![]() Three patients with symptomatic midline intraspinal facet cysts were reviewed. This article presents 3 unique cases of midline intraspinal facet cysts causing significant lumbar stenosis and symptomatic thecal sac compression. Clinically, however, both terms are used interchangeably to describe intraspinal facet cysts or juxtafacet cysts. Ganglion cysts contain a collagenous or fibrous wall encircling gelatinous or myxoid substance. In contrast, ganglion cysts lack synovial lining and structural communication to facet joints. Lined with cuboidal epithelium and filled with synovial fluid, synovial cysts frequently retain communication with their facet joint of origin. They are found in the postero-lateral region of the canal, consistent with their source of pathology. Synovial and ganglion cysts typically occur in the lower lumbar region, frequently the site of degenerative changes and dynamic instability. Breakdown of this articular lining or encapsulated accumulation of fluid outside of the facet joint may lead to pathologic cyst formation. Representing a zygapophyseal joint, facet joints lie enclosed within a capsule lined by synovial epithelium. Intraspinal facet cysts, also known as synovial and/or ganglion cysts, typically reside adjacent to the facet joints and may cause radicular symptoms due to nerve root compression and foraminal compromise. Though laminectomy is a commonly performed operation, stabilization may be required in cases of spondylolisthesis or instability. Midline cysts causing thecal sac compression respond favorably to lumbar surgical decompression and cyst resection. Such entities should enter the differential diagnosis of midline posterior cystic lesions. Midline intraspinal facet cysts represent an uncommon cause of lumbar stenosis and thecal sac compression. Following the three case presentations, we performed a thorough literature search in order to identify articles describing intraspinal cystic lesions in lateral or midline locations. All 3 patients initially responded favorably to lumbar decompression and midline cyst resection however, one patient required surgical stabilization 8 mo later. One patient presented with neurogenic claudication while two patients developed partial, subacute cauda equina syndrome. Documented clinical visits, operative notes, histopathology reports, and imaging findings were investigated for each patient. Three patients with symptomatic midline intraspinal facet cysts were retrospectively reviewed. ![]() This article summarizes the clinical presentation, radiographic appearance, and management of three intraspinal, midline facet cysts. ![]() Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms.
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