Professor of Neurosurgery, Director of Spinal Oncology Roswell Park Comprehensive Cancer Center Buffalo, New York, United States
Introduction: Multiple pathologies can mimic oncologic mass lesions of the vertebral column. Sarcoidosis, hyperparathyroidism, and rheumatoid arthritis are in the differential of an unknown bony spinal column lesion. Large articular cysts can erode bony spinal elements and present as mass lesions of the spinal column. Knowledge of this rare potential pathology is important for spinal surgeons to make the appropriate assessment and treatment plan.
Methods: Case study with educational illustrative imaging.
Results: A 73-year-old was referred to a Cancer Center for a mass lesion of her L2 posterior elements filling the lamina and extending to the left pedicle (Figure 1). The mass extended into the spinal canal causing compression of the thecal sac. The patient was experiencing significant bilateral lower extremity radicular pain without weakness or incontinence. CT-guided injection of the mass confirmed the diagnosis of articular cyst (Figure 2), and cyst aspiration resulted in a decrease in size of the mass (Figure 3). The patient experienced an immediate resolution of lower extremity radicular symptoms.
Conclusion : Large articular cysts can invade the posterior elements of the spinal column and mimic an oncologic mass lesion. CT-guided cyst injection can confirm the diagnosis, and cyst aspiration can provide symptomatic relief.
How to Improve Patient Care: A large articular cyst is a rare pathology to masquerade as an oncologic mass lesions. Spine surgeons are well-served to become familiar with these imaging characteristics to keep this entity in their differential diagnoses. Diagnosis can be confirmed by CT-guided cyst injection, and symptomatic relief can be obtained with CT-guided cyst aspiration.
