Characteristic MRI and MR Myelography Findings for the Facet Cyst Hematoma at T12-L1 Spine: A Case Report

제12번 흉추와 제1번 요추에서 발생한 후관절낭혈종의 특징적인 자기공명영상과 자기공명척수조영술 소견: 증례 보고

  • Chung, Seung-Eun (Department of Diagnostic Radiology, Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Kim, Tae-Hong (Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Choi, Gun (Department of Neurosurgery, Seoul Wooridul Hospital) ;
  • Paeng, Sung-Suk (Department of Pathology, Wooridul Spine Hospital)
  • 정승은 (우리들병원 영상의학과) ;
  • 이상호 (우리들병원 신경외과) ;
  • 김태홍 (인제대학교 상계백병원 신경외과) ;
  • 최건 (서울우리들병원 신경외과) ;
  • 팽성숙 (우리들병원 병리학과)
  • Published : 2011.05.01

Abstract

A facet cyst is a very rare condition in the thoracolumbar spine and more so, hemorrhage into a cyst is extremely rare. We present a case of a facet cyst hematoma in the T12-L1 spine. A 69-year-old woman complained of chronic back pain with right lower extremity pain, and weakness for 3 years. MRI and MR myelography showed an extradural mass at the T12-L1 level with heterogeneous signal intensity on both T1-and T2-weighted images, which was continuous to the right T12-L1 facet joint. The neighboring facet joint showed severe degeneration on the CT scan. The mass a was simple hematoma covered with a thin fibrous membrane and connected with facet joint macroscopically and microscopically. The pathogenesis of the facet cyst hematoma is not clear but it can compress nerve roots or dura mater and cause radiculopathy or cauda equina syndrome. Surgical removal should be recommended for symptomatic relief.

흉요추의 후관절낭혈종은 아주 드문 질환이다. 저자들은 만성적인 요통과 우 하 방사통을 호소하는 69세 환자에서 12번 흉추와 1번 요추에서 발생한 우측 후관절낭혈종을 경험하여 증례 보고 및 문헌고찰을 하는 바이다. 자기공명영상과 자기공명척수조영술에서 척추관 우측 후방에 경막 외 비균질성 고신호 병변이 보였고 인접한 후관절과 연결되어 있었다. 수술적 소견으로는 얇은 막을 갖는 혈종으로 후관절과 연결되어 있었고, 조직학적 검사에서 혈종으로 확진 되었다. 자기공명영상과 자기공명척수조영술은 비침습적 검사로 병변의 특징적인 신호강도를 보여 줌으로써 진단과 치료에 큰 도움이 되었다.

Keywords

References

  1. Lyons MK, Atkinson JL, Wharen RE, Deen HG, Zimmerman RS, Lemens SM. Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg 2000;93(1 Suppl):53-57 https://doi.org/10.3171/jns.2000.93.1.0053
  2. Kjerulf TD, Terry DW Jr., Boubelik RJ. Lumbar synovial or ganglion cysts. Neurosurgery 1986;19:415-420 https://doi.org/10.1227/00006123-198609000-00013
  3. Wildi LM, Kurrer MO, Benini A, Weishaupt D, Michel BA, Bruhlmann P. Pseudocystic degeneration of the lumbar ligamentum flavum: a little known entity. J Spinal Disord Tech 2004;17:395-400 https://doi.org/10.1097/01.bsd.0000109837.59382.0e
  4. Kusakabe T, Kasama F, Aizawa T, Sato T, Kokubun S. Facet cyst in the lumbar spine: radiological and histopathological findings and possible pathogenesis. J Neurosurg Spine 2006;5:398-403 https://doi.org/10.3171/spi.2006.5.5.398
  5. Ramieri A, Domenicucci M, Seferi A, Paolini S, Petrozza V, Delfini R. Lumbar hemorrhagic synovial cysts: diagnosis, pathogenesis, and treatment. Report of 3 cases. Surg Neurol 2006;65:385-390 https://doi.org/10.1016/j.surneu.2005.07.073
  6. Wait SD, Jones FD, Lonser RR, Lee KS. Symptomatic epidural hematoma caused by lumbar synovial cyst rupture: report of two cases and review of the literature. Neurosurgery 2005;56:E1157
  7. Miyatake N, Aizawa T, Hyodo H, Sasaki H, Kusakabe T, Sato T. Facet cyst haematoma in the lumbar spine: a report of four cases. J Orthopaedic Surg 2009;17:80-84 https://doi.org/10.1177/230949900901700118
  8. Fukuda C, Hirofuji E. Juxta-facet hematom. J Orthop Sci 2007;12:597-600 https://doi.org/10.1007/s00776-007-1170-x
  9. Hsu KY, Zucherman J, Shea WJ, Jeffrey RA. Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment. Spine 1995;20:80-89 https://doi.org/10.1097/00007632-199501000-00015
  10. Khan A, Synnot K, Cammisa F, Girardi F. Lumbar synovial cysts of the spine: an evaluation of surgical outcome. J Spinal Disord Tech 2005;18:127-131 https://doi.org/10.1097/01.bsd.0000156830.68431.70