Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2016; 7(7): 452-457
Published online Jul 18, 2016. doi: 10.5312/wjo.v7.i7.452
Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection: A case report and review of the literature
Hossein Elgafy, Nicholas Peters, Justin E Lea, Robert M Wetzel
Hossein Elgafy, Nicholas Peters, Justin E Lea, Robert M Wetzel, Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
Author contributions: All the authors contributed in outlining the manuscript, gathering the data, and writing the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: None of the authors have any financial or any other conflicts of interest that may bias the current study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hossein Elgafy, MD, MCH, FRCSEd, FRCSC, Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, United States.
Telephone: +1-419-3833515 Fax: +1-419-3836170
Received: January 25, 2016
Peer-review started: January 26, 2016
First decision: March 1, 2016
Revised: March 12, 2016
Accepted: May 10, 2016
Article in press: May 11, 2016
Published online: July 18, 2016

A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection (ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel (antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors’ knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking anti-platelet medications.

Keywords: Lumbar synovial cyst, Hemorrhage, Anti-platelet therapy, Epidural injection

Core tip: With modern advances in magnetic resonance imaging studies, synovial cysts are seen with degenerative lumbar facet disease. A symptomatic synovial cyst usually presents with a gradual onset low back pain originating from facet arthropathy and radicular pain or neurogenic claudication due to nerve roots compression. Previous reports showed synovial cyst can present with a progressive radicular pain and weakness secondary to spontaneous hemorrhage into the cyst. To the authors’ best knowledge, this is the first case report of iatrogenic hemorrhagic lumbar synovial cyst.