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Unusual facet cyst containing struvite and hydroxyapatite
1Department of Musculoskeletal Radiology, Cleveland Clinic Foundation, OH 44195, USA.
Skeletal Radiology
|April 6, 2001
Summary
This case report details a lumbar facet cyst containing calcium ammonium phosphate (struvite) and calcium phosphate (hydroxyapatite). We suggest a prior urease-producing bacterial infection caused the struvite formation in this severe back pain patient.
Area of Science:
- Nephrology
- Orthopedics
- Microbiology
Background:
- Facet cysts are fluid-filled sacs that can cause back pain and radiculopathy.
- Calcium deposition within spinal cysts is uncommon.
- The etiology of spinal facet cysts is not fully understood.
Observation:
- A patient presented with severe back pain and radiculopathy attributed to a lumbar facet cyst.
- Imaging (MRI and CT) revealed a cyst containing calcium within the lumbar facet.
- Aspiration of the cyst confirmed the presence of calcium ammonium phosphate (struvite) and calcium phosphate (hydroxyapatite).
Findings:
- The cyst's contents, particularly struvite, suggest a biochemical reaction involving ammonia.
- Urease-producing bacteria are known to generate ammonia, facilitating struvite formation.
- The presence of hydroxyapatite indicates a secondary calcification process.
Implications:
- This case suggests a potential link between prior bacterial infection and the formation of mineralized facet cysts.
- Understanding the role of bacteria and ammonia production may offer new insights into facet cyst pathogenesis.
- Further research could explore diagnostic markers for infection in patients with spinal cysts.