Manuel Rodríguez-García, MD. Instituto Soriano de Cirugía de Columna Mínimamente. Invasiva at ABC Medical Center, Santa Fe Campus,. Neurological Center ...
The Spine Journal 16 (2016) e329–e330
Images of Spine Care Spinal extradural arachnoid cyst in aging spine A 67-year-old man presented with complaints of low back pain associated with bilateral claudication and weakness of both feet of 15 months’ duration. Physical examination revealed an increase of osteotendinous reflexes in both legs and Babinski sign. Magnetic resonance imaging examination
showed a cystic lesion with regular contour from T12 to L2. The lesion was hypointense on T1-weighted image and hyperintense on T2-weighted image; it was homogenous with cerebrospinal fluid, with no contrast enhancement noted (Fig. 1). Medullary cone and cauda equina were compressed dorsally (Fig. 2). The patient was surgically managed and the diagnosis was spinal extradural arachnoid cyst and lumbar canal stenosis. Spinal arachnoid cysts are uncommon, accounting for about 1% of all spinal tumors [1]. Spinal
Fig. 1. Sagittal T1-weighted image (A) shows a hypointense cystic lesion (arrows) from T12 to L2. Sagittal T2-weighted image (B) shows the same lesion hyperintense (arrows). No enhancement of the lesion in sagittal image (C). Regular contours and foraminal extension to L1–L2 appreciated in coronal image (D). http://dx.doi.org/10.1016/j.spinee.2015.11.047 1529-9430/© 2015 Elsevier Inc. All rights reserved.
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J. Quillo-Olvera et al. / The Spine Journal 16 (2016) e329–e330
arachnoid cysts occur most frequently in the thoracic spine (65%), followed by the lumbosacral spine (3%), and the thoracolumbar spine (3.3%). Most of the lesions are located posteriorly in the spinal canal [1]. Its etiology remains uncertain. Most non-traumatic spinal extradural arachnoid cysts are thought to be congenital; nevertheless, arachnoid pouching through a possibly congenital dural defect and enlargement of the cyst caused by a one-way valve is the most accredited theory [2].
References [1] Chae KH, Kim SW, Shin H. Septated extradural arachnoid cyst in thoracolumbar spine causing myelopathy. J Korean Neurosurg Soc 2006;40:381–3. [2] Liu JK, Cole CD, Kan P, Schmidt MH. Spinal extradural arachnoid cysts: clinical, radiological and surgical features. Neurosurg Focus 2007;22:1–5.
Javier Quillo-Olvera, MD Julio Cesar Zúñiga-Rivera, MD Sergio Soriano-Solis, MD Carlos Francisco Gutierrez-Partida, MD José Antonio Soriano-Sánchez, MD Manuel Rodríguez-García, MD Instituto Soriano de Cirugía de Columna Mínimamente Invasiva at ABC Medical Center, Santa Fe Campus, Neurological Center, Neurosurgery and Spine Surgery Department. Avenida Carlos Graef Fernández No. 154, Colonia Tlaxala Santa Fe, Delegación Cuajimalpa de Morelos, México, Distrito Federal C.P. 05300, Mexico
Fig. 2. Axial T2-weighted image (Top) from T12 shows compression of the medullary cone (arrow) dorsally. Axial T2-weighted image (Bottom) from L1 shows cauda equina ventralized (arrow).
FDA device/drug status: Not applicable. Author disclosures: JQO: Nothing to disclose. JCZR: Nothing to disclose. SSS: Nothing to disclose. CFGP: Nothing to disclose. JASS: Nothing to disclose. MRG: Nothing to disclose.
