J Korean Orthop Assoc.  2017 Dec;52(6):556-561. 10.4055/jkoa.2017.52.6.556.

Cauda Equina Syndrome by Facet Synovial Pseudocyst Secondary to Epidural Injection

• Kang MS
• Lee YR
• Kim TH
• Lee SH

• KMID: 2421350
• DOI: http://doi.org/10.4055/jkoa.2017.52.6.556

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.

Keyword

cauda equina syndrome; facet synovial pseudocyst; epidural injection; lumbar degenerative disc disease

MeSH Terms

Aged
Cauda Equina*
Epidural Space
Female
Humans
Injections, Epidural*
Leg
Polyradiculopathy*
Spinal Canal

Figure

• 

  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.

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  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).

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  Figure 3 (A) Intraoperative photograph showing the central canal compromising epidural cystic lesion. (B) Photograph showing the resected cystic lesion.

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  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).

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