Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Spinal ganglion cyst presenting with radiculopathy: diagnostic challenges and differential

Spinal Cord Series and Cases volume 7, Article number: 6 (2021) Cite this article

Subjects

Abstract

Introduction

Ganglion cysts are benign soft tissue lesions, usually arising from periarticular connective tissue. These are very rarely reported in the spine, but when seen can cause radiculopathy or myelopathy.

Case presentation

A 68-year-old female patient presented with worsening radiculopathy and right foot drop and imaging noted a right L5–S1 foraminal mass. The lesion was gross totally resected. Histological analysis revealed myxoid degeneration and inflammation, without a synovial lining, consistent with ganglion cyst.

Discussion

While uncommon, intra-foraminal ganglion cysts can be distinguished from synovial cysts through imaging and histology and are typically amenable to surgical resection. Greater knowledge and insight about differentiating ganglion versus synovial cyst may prevent resection of facet joints and prevent a fusion procedure.

Your institute does not have access to this article

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

Buy

All prices are NET prices.

Fig. 1: Axial MRI imaging.
Fig. 2: Sagittal MRI imaging.
Fig. 3: Intaoperative ultrasound imaging.
Fig. 4: Lesion gross appearance.
Fig. 5: Histologic examination of the ganglion cyst reveals a fibroconnective tissue wall (triangle) with area of mural reactive chronic inflammation (arrow), and myxoid degeneration that leads to cyst formation (star).

References

  1. Schoellhammer L, Nielsen TW, Berg JO. Large ganglion cyst with unusual location on the back—a case report. Plast Reconstr Surg Glob Open. 2016;4:729. https://doi.org/10.1097/GOX.0000000000000746.

    Article  Google Scholar 

  2. Kim SW, Choi JH, Kim MS, Chang CH. A ganglion cyst in the second lumbar intervertebral foramen. J Korean Neurosurg Soc. 2011;49:237–40. https://doi.org/10.3340/jkns.2011.49.4.237.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lyons MK, Atkinson JLD, Wharen RE, Deen HG, Zimmerman RS, Lemens SM. Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg. 2000;93:53–7. https://doi.org/10.3171/spi.2000.93.1.0053.

    CAS  Article  PubMed  Google Scholar 

  4. Radatz M, Jakubowski J, Cooper J, Powell T. Synovial cysts of the lumbar spine: a review. Br J Neurosurg. 1997;11:520–4. https://doi.org/10.1080/02688699745673.

    CAS  Article  PubMed  Google Scholar 

  5. Domenicucci M, Ramieri A, Marruzzo D, Missori P, Miscusi M, Tarantino R, et al. Lumbar ganglion cyst: nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review. World J Orthop. 2017;8:697–704. https://doi.org/10.5312/wjo.v8.i9.697.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kim J, Choi J, Son B. Bilateral ganglion cysts of the ligamentum flavum in the cervical spine causing a progressive cervical radiculomyelopathy and literature review. Case Rep Neurol Med. 2017;2017:1–5. https://doi.org/10.1155/2017/3953641.

    CAS  Article  Google Scholar 

  7. Yamamoto A, Nishiura I, Handa H, Kondo A. Ganglion cyst in the ligamentum flavum of the cervical spine causing myelopathy: report of two cases. Surg Neurol. 2001;56:390–5. https://doi.org/10.1016/S0090-3019(01)00639-5.

    CAS  Article  PubMed  Google Scholar 

  8. Neto N, Nunnes P. Spectrum of MRI features of ganglion and synovial cysts. Insights Imaging. 2016;7:179–86. https://doi.org/10.1007/s13244-016-0463-z.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. Case Rep J Neurosurg. 1974;41:372–6. https://doi.org/10.3171/jns.1974.41.3.0372.

    CAS  Article  Google Scholar 

  10. Stoodley MA, Jones NR, Scott G. Cervical and thoracic juxtafacet cysts causing neurologic deficits. Spine. 2000;25:970–3. https://doi.org/10.1097/00007632-200004150-00012.

    CAS  Article  PubMed  Google Scholar 

  11. Song JK, Musleh W, Christie SD, Fessler RG. Cervical juxtafacet cysts: case report and literature review. Spine J. 2006;6:279–81. https://doi.org/10.1016/j.spinee.2005.09.006.

