Abstract
Synovial cysts are a common accompaniment of osteoarthritis in the lumbar spine, causing pain and neurological symptoms. Bleeding within the cyst generally leads to changes in intensity and can cause neurological deterioration and/or painful symptoms that are violent and generally intractable. We present here an interesting case of hemorrhage in a synovial cyst while the patient was waiting for surgery. A 64-year-old man, who was on anti-platelet therapy, presented with severe lumbago and pain over the left lower extremity during gardening, which had persisted for two months. The initial magnetic resonance imaging (MRI) scan revealed a space occupying the intraspinal lesion that was close to the facet joint at the left L4-L5. His lumbago and pain over his left lower extremity suddenly deteriorated while he was waiting for his surgery. A follow-up MRI revealed signal changes of the lesion, which indicated a hemorrhagic change in the cyst. During surgery, this was proven to be a hemorrhagic mass on the left L5 root sleeve, arising from the facet joint. There was no epidural vascular lesion present. The operation dramatically relieved the patient's symptoms. The diagnosis was confirmed by the histopathological analysis, which presented partially synovial lining cells and a capsule with intracystic bleeding. These pathological findings coincided with the clinical and the radiological findings. MRI is useful for diagnosing hemorrhage of which will show changes in its intensity depending on its onset. The post-operative results following hemorrhagic synovial cyst excision are excellent, if they are treated in the early stage. Surgical treatment should be performed as soon as possible in order to prevent any post operative residual neurological deficit.
