Cauda Equina Syndrome by Facet Synovial Pseudocyst Secondary to Epidural Injection

Min-Seok Kang; Yeong-Ryung Lee; Tae-Hoon Kim; Suk-Ha Lee

doi:10.4055/jkoa.2017.52.6.556

Journal List > J Korean Orthop Assoc > v.52(6) > 1013566

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Kang, Lee, Kim, and Lee: Cauda Equina Syndrome by Facet Synovial Pseudocyst Secondary to Epidural Injection

Case Report

Journal of the Korean Orthopaedic Association 2017; 52(6): 556-561.

Published online: 22 December 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.6.556

Cauda Equina Syndrome by Facet Synovial Pseudocyst Secondary to Epidural Injection

Min-Seok Kang, M.D., Yeong-Ryung Lee, M.D., Tae-Hoon Kim, M.D.^*, Suk-Ha Lee, M.D., Ph.D.^*

Department of Orthopedic Surgery, Seoul Red Cross Hospital, Seoul, Korea.

^*Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

Correspondence to: Suk-Ha Lee, M.D., Ph.D. Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea. TEL: +82-2-2030-7608, FAX: +82-2-2030-7369, sthkim96@gmail.com

Received 26 January 2017 Revised 8 February 2017 Accepted 9 February 2017

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 77-year-old woman presented with bilateral leg weakness, accompanied by severe axial back and radicular pain, after a L4–5 epidural injection. She had been receiving misappropriated epidural injections for the last few months. A contrast-enhanced magnetic resonance image showed rim enhancing, spinal canal compromising cystic lesion at the posterior epidural space of L4–5. During surgery, a severely central compromised non-communicating cystic lesion located at posterior epidural space was resected. A histological report of this lesion confirmed a pseudocyst containing a degenerated synovial tissue. Herein, we report our experience of cauda equine syndrome after epidural injection with successful treatment.

Keywords: cauda equina syndrome, facet synovial pseudocyst, epidural injection, lumbar degenerative disc disease

Figures and Tables

Figure 1

The plane lateral radiograph (A) and sagittal T2WI magnetic resonance imaging (B) demonstrate L4 degenerative spondylolisthesis and central canal stenosis at L4–5.

Figure 2

Contrast magnetic resonance imaging demonstrates a posterior epidural cystic lesion at L4–5. Sagittal T1WI shows a low signal (A) and T2WI shows a high signal intensity of the mass (arrows) (B), suggesting the facet synovial cyst. This intraspinal cystic lesion was located on the posterior epidural space (arrows) on axial T1WI (C) and T2WI (D).

Figure 3

(A) Intraoperative photograph showing the central canal compromising epidural cystic lesion. (B) Photograph showing the resected cystic lesion.

Figure 4

Histologic findings. Photomicrographs show a degenerated synovial tissue with calcification (A: H&E, ×100) and show an infiltration of chronic inflammatory cells and scattered foreign body type giant cells (arrows) (B: H&E, ×200).

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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