    CAS  Article  PubMed  Google Scholar 

  12. Cho SM, Rhee WT, Lee SY, Lee SB. Ganglion cyst of the posterior longitudinal ligament causing lumbar radiculopathy. J Korean Neurosurg Soc. 2010;47:298–301. https://doi.org/10.3340/jkns.2010.47.4.298.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Giger R, Szalay-Quinodoz I, Haenggeli A, Dulguerov P. Ganglion cyst of the spinal anterior longitudinal ligament presenting as a retropharyngeal mass. Am J Otolaryngol Head Neck Med Surg. 2002;23:390–3. https://doi.org/10.1053/ajot.2002.126323.

    Article  Google Scholar 

  14. Mizutamari M, Sei A, Fujimoto T, Taniwaki T, Mizuta H. L5 radiculopathy caused by a ganglion cyst of the posterior longitudinal ligament in a teenager. Spine J. 2009;9:e11–4. https://doi.org/10.1016/j.spinee.2008.05.013.

    Article  PubMed  Google Scholar 

  15. Cohen-Gadol AA, White JB, Lynch JJ, Miller GM, Krauss WE. Synovial cysts of the thoracic spine. J Neurosurg. 2004;101:52–7. https://doi.org/10.3171/spi.2004.1.1.0052.

    Article  Google Scholar 

  16. Vanhoenacker FM, Eyselbergs M, Van Hul E, Van Dyck P, De Schepper AM. Pseudotumoural soft tissue lesions of the hand and wrist: a pictorial review. Insights Imaging. 2011;2:319–33. https://doi.org/10.1007/s13244-011-0076-5.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cheng WY, Shen CC, Wen MC. Ganglion cyst of the cervical spine presenting with Brown-Sequard syndrome. J Clin Neurosci. 2006;13:1041–5. https://doi.org/10.1016/j.jocn.2005.07.028.

    Article  PubMed  Google Scholar 

  18. Kurz LT, Garfin SR, Unger AS, Thorne RP, Rothman RH. Intraspinal synovial cyst causing sciatica. J Bone Jt Surg Ser A. 1985;67:865–71. https://doi.org/10.2106/00004623-198567060-00006.

    CAS  Article  Google Scholar 

  19. Cudlip S, Johnston F, Marsh H. Subaxial cervical synovial cyst presenting with myelopathy. J Neurosurg Spine. 2009;90:141–4. https://doi.org/10.3171/spi.1999.90.1.0141.

    Article  Google Scholar 

  20. Arantes M, Silva RS, Romão H, Resende M, Moniz P, Honavar M, et al. Spontaneous hemorrhage in a lumbar ganglion cyst. Spine (Phila Pa 1976). 2008;33:e521–4. https://doi.org/10.1097/BRS.0b013e31817b6206.

    Article  Google Scholar 

  21. 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;65:385–90. https://doi.org/10.1016/j.surneu.2005.07.073.

    Article  PubMed  Google Scholar 

  22. Métellus P, Fuentes S, Adetchessi T, Levrier O, Flores-Parra I, Talianu D, et al. Retrospective study of 77 patients harbouring lumbar synovial cysts: Functional and neurological outcome. Acta Neurochir (Wien). 2006;148:4754. https://doi.org/10.1007/s00701-005-0650-z.

    Article  PubMed  Google Scholar 

  23. Sabo RA, Tracy PT, Weinger JM. A series of 60 juxtafacet cysts: Clinical presentation, the role of spinal instability, and treatment. J Neurosurg. 1996;85:560–5. https://doi.org/10.3171/jns.1996.85.4.0560.

    CAS  Article  PubMed  Google Scholar 

  24. Denis DR, Hirt D, Shah S, Lu DC, Holly LT. Minimally invasive surgery for lumbar synovial cysts with coexisting degenerative spondylolisthesis. Int J Spine Surg. 2016;10. https://doi.org/10.14444/3037.

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    Lohit Velagapudi, Caio M. Matias, Christopher Elia, Garrett Largoza & James S. Harrop

  2. Rothman Orthopedic Institute, Thomas Jefferson University, Philadelphia, PA, USA

    David Stolzenberg

  3. Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA

    Rick Feld

  4. Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA

    Mark Curtis

Authors
  1. Lohit Velagapudi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caio M. Matias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher Elia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Stolzenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Garrett Largoza
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rick Feld
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mark Curtis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. James S. Harrop
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lohit Velagapudi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Velagapudi, L., Matias, C.M., Elia, C. et al. Spinal ganglion cyst presenting with radiculopathy: diagnostic challenges and differential. Spinal Cord Ser Cases 7, 6 (2021). https://doi.org/10.1038/s41394-020-00373-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41394-020-00373-3

Search

Advanced search

Quick links