[A synovial cyst accompanied by asymptomatic lumbar vertebral fracture requiring differentiation from spinal...

We experienced a case with a synovial cyst accompanied by asymptomatic lumbar vertebral fracture that required differentiation from spinal metastasis. An 82-year-old man suffered from right leg and anal pain. Computed tomography (CT) showed L5 spondylolysis. Magnetic resonance images (MRI) revealed an intra spinal cyst and acute lumbar vertebral fracture of L5 vertebral body. The surrounding area of the cyst presented contrast enhancement, and the extradural mass compressed the dural sac. Bone scintigraphy with 99m technetium-MDP demonstrated intense uptake on the right first, fourth, fifth, and seventh ribs and L2, L3, and L5 vertebra. The F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) image demonstrated an increased radiotracer uptake in the L5 vertebra(standardized uptake value(SUV) max=3.5). Spinal metastasis was suspected. Because of the cauda equina compression syndrome, it was surgically removed. Intraoperatively, a well-demarcated extradural cyst was found and compressed the dural sac markedly. The cyst capsule was thin and contained clear, thin fluid with no signs of bleeding. The histological diagnosis was a synovial cyst. His neurological symptoms improved after the surgery. The synovial cyst may enlarge after asymptomatic vertebral fractures.