Lumbar juxtafacet cyst clinical [Neurosurgery Wiki]

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====== Lumbar juxtafacet cyst clinical ======

The average age was 63 years in one series
((Sabo RA, Tracy PT, Weinger JM. A Series of 60 Juxtafacet Cysts: Clinical Presentation, the Role of Spinal Instability, and Treatment. J Neurosurg. 1996; 85:560–565))
and 58 years in a review of 54 cases in the literature
((Liu SS, Williams KD, Drayer BP, et al. Synovial Cysts of the Lumbosacral Spine: Diagnosis by MR Imaging. AJNR. 1989; 10:1239–1242)) 
(range: 33–87) with a slight female preponderance in both series. Most occur in patients with severe [[spondylosis]] and facet joint degeneration,
((Silbergleit R, Gebarski SS, Brunberg JA, et al. Lumbar Synovial Cysts: Correlation of Myelographic, CT, MR, and Pathologic Findings. AJNR. 1990; 11:777–779)) 
25% had degenerative spondylolisthesis.
((Sabo RA, Tracy PT, Weinger JM. A Series of 60 Juxtafacet Cysts: Clinical Presentation, the Role of Spinal Instability, and Treatment. J Neurosurg. 1996; 85:560–565))
L4–5 is the most common level.
((Sabo RA, Tracy PT, Weinger JM. A Series of 60 Juxtafacet Cysts: Clinical Presentation, the Role of Spinal Instability, and Treatment. J Neurosurg. 1996; 85:560–565))
((Gorey MT, Hyman RA, Black KS, et al. Lumbar Synovial Cysts Eroding Bone. AJNR. 1992; 13:161–163))
They may be bilateral. Pain is the most common symptom and is usually radicular. Some JFC may contribute to canal stenosis and can produce [[neurogenic claudication]] 
((Conrad M, Pitkethly D. Bilateral Synovial Cysts Creating Spinal Stenosis. J Comput Assist Tomogr. 1987; 11:196–197)) 
or on occasion a cauda equina syndrome. Symptoms may be more intermittent in nature than with firm 
compressive lesions, such as HLD. A sudden exacerbation in pain may be due to hemorrhage within the cyst. Some JFC may be asymptomatic
((Hemminghytt S, Daniels DL, Williams ML, et al. Intraspinal Synovial Cysts: Natural History and Diagnosis by CT. Radiology. 1982; 145:375–376)).
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[[Lumbar]] [[juxtafacet cyst]]s are a rare but increasingly common cause of symptomatic [[nerve root compression]] and can lead to [[radiculopathy]], [[neurogenic claudication]]
((Conrad MR, Pitkethly DT. Bilateral synovial cysts creating spinal stenosis: CT
diagnosis. J Comput Assist Tomogr. 1987 Jan-Feb;11(1):196-7. PubMed PMID:
3805420.))
, and [[cauda equina syndrome]].

Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. 

It is a benign condition, and the symptoms and level of pain or discomfort may remain stable for many years.

The fluid-filled sac creates pressure inside the [[spinal canal]], which can give a patient all the symptoms of stenosis of the spine.

The pain probably comes from the venous blood around the nerves not being able to drain, which leads to pain and irritation of the nerves. Sitting down allows the blood to drain and relieves the pressure.


Less commonly, neurological deterioration has been attributed to rapid cystic growth with hemorrhage
((Eck JC, Triantafyllou SJ (2005) Hemorrhagic lumbar synovial facet cyst secondary to anticoagulation therapy. Spine J 5:451–453))
((Wang YY, McKelvie P, Trost N, Murphy MA (2004) Trauma as a precipitant of haemorrhage in synovial cysts. J Clin Neurosci 11:436–439)).