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may enlarge neural foraminae as well. The cysts may compress the spinal cord and lead to thinning and atrophy of this structure.

Clinical Presentation

As with perineural cysts, most patients with arachnoid cysts remain asymptomatic. If the cysts are large and affect the vertebrae the patients may present with fluctuating back pain and radicular pain that may be severe and is worse during straining or coughing. Spinal cord compression results in myelopathic symptoms: gait dysfunction, paraparesis, and sphincter involvement. In the latter cases the patients should be operated on promptly as undue delay may lead to compromised function.

Imaging Studies

The cyst may appear as a solitary, oval structure. At times, multiple cysts may be present. The density and signal characteristics of these cysts on CT and MRI studies are similar to those of perineural cysts.

Management

Complete excision of the cyst is the definitive treatment. Bibliography

Banning CS, Thorell WE, Leibrock LG: Patient outcome after resection of lumbar juxtafacet cysts. Spine 26: 969-972, 2001.

Bassiouni H, Hunold A, Asgari S, Hubschen U, Konig HJ, Stolke D: Spinal intradural juxtamedul-lary cysts in the adult: Surgical management and outcome. Neurosurgery 55: 1352-1360, 2004.

Charest DR, Kenny BG: Radicular pain caused by synovial cyst: An underdiagnosed entity in the elderly? J Neurosurg 92: 57-60, 2000.

DePalma MJ, Strakowski JA, Mandelker EM, Zerick WR: An instance of an atypical intraspinal cyst presenting as S1 radiculopathy: A case report and brief review of pathophysiology Arch Phys Med Rehabil 85: 1021-1025, 2004.

Doita M, Nishida K, Miura J, Takada T, Kurosaka M, Fujii M: Kinematic magnetic resonance imaging of a thoracic spinal extradural arachnoid cyst: An alternative suggestion for exacerbation of symptoms during straining. Spine 28: E229-E233, 2003.

Kaneko K, Inoiue Y: Haemorrhagic lumbar synovial cyst: A case of acute radiculopathy J Bone Joint Surg Br 82: 583-584, 2000.

Khan AM, Synnot K, Cammisa FP, Girardi FP: Lumbar synovial cysts of the spine: An evaluation of surgical outcome. J Spinal Disord Tech 18: 127-131, 2005.

Langdown AJ, Grundy JRB, Birch NC: The clinical relevance of Tarlov cyst. J Spinal Disord Tech 18: 29-33, 2005.

Paulsen RD, Call RD, Murtagh FR: Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). Am J Neuroradiol 15: 293-297, 1994.

Ross JS, Brant-Zawadzki M, Moore KR, Crim J, Chen MZ, Katman GL: Infections, pp. 2-13 in Ross JS, Brandt-Zawadzki M, Moore KR, Crim J, Chen MZ, Katman GL: Diagnostic imaging, vol IV: Spine. Amirsys, 2004.

Sabers SR, Ross SR, Grogg BE, Lauder TD: Procedure-based nonsurgical management of lumbar zygapophyseal joint cyst-induced radicular pain. Arch Phys Med Rehabil 86: 1767-1771, 2005.

Sabo RA, Tracey PT, Weinger JM: A series of 60 juxtafacet cysts: Clinical presentation, the role of spinal instability, and treatment. J Neurosurg 85: 560-565, 1996.

Shah R, Lutz G: Lumbar intraspinal synovial cysts: Conservative management and review of the world's literature. Spine J 3: 479-488, 2003.

Takeuchi A, Miyamoto K, Sugiyama S, Saitou M, Hosoe H, Shimizu K: Spinal arachnoid cysts associated with syringomyelia: Report of two cases and a review of the literature. J Spinal Disord Tech 16: 207-211, 2003.

Tarlov IM: Perineural cysts of the spinal root. Arch Neurol Psychiat 40: 1067-1074, 1938.

Tillich M, Trummer M, Lindbichler F, Flaschka G: Symptomatic intraspinal synovial cysts of the lumbar spine: Correlation of MR and surgical findings. Neuroradiology 43: 1070-1075, 2001.

Tunialan LM, Cawley CM, Barrow DL: Arachnoid cyst with associated arachnoiditis developing after subarachnoid hemorrhage: Case report. J Neurosurg 103: 1088-1091, 2005.

Voyadzis JM, Bhargava P, Henderson FC: Tarlov cysts: A study of 10 cases with review of the literature. J Neurosurg 95: 25-32, 2001.

The term spondyloarthropathy refers to a cluster of interrelated seronegative chronic inflammatory diseases that affect the spine and the peripheral joints. Other systems, such as the ocular, gastrointestinal, cardiovascular, and cutaneous systems, are affected as well.

The point of attachment of ligaments and tendons to bone is known as the enthesis. In the spondyloarthropathies, structural changes occur throughout the skeleton, including the spine at the enthesis sites. Initially, bone resorption takes place, and subsequently excessive bone formation occurs. These structural changes at the enthesis sites have been called enthesopathy.

Many patients with spondyloarthropathy have a positive HLA-B27. The rheumatoid factor, however, remains negative in these diseases. Seronegative spondyloarthropathy is the term that is applied to this class of disorders, which includes ankylosing spondylitis, psoriatic arthropathy, Reiter's disease, inflammatory bowel arthropathy, and Behcet's disease.

Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

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