Cervical Juxtafacet Cyst With Myelopathy Due to Postoperative Instability -Case Report-

Abstract

A 74-year-old man presented with a cervical juxtafacet cyst on the right side of C5-6 and prominent myelopathy. He had been treated with anterior cervical discectomy and fusion at C4-5 as well as anterior foraminotomy of the right C5-6 lesion 20 months previously. The patient underwent complete surgical excision of the lesion. The patient recovered uneventfully, and the myelopathy resolved. Reexamination of the images revealed that we failed to investigate a suspicious minimal cervical juxtafacet cyst on the initial preoperative images and that the degree of subluxation at C5-6 on flexion radiography had increased postoperatively. Therefore, the surgeon should be aware that juxtafacet cyst can be progressive in planning of cervical spinal surgery which can cause or aggravate instability in the presence of an incidental, suspicious juxtafacet cyst on preoperative imaging at the same level, even if the lesion is very small and subclinical.

Atlantoaxial Intraspinal Juxtafacet Cyst

“…15,18,21) Reports of occurrence in the cervicothoracic spine are even rarer, with the majority found at the C7-T1 level. 22) Few have occurred at the level of the odontoid process, as in the present case, with approximately 50 cases reported, including the present case. Synovial cysts are another form of cystic lesion within the vertebral canal that arises in the neighborhood of spinal facet joints.…”

“…Since there is little clinical significance in differentiation, both types are jointly included under the general term of juxtafacet cysts, and recently many reports have used this terminology. 15,22) Various hypotheses have been proposed for the pathogenesis of juxtafacet cysts, including trauma, repeated microtrauma due to instability or other reason, aberrancy, and mesenchymal cell proliferation. Juxtafacet cysts are common in elderly people and frequently occur together with degenerative facet disease and spondylolisthesis, so the dominant hypothesis is repeated microtrauma to joint tissue.…”

“…Juxtafacet cysts are common in elderly people and frequently occur together with degenerative facet disease and spondylolisthesis, so the dominant hypothesis is repeated microtrauma to joint tissue. 22) Pseudotumor occurring secondarily in the area of the odontoid process in rheumatoid arthritis patients is also regarded as having the same cause. 23) Juxtafacet cysts occurring as a result of postoperative instability following cervical spine or lumbar spine surgery have also been reported, 22) as have cases in which a cyst has spontaneously disappeared after only posterior fusion or wearing a Philadelphia collar, 6,23,26) providing evidence supporting the hypothesis of microtrauma due to instability as the cause.…”

“…22) Pseudotumor occurring secondarily in the area of the odontoid process in rheumatoid arthritis patients is also regarded as having the same cause. 23) Juxtafacet cysts occurring as a result of postoperative instability following cervical spine or lumbar spine surgery have also been reported, 22) as have cases in which a cyst has spontaneously disappeared after only posterior fusion or wearing a Philadelphia collar, 6,23,26) providing evidence supporting the hypothesis of microtrauma due to instability as the cause. However, no history of trauma, rheumatism, facet degeneration, spondylolisthesis, or resultant instability was evident in most of the reported cases of juxtafacet cyst at the level of the odontoid process, including the present case, meaning that the microtrauma hypothesis is implausible.…”

“…However, since differentiation has little meaning in terms of clinical treatment, the term`j uxtafacet cyst'' is now frequently used. 15,22) Juxtafacet cysts usually occur in the lumbar spine (88-99%), with up to 8% found in the thoracic spine and 1-4% in the cervical spine. 8) Occurrence at the level of the odontoid process is extremely rare, and preoperative diagnosis is often difficult.…”