Femoral nerve compression by an iliopsoas bursal cyst coexisting With lumbar spinal stenosis: a case report
- 1Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
- 2Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
Abstract
BackgroundIliopsoas bursal cysts are rare synovial proliferative lesions, most commonly associated with osteonecrosis of the femoral head, osteoarthritis, and rheumatoid arthritis. When a cyst compresses the femoral nerve, it may cause groin pain, radiating anterior thigh pain, and an antalgic gait, closely mimicking lumbar spinal stenosis (LSS). Only approximately 20 comparable cases of femoral nerve compression have been documented worldwide. Concomitant LSS and femoral nerve compression by an iliopsoas bursal cyst have not previously been reported. The coexistence of LSS and femoral nerve compression caused by an iliopsoas bursal cyst may result in delayed or missed diagnosis.Case presentationWe report a patient with concomitant LSS and femoral nerve compression caused by an iliopsoas bursal cyst who was initially treated for LSS alone. After 3 days of integrative conservative treatment for LSS, the low-back, posterior thigh, and lateral calf pain improved substantially; however, the right anterior thigh and groin pain became intolerable. Subsequent hip ultrasonography and magnetic resonance imaging (MRI) demonstrated an iliopsoas bursal cyst adjacent to the femoral nerve. Available electromyography findings showed a reduced right femoral nerve response amplitude. Considering the patient's overall clinical presentation, we considered right femoral nerve injury to be the most likely diagnosis. The patient underwent open anterior cyst excision to achieve complete neural decompression. The anterior thigh pain improved rapidly, with the visual analog scale (VAS) score decreasing from 8 to 2 on postoperative day 1. No symptom recurrence was observed during 12 months of follow-up.ConclusionThis case provides an important clinical warning. In older patients with chronic occupational musculoskeletal overuse, extraspinal femoral nerve compression should be considered when treatment for LSS relieves low-back and posterior thigh pain but severe anterior thigh or groin pain persists or worsens. Hip Doppler ultrasonography, MRI, and electromyography/nerve conduction studies should be performed to exclude extraspinal femoral nerve compression. In patients with severe cyst-related femoral nerve compression, open cyst excision can provide rapid neural decompression.
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BibTeX
@article{zhou2026femoral,
title = {{Femoral nerve compression by an iliopsoas bursal cyst coexisting With lumbar spinal stenosis: a case report}},
author = {Yongdong Zhou and Shanzhi Li and Hongyi Kang and Bangjian Zhou and Wenping Liu and Haoduan Dou and Rui Tang},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1948532},
url = {https://doi.org/10.3389/fsurg.2026.1948532},
note = {CC BY},
}
RIS
TY - JOUR
TI - Femoral nerve compression by an iliopsoas bursal cyst coexisting With lumbar spinal stenosis: a case report
AU - Yongdong Zhou
AU - Shanzhi Li
AU - Hongyi Kang
AU - Bangjian Zhou
AU - Wenping Liu
AU - Haoduan Dou
AU - Rui Tang
PY - 2026
DA - 2026/10/23
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1948532
UR - https://doi.org/10.3389/fsurg.2026.1948532
AB - BackgroundIliopsoas bursal cysts are rare synovial proliferative lesions, most commonly associated with osteonecrosis of the femoral head, osteoarthritis, and rheumatoid arthritis. When a cyst compresses the femoral nerve, it may cause groin pain, radiating anterior thigh pain, and an antalgic gait, closely mimicking lumbar spinal stenosis (LSS). Only approximately 20 comparable cases of femoral nerve compression have been documented worldwide. Concomitant LSS and femoral nerve compression by an iliopsoas bursal cyst have not previously been reported. The coexistence of LSS and femoral nerve compression caused by an iliopsoas bursal cyst may result in delayed or missed diagnosis.Case presentationWe report a patient with concomitant LSS and femoral nerve compression caused by an iliopsoas bursal cyst who was initially treated for LSS alone. After 3 days of integrative conservative treatment for LSS, the low-back, posterior thigh, and lateral calf pain improved substantially; however, the right anterior thigh and groin pain became intolerable. Subsequent hip ultrasonography and magnetic resonance imaging (MRI) demonstrated an iliopsoas bursal cyst adjacent to the femoral nerve. Available electromyography findings showed a reduced right femoral nerve response amplitude. Considering the patient's overall clinical presentation, we considered right femoral nerve injury to be the most likely diagnosis. The patient underwent open anterior cyst excision to achieve complete neural decompression. The anterior thigh pain improved rapidly, with the visual analog scale (VAS) score decreasing from 8 to 2 on postoperative day 1. No symptom recurrence was observed during 12 months of follow-up.ConclusionThis case provides an important clinical warning. In older patients with chronic occupational musculoskeletal overuse, extraspinal femoral nerve compression should be considered when treatment for LSS relieves low-back and posterior thigh pain but severe anterior thigh or groin pain persists or worsens. Hip Doppler ultrasonography, MRI, and electromyography/nerve conduction studies should be performed to exclude extraspinal femoral nerve compression. In patients with severe cyst-related femoral nerve compression, open cyst excision can provide rapid neural decompression.
SN - 2296-875X
ER -