Published date:Mar 13 2025

Journal Title: Journal of Spine Practice

Issue title: Journal of Spine Practice (JSP): Volume 4, Issue 2

Pages:28 - 36

DOI: 10.18502/jsp.v4i2.17702

Alexandra H. KramerAkrame15@uthsc.eduCollege of Medicine, University of Tennessee Health Science Center, Memphis, TN

Camille Miltoncmilton3@uthsc.eduDepartment of Neurological Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

Emal Leshaelesha@uthsc.eduDepartment of Neurological Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

John E. Duganjdugan5@uthsc.eduCollege of Medicine, University of Tennessee Health Science Center, Memphis, TN

Logan N. Eskinleskin@uthsc.eduCollege of Medicine, University of Tennessee Health Science Center, Memphis, TN

Andrew Boucheraboucher@semmes-murphey.comDepartment of Neurological Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

Introduction

Spinal arachnoid cysts are commonly encountered throughout all age groups and are often managed observantly, but a minority cause symptoms requiring intervention. These cysts can be caused by congenital malformations, trauma, inflammation, or even occur spontaneously. A vast majority of arachnoid cysts in the spine are extradural, and about 10% are intradural. One type of intradural cyst occurs between two leaflets of the dura, described as an interdural cyst.

Case Report

This case report describes a 47-year-old female with an interdural arachnoid cyst spanning the thoracolumbar region (T11-L3). Initially, the patient was asymptomatic but later presented with progressive neurologic symptoms, including intermittent back pressure, heaviness in her legs, paresthesia, urinary hesitancy, and decreased sensation in the perineal area. Surgical intervention via direct lumbar laminectomy was performed from the bottom of T11 to the top of L3, revealing an interdural cyst without communication to the subarachnoid space. Thus, surgical fenestration was performed to establish a pathway between the cyst and the subarachnoid space to alleviate symptoms and prevent recurrence.

Discussion

The absence of communication between the cyst and the subarachnoid space suggests alternative mechanisms, such as a ball valve mechanism, contributing to cyst expansion. A comprehensive review of existing literature on interdural cysts underscores the necessity for revised classification systems, considering both their fluid content and communication with the subarachnoid space.

Conclusions

The proposed classification of interdural cysts based on CSF analysis and connection to the subarachnoid space may guide operative management and provide more information on the etiology. This classification system could refine outcome data in the operative management of interdural spinal cysts.

Keywords: spinal cyst, arachnoid cyst, interdural cyst, spine, thoracolumbar

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