Journal of Clinical PracticeJournal of Clinical Practice2220-30952618-8627Eco-Vector1520310.17816/clinpract10297-103Research ArticleA rare clinical case of surgical treatment of a periarticular cyst of the facet joint of the lumbar spinePotapovVitaliy E.<p>Candidate of Medical Sciences, Head of Neurosurgical Unit, Leading Research Officer at the Research Clinical Department of Neurosurgery</p>pva454@yandex.ruhttps://orcid.org/0000-0001-9167-637XKoshkarevaZinaida V.zina.koshkareva1941@mail.ruhttps://orcid.org/0000-0002-4387-5048ZhivotenkoAleksandr P.sivotenko1976@mail.ruhttps://orcid.org/0000-0002-4032-8575SklyarenkoOksana V.oxanasklyarenko@mail.ruhttps://orcid.org/0000-0003-1077-7369GorbunovAnatoly V.a.v.gorbunov58@mail.ruhttps://orcid.org/0000-0002-1352-0502GlotovSergey D.glotovsd@gmail.comSorokovikovVladimir A.vasorokovikov@mail.ruhttps://orcid.org/0000-0002-9008-6383Irkutsk Scientific Centre of Surgery and TraumatologyIrkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education17082019102971030307201914072019Copyright © 2019, Potapov V.E., Koshkareva Z.V., Zhivotenko A.P., Sklyarenko O.V., Gorbunov A.V., Glotov S.D., Sorokovikov V.A.2019<p><strong>Background.</strong> Periarticular cysts of the facet joint, due to their rare occurrence, often slip away from the attention of clinicians. However their formation and progression may cause compression of vascular-neural structures with subsequent manifestations of severe neurological disorders.</p>
<p><strong>Description of the clinical case.</strong> We present a rare clinical case of surgical treatment of a periarticular cyst of the facet joint. A comprehensive examination of the patient S. revealed: Dorsopathy with degenerative spinal canal stenosis at L<sub>V</sub>-S<sub>I </sub>level; spondyloarthrosis; periarticular facet cyst at L<sub>V</sub>-S<sub>I</sub> level on the left; radiculopathy L<sub>V</sub> on the left, in the acute stage; pronounced pain and musculo-tonic syndrome. Complaints of the patient: constant pain in the lumbar spine, extending to the left lower extremity and aggravating when walking at a distance of 50-100 meters; feeling numb when walking on the plantar surface of the left foot. When examining the local status, a forced posture with a bowed head and torso forward was noted; smooth lumbar lordosis and antalgic right-sided scoliosis; tension of paravertebral muscles. Neurological examination revealed L<sub>V</sub>radiculopathy on the left with moderate paresis of the extensor muscles of the left foot and ipsilateral Lasgue's positive test. MRI examination revealed spinal canal stenosis, facet joint cyst at the level of L<sub>V</sub>-S<sub>I</sub> with dimensions of 1488.5 mm. An operative intervention was performed: reconstructive decompressive-stabilizing spinal surgery with a single block removing the articular facet with a periarticular cyst at the left L<sub>V</sub>-S<sub>I</sub> level with subsequent posterior transpedicular fixation of the vertebral motor segment. Two months after the operation, complete medical and social rehabilitation of the patient was achieved. No complaints.</p>
<p><strong>Conclusion.</strong> In case of compression of a periarticular cyst of vascular-neural structures with severe neurological disorders, surgical treatment with the cyst removal is recommended.</p>spineosteochondrosisperiarticular cystfacet jointsurgical treatmentпозвоночникостеохондрозпериартикулярная кистафасеточный суставхирургическое лечение[Евзиков Г.Ю., Егоров О.Е., Горбачёва Ю.В. Поясничные периартикулярные кисты фасеточных суставов. Клинические наблюдения и обзор литературы // Неврологический журнал. — 2012. — Т.17. — №3. — С. 30-33. [Evzikov GYu, Egorov OE, Gorbacheva YuV. Lumbal peri-articularis cysts of facet joints. Series of case reports and literature review. Journal of neurology. 2012;17(3):30-33. (In Russ).]][Boviatsis EJ, Stavrinou LC, Kouyialis AT, et al. Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a seriesof seven cases and literature review. Eur Spine J. 2008;17(6):831-837. doi: 10.1007/s00586-007-0563-z.][Finkelshtein SD, Sayegh R, Watson P, et al. Juxta-facet cysts. Report of two cases and review of the clinicopathologic features. Spine (Phila Pa 1976). 1993;18(6):779-782. doi: 10.1097/00007632-199305000-00020.][Hodges SD, Frongzak S, Zindrick MR, et al. Extradural synovial thoracic cyst. Spine (Phila Pa 1976). 1994;19(21):2471-2473. doi: 10.1097/00007632-199411000-00020.][Indar R, Tsiridis E, Morgan M, et al. Intraspinal lumbar synovial cysts: diagnosis and surgical management. Surgeon. 2004;2(3):141-144. doi: 10.1016/s1479-666x(04)80074-x.][Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. Case report. J Neurosurg. 1974;41(3):372-376. doi: 10.3171/jns.1974.41.3.0372.][Lyons MK, Atkinson JL, Wharen RE, et al. Surgical evaluation and management of lumbar synovial cysts: the Mayo clinic experience. J Neurosurg. 2000;93(1 Suppl):53-57. doi: 10.3171/spi.2000.93.1.0053.][Бывальцев В.А., Сороковиков В.А., Калинин А.А., Оконешникова А.К. Периартикулярные кисты дугоотростчатых суставов: этиопатогенез, диагностика, способы хирургического лечения. Клинический пример // Acta Biomedica Scientifica. — 2018. — Т.3. — №4. — С. 61-68. [Byvaltsev VA, Sorokovikov VA, Kalinin AA, Okoneshnikova AK. Periarticular cysts of facet joints: etiopatho-genesis, diagnosis, methods of surgical treatment. A clinical example. Acta Biomedica Scientifica. 2018;3(4):61-68. (In Russ).] doi: 10.29413/ABS.2018-3.4.10.][Metellus P, Fuentes S, Adetchessi T, et al. Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome. Acta Neurochir (Wien). 2006;148(1):47-54; discussion 54. doi: 10.1007/s00701-005-0650-z.][Cohen-Gadol AA, White JB, Lynch JJ, et al. Synovial cysts of the thoracic spine. J Neurosurg Spine. 2004;1(1):52-57. doi: 10.3171/spi.2004.1.1.0052.][Miwa M, Doita M, Takayama H, et al. An expanding cervical synovial cyst causing acute cervical radiculopathy. J Spinal Disord Tech. 2004;17(4):331-333. doi: 10.1097/01.bsd.0000095892.46978.6e.][Song JK, Musleh W, Cristie SD, et al. Cervical juxtafacet cysts: case report and literature review. Spine J. 2006;6(3):279-281. doi: 10.1016/j.spinee.2005.09.006.]