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Intraspinal Posterior Epidural Cysts Associated with Baastrup's Disease: Report of 10 Patients

Clement K. H. Chen1,2, LeeRen Yeh1,2, Donald Resnick3, Ping-Hong Lai1,2, Huei-Lung Liang1,2, Huay-Ben Pan1,2 and Chien-Fang Yang1,2

1 Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd., Kaohsiung 813, Taiwan.
2 National Yang-Ming University, School of Medicine, 155, Sec. 2, Li-Nong St., Shih-Pai Rd., PeiTou, Taipei 112, Taiwan.
3 Department of Radiology, Veterans Affairs Medical Center and University of California San Diego, 3350 La Jolla Village Dr., San Diego, CA 92161.



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  		Fig. 1A. —75-year-old man with lower back pain. Sagittal spin-echo T1-weighted image (TR/TE, 416/16) shows Baastrup's disease at L4–L5 disk level with approximation of spinous processes and flattening of their apposing surfaces. Small posterocentral epidural cystic mass (arrow) is contiguous to interspinous soft tissue.

 


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  		Fig. 1B. —75-year-old man with lower back pain. Axial fat-suppressed fast spin-echo T2-weighted image (6,000/96) confirms posterocentral epidural cystic mass (arrow) that has led to mild compression of thecal sac. No significant facet arthrosis or effusion or evidence of communicating channel between cyst and facet joints is present.

 


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  		Fig. 2A. —73-year-old man with lower back pain radiating to both legs. Sagittal fast spin-echo T2-weighted image (TR/TE, 3,500/105) shows evidence of Baastrup's disease and central canal stenosis resulting from anterior disk bulging and posterior epidural lesion (arrow) at L4–L5 level.

 


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  		Fig. 3A. —60-year-old man with lower back pain radiating to both legs. Sagittal fast spin-echo T2-weighted image (TR/TE, 3,500/110) shows posterocentral epidural cystic mass (straight arrow) at L2–L3 level and Baastrup's disease with interspinous bursal fluid (curved arrow). Subjacent spondylolisthesis between L3 and L4 is also seen.

 


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  		Fig. 3B. —60-year-old man with lower back pain radiating to both legs. Axial fat-suppressed fast spin-echo T2-weighted image (7,500/96) shows evident compression of thecal sac by posterocentral epidural cyst (arrow).

 


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  		Fig. 2B. —73-year-old man with lower back pain radiating to both legs. Interspinous bursogram, lateral projection, shows bursal fluid extending directly to posterior epidural cyst (open arrow). Tip of spinal needle (solid arrow) was placed at midpoint of L4–L5 interspinous space.

 


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  		Fig. 2C. —73-year-old man with lower back pain radiating to both legs. Interspinous bursogram, frontal projection, shows opacified posterior epidural cyst located in midline.

 


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  		Fig. 1C. —75-year-old man with lower back pain. Sagittally reformatted CT image obtained after interspinous bursogram shows contrast material (arrowheads) in interspinous space extending to small posterior epidural cyst. Note air (arrow) that was inadvertently injected and accumulated in cyst.

 


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  		Fig. 2D. —73-year-old man with lower back pain radiating to both legs. Axial CT image shows bursal fluid extending directly to posterior epidural cyst (arrow). Small opacified communicating channel is evident between cyst and interspinous bursal fluid. No significant facet arthrosis or effusion is present.

 


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  		Fig. 3C. —60-year-old man with lower back pain radiating to both legs. Interspinous bursograms reveal opacification of interspinous bursa (curved arrow) and fluid extending to posterior epidural cyst (straight arrow). Concurrent opacification of L3 spondylolysis (arrowhead) is also present. Spondylolysis at L3 level is more evident on lateral radiograph and MRI of lumbar spine.

 


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  		Fig. 3D. —60-year-old man with lower back pain radiating to both legs. Axial CT image shows contrast material opacification of interspinous bursa extending to posterior epidural cyst (open arrow). Small opacified communicating channel is evident between cyst and interspinous bursal fluid. Resultant moderate to severe central canal stenosis is evident. Concurrent opacification of bilateral facet joint spaces (solid arrows) at L2–L3 spinal level is also visible.

 

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