Spinal epidural cystic lesions

Changed by Henry Knipe, 14 Sep 2023

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Disclosures - updated 16 Jan 2023:

Integral Diagnostics, Shareholder (ongoing)
Micro-X Ltd, Shareholder (ongoing)

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Spinal epidural cystic lesions are fluid-filled lesions within the spinal canal but outside the thecal sac. Their clinical significance is as a potential contributor to spinal cord or nerve root impingement. Simple appearing spinal epidural cysts may represent several entities that differ by origin:

cysts related to interspinous bursitis ¹
discal cysts ¹ and disc sequestration ⁷
extradural spinal arachnoid cysts (Nabor type I spinal meningeal cysts, sometimes referred to as spinal extradural cysts, extra-arachnoid fluid collections, or pseudomeningoceles) ^2,3
facet synovial cysts ~~(sometimes referred to generically as lumbar extradural cysts, or specifically as juxtafacet cysts or spinal ganglion cysts)~~ ^1,4,5
cysts of the ligamentum flavum ^1,6
perineural cysts

More complex fluid collections can also be included in the differential of spinal epidural cyst-like lesions:

varices ⁷
~~hemangioma~~haemangioma (vascular malformation) ⁸
~~hematoma~~
haematoma
abscess

~~-<li>cysts related to <a href="/articles/baastrup-disease-1">interspinous bursitis</a> 1~~
~~-</li>~~
~~-<li>~~
~~-<a href="/articles/discal-cyst">discal cysts</a> 1 and <a href="/articles/disc-sequestration">disc sequestration</a> 7~~
~~-</li>~~
-<li>extradural <a href="/articles/spinal-arachnoid-cyst">spinal arachnoid cysts</a> (<a href="/articles/classification-of-spinal-meningeal-cysts-1">Nabor type</a> I spinal meningeal cysts, sometimes referred to as spinal extradural cysts, extra-arachnoid fluid collections, or <a href="/articles/pseudomeningocele-1">pseudomeningoceles</a>) 2,3
~~-</li>~~
-<li>facet <a href="/articles/spinal-synovial-cyst-1">synovial cysts</a> (sometimes referred to generically as lumbar extradural cysts, or specifically as juxtafacet cysts or spinal ganglion cysts) 1,4,5
~~-</li>~~
~~-<li>~~
~~-<a href="/articles/cyst-of-the-ligamentum-flavum">cysts of the ligamentum flavum</a> 1,6~~
~~-</li>~~
~~-<li><a href="/articles/tarlov-cyst">perineural cysts</a></li>~~
+<li>cysts related to <a href="/articles/baastrup-disease-1">interspinous bursitis</a> 1</li>
+<li><a href="/articles/discal-cyst">discal cysts</a> 1 and <a href="/articles/disc-sequestration">disc sequestration</a> 7</li>
+<li>extradural <a href="/articles/spinal-arachnoid-cyst">spinal arachnoid cysts</a> (<a href="/articles/classification-of-spinal-meningeal-cysts-1">Nabor type</a> I spinal meningeal cysts, sometimes referred to as spinal extradural cysts, extra-arachnoid fluid collections, or <a href="/articles/pseudomeningocele-1">pseudomeningoceles</a>) 2,3</li>
+<li>facet <a href="/articles/spinal-synovial-cyst-1">synovial cysts</a> 1,4,5</li>
+<li><a href="/articles/cyst-of-the-ligamentum-flavum">cysts of the ligamentum flavum</a> 1,6</li>
+<li><a href="/articles/tarlov-cyst">perineural cysts</a></li>
~~-<li>~~
~~-<a href="/articles/portosystemic-collateral-pathways-1">varices</a> 7~~
~~-</li>~~
~~-<li>~~
~~-<a href="/articles/spinal-epidural-hemangioma">hemangioma (vascular malformation)</a> 8~~
~~-</li>~~
~~-<li><a href="/articles/spinal-epidural-haematoma">hematoma</a></li>~~
~~-<li><a href="/articles/spinal-epidural-abscess">abscess</a></li>~~
+<li><a href="/articles/portosystemic-collateral-pathways-1">varices</a> 7</li>
+<li><a href="/articles/spinal-epidural-hemangioma">haemangioma (vascular malformation)</a> 8</li>
+<li><a href="/articles/spinal-epidural-hematoma-1">haematoma</a></li>
+<li><a href="/articles/spinal-epidural-abscess">abscess</a></li>

References changed:

