Hemorrhagic Lumbar Synovial Cyst
A 72-year-old-woman with a past history of hypertension presented to the clinic with acute back pain radiating to the anterior surface of the right thigh and leg. There was no history of a previous traumatic event or history of anticoagulation treatment. She denied any bowel or bladder incontinence. On neurologic examination, muscle power and sensation were intact. The right straight-leg-raise test elicited pain in the leg at 30° which was exacerbated further by ankle dorsiflexion. Routine biochemical and hematological tests were within normal limit. Magnetic resonance imaging (MRI) revealed the presence of a cystic formation in the right L2-L3 facet joint with arthritis compressing the L3 right root and the dural sac (). In addition, the MRI displayed a hyperintense abnormality on T1-weighted images and hypointense on T2-weighted images consistent with hemorrhage. No connection with the intervertebral disc was identified. Surgical excision was perfomed 2 days after admission. The posterior elements from L1 to L3 were exposed and right L2-L3 laminectomy and facetectomy were performed. A brownish mass was found in continuity with the right L2-L3 facet joint adherent to the dural sac. The extradural hematoma was visualized and evacuated, effectively decompressing the right 2 nerve root and sacral sac. Histological examination of the surgical specimen revealed a synovial cyst with hematoma. Microscopically, there was a synovial cyst with synovial cell lining, neovascularization, hemosiderin microdeposits, and blood (). On postoperative day 1, the patient was able to walk independently. Recovery was uneventful except for an episode of slight pain in the right leg. One month after the operation, the patient had no symptoms in her lower back and leg.