Presentation
Two months history of lumbar back pain, radiating to both lower limbs.
Patient Data
An intraspinal extradural small cystic lesion with a hypointense signal on T1, hyperintense signal on T2 and post-contrast marginal enhancement. It is seen distal to the conus opposite L3-4 level at left side with no foraminal extension. It exerts moderate spinal canal stenosis, compressing thecal sac and encroaching upon the ipsilateral exiting and traversing nerve roots.
Moderate spondylodegenerative changes with marginal osteophytes and intervertebral disc desiccation, more on L4-5 disc level.
L3-4 mild diffuse posterior disc bulge partially encroaching upon both exit neural foramina.
L4-5 moderate diffuse posterior disc bulge with right posterolateral protrusion encroaching upon both exit neural foramina more on right side.
Bilateral facet arthropathy, more on L3-4 level.
The patient was treated with surgical decompression laminectomy and excision of synovial cyst. Thecal sac has regained its normal shape.
Case Discussion
The patient's symptoms were due to the effects of degenerative disc herniations and spinal synovial cyst, so a decompression spinal laminectomy with excision of the cyst was done. There is adjacent facet joint arthropathy, which is a typical association.
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