Diagnostic challenge between hemorrhagic facet cyst and spontaneous spinal epidural hematoma: a case report and literature review

Abstract Background A rare condition that can mimic spontaneous spinal epidural hematoma (SSEH) is hemorrhagic transformation of lumbar facet cysts. Clinical and magnetic resonance imaging (MRI) findings often overlap, making preoperative differential diagnosis challenging. Case presentation The patient, a 72-year-old woman, had right S1 radiculopathy and low back pain. A cystic lesion at the right L5-S1 facet joint was first seen on MRI; later, the lesion became hypointense, indicating bleeding. The patient had the cyst completely removed and a partial hemilaminectomy performed on the right L5. There was a hemorrhagic facet cyst confirmed by histology. Six months following surgery, there was no sign of a recurrence of the symptoms. Conclusions Decompression without fusion produces good outcomes, and sequential MRI is useful for diagnosis. In order to avoid misdiagnosis and unnecessary surgical procedures, it is critical to identify this condition.