Disclosures: Jason T. Hamamoto, MD: Teladoc Health (Products/Services: No) (Stockholder/Ownership Interest (excluding diversified mutual funds))

Case Diagnosis: Intra-Foraminal Ganglion Cyst

Case Description: A 68-year-old female with history of cervical myelopathy status post anterior cervical discectomy and fusion presented with a 1-month history of severe low back and radiating right leg pain in the L5 distribution without weakness. There was no bowel or bladder dysfunction or saddle anesthesia. Seated positioning worsened the pain while standing and ambulation relieved the pain. Conservative measures with oral medications provided minimal relief. The patient was able to heel walk with full dorsiflexion and had a positive seated straight leg raise on the right. MRI of the lumbar spine revealed a large T2 hyperintense structure in the right L5-S1 neural foramen compressing the L5 nerve root, initially thought to be a perineural cyst. Given the severity of symptoms, the patient underwent a right L5 transforaminal epidural steroid injection under fluoroscopic guidance. There were no procedural complications but given the continued severe pain, a contrast-enhanced MRI was ordered, and she was referred for neurosurgical consultation.

Setting: Pain ClinicAssessment/

Results: MRI with contrast showed no abnormal enhancement and patient developed progressively worsening radicular pain and dorsiflexion weakness. After neurosurgical evaluation, she underwent a right L5-S1 laminectomy and instrumented fusion. Intraoperatively, an extradural nerve sheath mass was identified and resected. Immunohistochemical analysis demonstrated a multiloculated cyst with yellow viscous fluid, myxoid degeneration, no synovial lining and negative staining for S100 ruling out peripheral nerve sheath neoplasm indicating a ganglion cyst. Following surgery, her weakness quickly resolved, and pain gradually improved.

Discussion: Ganglion cysts are benign soft tissue lesions that arise from periarticular connective tissue usually found in the hand and wrist. They are a rare cause of lumbosacral radiculopathy and can mimic the clinical presentation of a disk herniation.

Conclusion: Ganglion cysts should be considered on the differential diagnosis of a patient presenting with lumbosacral radiculopathy and may cause neurologic deficits requiring surgery.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/intra-foraminal-ganglion-cyst-causing-severe-lumbosacral-radiculopathy-with-foot-drop-a-case-report/