Facet joint cyst haematoma: a rare cause of cauda equina syndrome

Abstract

Facet joint cysts are a feature of lumbar spondylosis and are an uncommon cause of radiculopathy. Facet joint cyst haematoma is a very rare entity and has previously been reported as a subacute cause of leg pain, back pain, sensory deficit and lower limb weakness. We present the unique case of facet joint cyst haematoma presenting as cauda equina syndrome. An 81 year old lady presented with a 7 day history of back pain and left foot drop, a 1 day history of perineal numbness and urinary retention with absent rectal tone, perianal anaesthesia and left leg hypoaesthesia. Emergency MRI scan demonstrated spinal canal stenosis as the aetiology of her cauda equina syndrome. She was taken to theatre for emergency lumbar decompression. At operation a facet joint haematoma compressing the cauda equina was found and extirpated with complete resolution of symptoms. In this case, the aetiology of cauda equina compression was not demonstrated effectively on pre-operative MRI scanning.

Keywords:

• Cauda equina syndrome
• facet joint cyst
• haematoma
• haemorrhage

Acknowledgements

Patient provided informed consent for report of her case. Authors would like to thank Mrs Debbie Walters for excellent administrative support. The patient kindly provided consent for the anonymised used of her clinical information and images for publication as a case report. Consent was obtained by Mr Antony Bateman (Consultant Spinal Surgeon) and is documented in the patient’s medical notes.

Disclosure statement

AK is a BNTRC trainee investigator for the UCES study. No other conflicts of interest to declare.