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Case report
peer-reviewed

Fifth Lumbar L5 Perineural Cyst with Unusual Radiculopathy: Traction Plexopathy



Abstract

Perineural cysts are cystic dilations and are frequently seen in relation to the lumbosacral spine. We describe a case of a fifth lumbar (L5) perineural cyst with unusual radicular symptoms and discuss the possible role of traction plexopathy caused by the cyst. A 38-year-old male presented with a longstanding history of back pain and right side thigh pain. This pain radiated from the buttocks to the lateral and anterior aspect of the thigh. He described the pain as pins and needles/burning with no significant relief with medications or rest. Imaging of the lumbar spine revealed a cystic lesion on the right side involving the L5 nerve root in the foraminal region. He failed conservative treatment and elected to have the cyst removed even with a guarded prognosis. A wide L5 laminectomy was performed. Due to the size of the cyst which was causing traction on the exiting L5 nerve root, the L5 pedicle was excised in order to delineate the cyst and to prevent any iatrogenic injury to the root. The patient had the dramatic improvement in his radicular pain immediately after the surgery and continues to be pain-free at his latest three-year follow-up. This case highlights the unusual pain pattern distribution from a perineural cyst possibly secondary to traction effect of the tumor.



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Case report
peer-reviewed

Fifth Lumbar L5 Perineural Cyst with Unusual Radiculopathy: Traction Plexopathy


Author Information

Tarush Rustagi

Department of Spine Surgery, Indian Spinal Injuries Center, New Delhi

Swamy Kurra

Department of Orthopedic Surgery, SUNY Upstate Medical University

William Lavelle Corresponding Author

Department of Orthopedic Surgery, SUNY Upstate Medical University


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Fifth Lumbar L5 Perineural Cyst with Unusual Radiculopathy: Traction Plexopathy


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Case report
peer-reviewed

Fifth Lumbar L5 Perineural Cyst with Unusual Radiculopathy: Traction Plexopathy

  • Author Information
    Tarush Rustagi

    Department of Spine Surgery, Indian Spinal Injuries Center, New Delhi

    Swamy Kurra

    Department of Orthopedic Surgery, SUNY Upstate Medical University

    William Lavelle Corresponding Author

    Department of Orthopedic Surgery, SUNY Upstate Medical University


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 11, 2018

    DOI

    10.7759/cureus.2052

    Cite this article as:

    Rustagi T, Kurra S, Lavelle W (January 11, 2018) Fifth Lumbar L5 Perineural Cyst with Unusual Radiculopathy: Traction Plexopathy. Cureus 10(1): e2052. doi:10.7759/cureus.2052

    Publication history

    Received by Cureus: December 07, 2017
    Peer review began: December 12, 2017
    Peer review concluded: January 05, 2018
    Published: January 11, 2018

    Copyright

    © Copyright 2018
    Rustagi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Perineural cysts are cystic dilations and are frequently seen in relation to the lumbosacral spine. We describe a case of a fifth lumbar (L5) perineural cyst with unusual radicular symptoms and discuss the possible role of traction plexopathy caused by the cyst. A 38-year-old male presented with a longstanding history of back pain and right side thigh pain. This pain radiated from the buttocks to the lateral and anterior aspect of the thigh. He described the pain as pins and needles/burning with no significant relief with medications or rest. Imaging of the lumbar spine revealed a cystic lesion on the right side involving the L5 nerve root in the foraminal region. He failed conservative treatment and elected to have the cyst removed even with a guarded prognosis. A wide L5 laminectomy was performed. Due to the size of the cyst which was causing traction on the exiting L5 nerve root, the L5 pedicle was excised in order to delineate the cyst and to prevent any iatrogenic injury to the root. The patient had the dramatic improvement in his radicular pain immediately after the surgery and continues to be pain-free at his latest three-year follow-up. This case highlights the unusual pain pattern distribution from a perineural cyst possibly secondary to traction effect of the tumor.



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Tarush Rustagi, M.D.

Department of Spine Surgery, Indian Spinal Injuries Center, New Delhi

Swamy Kurra

Department of Orthopedic Surgery, SUNY Upstate Medical University

William Lavelle

Department of Orthopedic Surgery, SUNY Upstate Medical University

For correspondence:
lavellwf@yahoo.com

Tarush Rustagi, M.D.

Department of Spine Surgery, Indian Spinal Injuries Center, New Delhi

Swamy Kurra

Department of Orthopedic Surgery, SUNY Upstate Medical University

William Lavelle

Department of Orthopedic Surgery, SUNY Upstate Medical University

For correspondence:
lavellwf@yahoo.com