Retro-odontoid cystic mass treated by laminectomy and C1-C2 fixation

Abstract

Retro-odontoid cysts associated with chronic atlantoaxial subluxation are extremely rare. This article describes a case of retro-odontoid cystic mass associated with chronic atlantoaxial subluxation and its management with posterior C1 and partial C2 laminectomy and C1-C2 pedicle screw fixation without resection of the retro-odontoid cyst. A 64-year-old woman experienced a sudden onset of neck pain, hand and foot paresthesia. Atlantoaxial instability associated with a retro-odontoid cystic mass was found in the imaging. The patient underwent posterior C1 and partial C2 laminectomy and C1-C2 pedicle screws fixation without resection of the retro-odontoid cyst. During the 24 months followup period, the cyst disappeared completely and the patient remained symptom free and returned to independent daily living. These findings suggest that posterior laminectomy and fixation without resection of the retro-odontoid cyst is relatively simple and safe and the results are satisfactory.

Retro-Odontoid Intradural Synovial Cyst Decompression via Endoscopic-Assisted Far-Lateral Approach C1-C2 Hemilaminectomy Without Fusion: The Use of Intracranial Denticulate Ligament as Intraoperative Landmark

“…Consequently, this instability can lead to progressive refractory neck pain and compressive cervical myelopathy, which becomes potentially disabling if left untreated. This destabilization appears to come from chronic stress to the facet and uncovertebral joints [ 14 ]. We concur and suggest that chronic focal irritation and inflammation of the retro-odontoid ligaments contribute to cyst formation by way of abnormal movement of the atlas on the dens.…”

“…After the screening of results by removing the duplicates, excluding case series and reviews, removing case reports involving calcium pyrophosphate deposition, and filtering for English as the preferred language, 10 case reports involving 11 patients were identified (Figure 3 ). The salient details of the operation in each case report are highlighted in Table 1 [ 2 , 3 , 6 , 9 , 14 , 16 - 18 , 20 , 21 ]. Even though each approach varied according to patient profile, symptomatology, and tumor location, there is consistency in the resolution of the synovial cyst in most cases, suggesting the possibility of multiple approaches to intervention.…”

“…Interestingly, Lin et al (2014), Meng and Liu (2016), and Ogata et al (2007) also approached a synovial cyst with posterior laminectomy, occipitocervical fusion, and posterior fixation, respectively, but without surgical resection due to technical challenges. Nonetheless, all of them reported resolution of the patients' symptoms along with regression of the cysts over several months [ 14 , 17 , 18 ]. Meanwhile, an anterior approach via the sternocleidomastoid muscle can permit access to the dura for cyst resection [ 3 ].…”

“…[2,3,6,9,14,[16][17][18]20,21]. Even though each approach varied according to patient profile, symptomatology, and tumor location, there is consistency in the resolution of the synovial cyst in most cases, suggesting the possibility of multiple approaches to intervention.…”

Atlantoaxial Intradural Synovial Cyst Mimicking an Extradural Lesion Adjacent to a Retro-odontoid Pseudotumor: A Case Report

“…[3][4][5] Evidence suggests that the cyst originates from the transverse ligament behind the dentate process of the axis. 4,6,7) Albeit quite rare, synovial cysts can penetrate the dura mater into the thecal sac and cause direct neural compression. Several case reports have been published on "intradural synovial cysts" (IDSCs).…”