A Facet-Associated Cyst with Aneurysmal Bone Cyst Morphology Causing T10-T11 Compressive Myelopathy Mimicking Cauda Equina Syndrome in an Octogenarian.
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Aneurysmal bone cysts (ABCs) are benign, locally aggressive osseous lesions that predominantly affect children and young adults; ABC morphology in a facet-associated cystic lesion in an octogenarian is highly unusual and may overlap radiologically with a degenerative facet or synovial cyst. An 81-year-old woman presented with a 2-month history of progressive bilateral lower-limb weakness, sensory disturbance, and gait deterioration, followed by acute saddle anaesthesia and bowel dysfunction, prompting concern for cauda equina syndrome. Examination showed bilateral MRC 3/5 weakness, mildly increased lower-limb tone, brisk reflexes, and bilateral Hoffmann signs. Lumbar MRI did not demonstrate cauda equina compression. Dedicated thoracic MRI revealed severe multifactorial T10-T11 canal stenosis with marked cord compression, together with a small right posterolateral extradural lesion adjacent to the facet/posterior elements. Posterior T10-T11 decompression, including laminectomy and flavectomy, with excision of the cystic lesion resulted in neurological improvement. Histopathology demonstrated blood-filled cystic spaces separated by fibrovascular septa containing osteoclast-like multinucleated giant cells and reactive bone, without malignant features, consistent with ABC morphology. This case emphasizes careful neurological localization when cauda equina-like symptoms coexist with upper motor neuron signs and highlights an unusual facet-associated cystic lesion with ABC morphology contributing to multifactorial thoracic spinal stenosis in an elderly patient.