1. Santos F, Souza R, Brotto M, Suguita F, Amaral D, Amaral L. Formações Císticas Epidurais Relacionadas a Bursite Interespinhosa, Cisto Sinovial E Cisto Discal. Radiol Bras. 2009;42(2):131-5. <a href="https://doi.org/10.1590/s0100-39842009000200013">doi:10.1590/s0100-39842009000200013</a>
3. Lee S, Foo A, Tan C et al. Spinal Extradural Cyst: Case Report and Review of Literature. World Neurosurg. 2018;116:343-6. <a href="https://doi.org/10.1016/j.wneu.2018.05.199">doi:10.1016/j.wneu.2018.05.199</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29870839">Pubmed</a>
4. Domenicucci M, Ramieri A, Marruzzo D et al. Lumbar Ganglion Cyst: Nosology, Surgical Management and Proposal of a New Classification Based on 34 Personal Cases and Literature Review. World J Orthop. 2017;8(9):697-704. <a href="https://doi.org/10.5312/wjo.v8.i9.697">doi:10.5312/wjo.v8.i9.697</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28979853">Pubmed</a>
5. Sabo R, Tracy P, Weinger J. A Series of 60 Juxtafacet Cysts: Clinical Presentation, the Role of Spinal Instability, and Treatment. J Neurosurg. 1996;85(4):560-5. <a href="https://doi.org/10.3171/jns.1996.85.4.0560">doi:10.3171/jns.1996.85.4.0560</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8814156">Pubmed</a>
6. Vernet O, Fankhauser H, Schnyder P, Déruaz J. Cyst of the Ligamentum Flavum: Report of Six Cases. Neurosurgery. 1991;29(2):277-83. <a href="https://doi.org/10.1097/00006123-199108000-00021">doi:10.1097/00006123-199108000-00021</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/1832212">Pubmed</a>
7. Im I, Son E, Kim D. Lumbar Epidural Varix Causing Radicular Pain: A Case Report and Differential Diagnosis of Lumbar Cystic Lesions. PM R. 2018;10(11):1283-7. <a href="https://doi.org/10.1016/j.pmrj.2018.04.002">doi:10.1016/j.pmrj.2018.04.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29705169">Pubmed</a>
8. Lee J, Cho E, Hong S et al. Spinal Epidural Hemangiomas: Various Types of MR Imaging Features with Histopathologic Correlation. AJNR Am J Neuroradiol. 2007;28(7):1242-8. <a href="https://doi.org/10.3174/ajnr.A0563">doi:10.3174/ajnr.A0563</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17698523">Pubmed</a>
1. de Paula Lopes Santos FG et al. Epidural cystic masses associated with interspinous bursitis, synovial and discal cysts. (2009) Radiologia Brasileira. 42(2): 131-135. <a href="https://doi.org/10.1590/S0100-39842009000200013">doi:10.1590/S0100-39842009000200013</a>.
3. Lee SW, Foo A, Tan CL, Tan T, Lwin S, Yeo TT, Nga VDW. Spinal Extradural Cyst: Case Report and Review of Literature. (2018) World neurosurgery. 116: 343-346. <a href="https://doi.org/10.1016/j.wneu.2018.05.199">doi:10.1016/j.wneu.2018.05.199</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29870839">Pubmed</a>
4. Domenicucci M, Ramieri A, Marruzzo D, Missori P, Miscusi M, Tarantino R, Delfini R. Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review. (2017) World journal of orthopedics. 8 (9): 697-704. <a href="https://doi.org/10.5312/wjo.v8.i9.697">doi:10.5312/wjo.v8.i9.697</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28979853">Pubmed</a>
5. Sabo RA, Tracy PT, Weinger JM. A series of 60 juxtafacet cysts: clinical presentation, the role of spinal instability, and treatment. (1996) Journal of neurosurgery. 85 (4): 560-5. <a href="https://doi.org/10.3171/jns.1996.85.4.0560">doi:10.3171/jns.1996.85.4.0560</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8814156">Pubmed</a>
6. Vernet O, Fankhauser H, Schnyder P, Déruaz JP. Cyst of the ligamentum flavum: report of six cases. (1991) Neurosurgery. 29 (2): 277-83. <a href="https://doi.org/10.1097/00006123-199108000-00021">doi:10.1097/00006123-199108000-00021</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/1832212">Pubmed</a>
7. Im IK, Son ES, Kim DH. Lumbar Epidural Varix Causing Radicular Pain: A Case Report and Differential Diagnosis of Lumbar Cystic Lesions. (2018) PM & R : the journal of injury, function, and rehabilitation. 10 (11): 1283-1287. <a href="https://doi.org/10.1016/j.pmrj.2018.04.002">doi:10.1016/j.pmrj.2018.04.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29705169">Pubmed</a>
8. Lee JW, Cho EY, Hong SH, Chung HW, Kim JH, Chang KH, Choi JY, Yeom JS, Kang HS. Spinal epidural hemangiomas: various types of MR imaging features with histopathologic correlation. (2007) AJNR. American journal of neuroradiology. 28 (7): 1242-8. <a href="https://doi.org/10.3174/ajnr.A0563">doi:10.3174/ajnr.A0563</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17698523">Pubmed</a>