cyst was diagnosed
37
according to these imaging findings.
38
Synovial cysts are formed as a result of degeneration and outpouching of joint
39
capsule [1]. Fifth and sixth decades are peak ages. L4-5 is the most commonly
40
location in the lumbar region.
41
symptoms [2]. Pain radiating to lower extremity is the most frequently clinical
42
symptom, while neurological deficit is rare. Gas content of synovial cyst is rare and
43
associated with vacuum phenomenon in the adjacent facet joint [3].
administration
(Fig
1c).
Computed
tomography
examination
Compression of spinal nerve roots causes clinical
44 45
Page 2 of 3
46 47
References:
48
1. Atalar, M. H., Isik, A. O., Gümüs, C. Lumbar Intraspinal Synovial Cyst
49
Containing Gas As a Cause for Low-Back Pain: Computed Tomography and
50
Magnetic Resonance Imaging Findings. C. U. Medical Faculty Journal 2006;
51
28: 33 – 36.
52
2. Milcan, A, Ozdemir, C, Karabacak, T, Duce, M. N, Bagdatoglu, C. A case of
53
lumbar
ganglion
cyst
causing
radiculopathy.
54
traumatologica turcica 2005; 39: 79-82.
Acta
orthopaedica
et
55
3. Firth, R. L. Lumbar intraspinal synovial cyst containing gas as a cause for low-
56
back pain. Journal of manipulative and physiological therapeutics 2000; 23:
57
276-278.
58 59
Figure Legends
60
1. Fig 1: Sagittal T2 weighted (a) and sagittal T1 weighted (b) images shows
61
spinal extradural well defined cystic lesion. Contrast enhanced sagittal T1
62
weighted (c) images revealed no enhancement
63
2. Fig 2: Axial computed tomography images (a) shows gas containing
64
encapsulated cystic lesion and axial T2 weighted images (b) shows the
65
location of cyst medially to left facet joint.
66
Page 3 of 3
S1529-9430(16)00284-9 http://dx.doi.org/doi: 10.1016/j.spinee.2016.01.175 SPINEE 56837
To appear in:
The Spine Journal
Please cite this article as: Hakan Cebeci, Ali Fuat Tekin, Mesut Sivri, Ali Sami Kıvrak, A rare cause of low back pain; intraspinal synovial cyst containing gas, The Spine Journal (2016), http://dx.doi.org/doi: 10.1016/j.spinee.2016.01.175. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
A rare cause of low back pain; intraspinal synovial cyst containing gas
2
Hakan Cebeci, MD, Specialist, Department of Radiology, Selcuk University Faculty of
3
Medicine, Konya, Turkey
4
Ali Fuat Tekin, MD, Assistant, Department of Radiology, Konya Research and Education
5
Hospital, Konya, Turkey.
6
Mesut Sivri, MD, Assistant , Department of Radiology, Selcuk University Faculty of
7
Medicine, Konya, Turkey
8
Ali Sami Kıvrak, MD, Associate Professor, Department of Radiology, Selcuk University
9
Faculty of Medicine, Konya, Turkey
10 11 12
Corresponding author:
13
Hakan Cebeci, MD, Specialist
14
Department of Radiology, Selcuk University Faculty of Medicine,
15
Konya, Turkey, 42075
16
Phone: +90 332 224 38 00 Fax: +90 332 224 38 00
17
E mail: [email protected]
18
The Authors declare that there is no conflict of interest.
19
Running Title: Intraspinal synovial cyst containing gas
20
Keywords: back pain; intraspinal; synovial cyst.
21
Page 1 of 3
22
A rare cause of low back pain; intraspinal synovial cyst containing gas
23
A 55-year-old female patient was admitted to our clinic with low back pain radiating to
24
left lower extremity, over a period of three months. On physical examination,
25
flattening of lumbar lordosis, thirty degrees of rotation limitation to the left side and
26
hypoesthesia on the area innervated by left L4 spinal nerve were determined. L4-5
27
degenerative disc disease was on top of definitive diagnosis according to the
28
physical examination. Magnetic resonance imaging of lumbar spine revealed spinal
29
extradural well defined nodular lesion (on the left paracentral area at the level of L4-5
30
intervertebral disc), with the size of 9x5 mm. The lesion was hyperintense with
31
peripherally hypointense rim on T2 weighted images and hypointense on T1
32
weighted images (Fig 1a, b). Enhancement was not demonstrated after intravenous
33
gadolinium
34
demonstrated encapsulated cystic lesion containing gas and vacuum phenomenon
35
on left facet joint (Fig 2a). The lesion was located medially to left facet joint with
36
compression to thecal sac (Fig 2b). Lumbar intraspinal synovial cyst was diagnosed
37
according to these imaging findings.
38
Synovial cysts are formed as a result of degeneration and outpouching of joint
39
capsule [1]. Fifth and sixth decades are peak ages. L4-5 is the most commonly
40
location in the lumbar region.
41
symptoms [2]. Pain radiating to lower extremity is the most frequently clinical
42
symptom, while neurological deficit is rare. Gas content of synovial cyst is rare and
43
associated with vacuum phenomenon in the adjacent facet joint [3].
administration
(Fig
1c).
Computed
tomography
examination
Compression of spinal nerve roots causes clinical
44 45
Page 2 of 3
46 47
References:
48
1. Atalar, M. H., Isik, A. O., Gümüs, C. Lumbar Intraspinal Synovial Cyst
49
Containing Gas As a Cause for Low-Back Pain: Computed Tomography and
50
Magnetic Resonance Imaging Findings. C. U. Medical Faculty Journal 2006;
51
28: 33 – 36.
52
2. Milcan, A, Ozdemir, C, Karabacak, T, Duce, M. N, Bagdatoglu, C. A case of
53
lumbar
ganglion
cyst
causing
radiculopathy.
54
traumatologica turcica 2005; 39: 79-82.
Acta
orthopaedica
et
55
3. Firth, R. L. Lumbar intraspinal synovial cyst containing gas as a cause for low-
56
back pain. Journal of manipulative and physiological therapeutics 2000; 23:
57
276-278.
58 59
Figure Legends
60
1. Fig 1: Sagittal T2 weighted (a) and sagittal T1 weighted (b) images shows
61
spinal extradural well defined cystic lesion. Contrast enhanced sagittal T1
62
weighted (c) images revealed no enhancement
63
2. Fig 2: Axial computed tomography images (a) shows gas containing
64
encapsulated cystic lesion and axial T2 weighted images (b) shows the
65
location of cyst medially to left facet joint.
66
Page 3 of 3