Skip to main content
SpringerLink
Log in

Intraosseous pseudomeningocele of the mobile spine: a case report and review of the literature

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

Pseudomeningoceles most commonly occur due to prior trauma or surgery and are often located in the posterior paraspinous tissues. Here, we report a case of an intraosseous pseudomeningocele that mimicked an intra-osseous T2 hyperintense lesion in the L1 vertebral body.

Case description

A 64-year-old male presented with back, left lateral thigh and left knee pain lasting several months. He had no prior history of trauma or surgery. Radiographs of the lumbar spine showed mild levoscoliotic curvature of the lumbar spine, Baastrup’s changes between the spinous processes, multilevel degenerative disc disease and facet arthropathy. Magnetic resonance imaging (MRI) of the lumbar spine performed without intravenous contrast showed severe spinal canal stenosis from L1–L2 to L3–L4 and moderate spinal canal stenosis at L4–L5. MRI also showed a 2.5-cm T2 hyperintense lesion involving the posterior aspect of the L1 vertebral body, with questionable contiguity with cerebrospinal fluid. Computed tomography (CT) myelogram was performed instead of biopsy. CT myelogram showed contiguity of the lesion with the intrathecal contrast and a rent in the posterior longitudinal ligament and anterior dura consistent with an intraosseous pseudomeningocele. The patient opted for non-operative management of the pseudomeningocele and his lumbar stenosis due to medical comorbidities.

Conclusions

This case illustrates a rare case of an intra-osseous pseudomeningocele and highlights the importance of CT myelogram for diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hyndman OR, Gerber WF (1946) Spinal extradural cysts, congenital and acquired. J Neurosurg 3(6):474–486

    Article  PubMed  CAS  Google Scholar 

  2. Hawk MW, Kim KD (2000) Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus 9(1):1–8

    Article  Google Scholar 

  3. Gandhoke GS, Hauptman JS, Salvetti DJ, Weiner GM, Panigrahy A, Yilmaz S, Pollack IF (2015) Transosseous cerebrospinal fluid fistula 14 years after Chiari decompression: presentation and management. J Neurosurg Pediatr 16:146–149

    Article  PubMed  Google Scholar 

  4. Couture D, Branch CL Jr (2003) Spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus 15(6):1–5

    Article  Google Scholar 

  5. Swanson HS, Fincher EF (1947) Extradural arachnoidal cysts of traumatic origin. J Neurosurg 4(6):530–538

    Article  PubMed  CAS  Google Scholar 

  6. Paolini S, Ciappetta P, Piattella MC (2003) Intraspinous postlaminectomy pseudomeningocele. Eur Spine J 12:325–327

    PubMed  Google Scholar 

  7. Shimazaki K, Nishida H, Harada Y, Hirohata K (1991) Late recurrence of spinal stenosis and claudication after laminectomy due to an ossified extradural pseudocyst. Spine 16(2):221–224

    Article  PubMed  CAS  Google Scholar 

  8. Teplick JG, Peyster RG, Teplick SK, Goodman LR, Haskin ME (1983) CT identification of postlaminectomy pseudomeningocele. AJR Am J Roentgenol 140:1203–1206

    Article  PubMed  CAS  Google Scholar 

  9. Schumacher HW, Wassmann H, Podlinski C (1988) Pseudomeningocele of the lumbar spine. Surg Neurol 29(1):77–78

    Article  PubMed  CAS  Google Scholar 

  10. Hadani M, Findler G, Knoler N, Tadmor R, Sahar A, Shacked I (1986) Entrapped lumbar nerve root in pseudomeningocele after laminectomy: report of three cases. Neurosurgery 19(3):405–407

    Article  PubMed  CAS  Google Scholar 

  11. Placantonakis DG, Lis E, Souweidane MM (2006) Intradiploic cerebrospinal fluid fistulas of iatrogenic origin. J Neurosurg (5 Suppl Pediatrics) 104:356–359

    Article  Google Scholar 

  12. Giordano M, Di Rocco C (2016) Iatrogenic intradiploic cerebrospinal fluid collection. Childs Nerv Syst 32:787–790

    Article  PubMed  Google Scholar 

  13. Cook DA, Heiner JP, Breed AL (1989) Pseudomeningocele following spinal fracture. Clin Orthop Relat Res 247:74–78

    Google Scholar 

  14. Mahaney KB, Menezes AH (2014) Intradiploic occipital pseudomeningocele in a patient with remote history of surgical treatment of Chiari malformation. J Neurosurg Spine 21:769–772

    Article  PubMed  Google Scholar 

  15. Radcliff K, Morrison WB, Kepler C, Moore J, Sidhu GS, Gendelberg D, Miller L, Sonagli MA, Vaccaro AR (2016) Distinguishing pseudomeningocele, epidural hematoma, and postoperative infection on postoperative MRI. Clin Spine Surg 29(9):E471–E474

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Emily Rider-Longmaid, Junjian Huang & Ronnie Sebro

  2. Department of Genetics, University of Pennsylvania, 421 Marie Curie Blvd, Philadelphia, PA, 19104, USA

    Ronnie Sebro

  3. Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA, 19104, USA

    Ronnie Sebro & Harvey Smith

Authors
  1. Emily Rider-Longmaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Junjian Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronnie Sebro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harvey Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Ronnie Sebro or Harvey Smith.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rider-Longmaid, E., Huang, J., Sebro, R. et al. Intraosseous pseudomeningocele of the mobile spine: a case report and review of the literature. Eur Spine J 27 (Suppl 3), 472–476 (2018). https://doi.org/10.1007/s00586-018-5498-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5498-z

Keywords

Search

Navigation