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LETTER TO EDITOR Table of Contents   
Year : 1999  |  Volume : 9  |  Issue : 1  |  Page : 33
MR of a lumbar ganglion cyst


Department of Neurosurgery, Ram Saran Das Kishorilal Hospital, Amritsar, Punjab, India

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How to cite this article:
Kapoor A, Chaudhary AK, Sandhu P, Sharma V. MR of a lumbar ganglion cyst. Indian J Radiol Imaging 1999;9:33

How to cite this URL:
Kapoor A, Chaudhary AK, Sandhu P, Sharma V. MR of a lumbar ganglion cyst. Indian J Radiol Imaging [serial online] 1999 [cited 2019 Nov 14];9:33. Available from: http://www.ijri.org/text.asp?1999/9/1/33/28372
Sir,

We would like to describe the MR findings in a rare case of a spinal ganglion cyst in the lumbar spine.

A 28-years old male presented with history of sudden low backache with radiation to the right lower limb that increased while at rest and at night. Physical examination revealed obliteration of the lumbar lordosis with an SLR of 30 degrees on the right side and an absent right ankle jerk along with hypoesthesia in the distribution of the L5 nerve root. A clinical diagnosis of a prolapsed L5/S1 disc was made. Routine plain radiographs of the lumbar spine showed a straightened curvature. A plain MR was performed which revealed an oval, hyperintense, extradural lesion in the right paramedian location at the posterior margin of L5 on T2W images [Figure - 1],[Figure - 2]. The L5/S1 disc was normal. The right L5 nerve root was thickened. The possibilities considered were ganglion cyst and epidural varix. At surgery, a thickened right L5 nerve root was seen displaced posteriorly by a gray rounded mass which was attached to the posterior longitudinal ligament. While excising the latter clear fluid came out. The disc space was normal. The lesion was removed and sent for histopathological examination that showed dense fibrous tissue with cystic areas. No cartilaginous or synovial tissue was seen. There was complete disappearance of the patient's symptoms after the surgery.

Only a few cases of a lumbar ganglion cyst have been described in literature [1],[2],[3]. The commonest clinical presentation is low backache and sciatica with a history of characteristic night pain that is due to the accumulation of fluid on the dorsal side of the cyst causing increased nerve root compression [4]. MR is a useful preoperative modality for diagnosing and differentiating it from disk herniation that is the commonest clinical diagnosis in such cases. It clearly delineates the oval extradural hyperintense cyst from the disk. The commonest sites of origin of a ganglion cyst are the capsule of the facet joint, posterior longitudinal ligament and annulus fibrosus [5],[6]. On imaging the differential diagnosis is an epidural varix which may show low signal intensity areas on T2W images [5].

 
   References Top

1.Eggert HR, Agnoli AI, Mennel HD. Lumbar intraspinal ganglionic cyst. Acta Neurochirugica 1981; 59: 263-266.   Back to cited text no. 1    
2.Gritizka TH, Taylor TKF. A ganglion arising from a lumbar articular facet associated with a low back pain and sciatica. J Bone Joint Surg 1970; 52-B: 528-531.   Back to cited text no. 2    
3.Barea D, Teschner D, Chouc P, Jeandel P, Briant JF. Cyst of the lumbar posterior longitudinal ligament. A unusual cause of non discal sciatica. J Radiol 1996; 77: 579-581.   Back to cited text no. 3    
4.Carp L, Stout AP. A study of ganglionic cyst. With special reference to treatment. Surg Gynaecol Obst 1928; 47: 460-468.   Back to cited text no. 4    
5.Ogawa Y, Kumano K, Hirabayashi S, Aota Y. A ganglion cyst in the lumbar spinal canal. A case report. Spine 1992; 17: 1429-1431.   Back to cited text no. 5    
6.Kornberg M. Nerve root compression by a ganglionic cyst of the lumbar annulus fibrosus. A case report. Spine 1995; 20: 1663-1665.   Back to cited text no. 6    

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Correspondence Address:
Atul Kapoor
Department of Neurosurgery, Ram Saran Das Kishorilal Hospital, Amritsar, Punjab
India
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Source of Support: None, Conflict of Interest: None


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