Synovial Cyst of the Cervical Spine

Jabre, Anthony; Shahbabian, Set; Keller, Jeffrey T.

doi:10.1227/00006123-198702000-00020

Cited by 88 publications

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“…Synovial cysts of the spine rarely present with acute pain and neurological deficit after haemorrhage into the cyst. [2][3][4][5][6][7][8][9] The bleeding is usually into the cyst and surrounding soft tissues, such as the ligamentum flavum or the epidural space. Haemorrhage into the spinal canal may cause acute compression of the spinal cord and/or nerve roots and may exacerbate the symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…1 Only eight cases of haemorrhagic cysts, however, have been reported in the English literature. [2][3][4][5][6][7][8][9] The most frequent presentation of a lumbar synovial cyst is with intermittent low back pain in the absence of motor or sensory impairment, classical radiculopathy and acute exacerbation of symptoms because of haemorrhage. 8 They rarely occur after injury to the back.…”

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confidence: 99%

“…8 They rarely occur after injury to the back. 4 We describe a patient with a synovial cyst of the lumbar spine who presented with neurological deficit as a result of acute radicular compression by a haematoma.…”

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Haemorrhagic lumbar synovial cyst

Inoue

2000

The Journal of Bone and Joint Surgery. British volume

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Intraspinal synovial or ganglion cysts are widely recognised.1 Only eight cases of haemorrhagic cysts, however, have been reported in the English literature. [2][3][4][5][6][7][8][9] The most frequent presentation of a lumbar synovial cyst is with intermittent low back pain in the absence of motor or sensory impairment, classical radiculopathy and acute exacerbation of symptoms because of haemorrhage. 8 They rarely occur after injury to the back. 4 We describe a patient with a synovial cyst of the lumbar spine who presented with neurological deficit as a result of acute radicular compression by a haematoma. Case reportA 55-year-old man complained of low back pain for a period of six months, which had increased during the month before presentation. Three days before admission, he fell and subsequently had pain radiating into his left leg from his buttock to the posterolateral aspect of the calf. He also complained of weakness, paraesthesia and a painful limp favouring the left leg. He did not have incontinence of the bowel or bladder. His medical history was otherwise unremarkable. The left straight-leg-raise test elicited pain in the leg at 30° which was exacerbated further by ankle dorsiflexion. He had mild weakness of the left extensor hallucis longus and tibialis anterior muscles (MRC grade 4). There was diminished sensation to light touch in the left thigh and calf, and in the distribution of the L3 and L4 dermatomes. The left patellar tendon reflex was present but diminished. Plain radiography of the lumbosacral spine was normal. CT of this area revealed a 10 mm osteolytic lesion of the left inferior facet of L3, with marked degenerative changes (Fig. 1). MRI showed an obvious haematoma and compression of the dura of the spinal canal at the level of L3 and L4 (Fig. 2). The neurological deficit indicated urgent surgical decompression. The posterior elements from L2 to L4 were exposed and an en-bloc hemilaminectomy and facetectomy were carried out on the left side at the level of L3. The extradural haematoma was directly visualised and evacuated, effecting decompression of the left L3 and L4 nerve roots. Subsequent histological examination of the surgical specimen revealed a synovial cyst (Fig. 3). Recovery was uneventful except for an episode of slight pain in the left leg. Three months after operation he returned to work and Fig. 1 CT of the third lumbar lamina and the lower facet showing the cyst and destruction of the ventral aspect of the cortex associated with loss of articular cartilage, osteophytes and subchondral cysts.

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Haemorrhagic lumbar synovial cyst

Inoue

2000

The Journal of Bone and Joint Surgery. British volume

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“…Cervical cysts at C1/C2 level can present due to a range of dens degeneration/trauma, without dens involvement at all, or can themselves be the cause of spinal trauma, for example dens hypoplasia [7]. Where there is dens involvement, treatment is surgical, through one of a number of options including posterior craniocervical fusion [8], decompression and excision of the lesion [9], posterior atlantoaxial arthrodesis [7].…”

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confidence: 99%

Transarticular fusion for treatment of cystic lesion arising from an odontoid fracture

et al. 2012

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Introduction Odontoid fractures are the most common upper cervical spine fracture. There are two mechanisms in which odontoid fractures occur, most commonly hyperflexion of the neck resulting in displacement of the dens anteriorly and hyperextension resulting in posterior dens displacement. Type 2 fractures are the most common and are associated with significant non-union rates after treatment. One possible consequence of an odontoid fracture is a synovial cyst, resulting in spinal cord compression, presenting as myelopathy or radiculopathy. Synovial cysts as a result of spinal fracture, usually of the facet joint, are most common in the lumbar region, followed by the thoracic and then cervical region; cervical cysts are rare. Fracture and subsequent cyst formation is thought to be related to hypermotion or trauma of the spine. This is reinforced by the

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“…36) Synovial cysts of the spine are relatively rare, and may occur in the cervical, 21) thoracic, 4) and lumbar spine, with the latter segment being the most common localization, accounting for 94% 19) to 85% 15) of the total reported cases. Most spinal synovial cysts occur at the L4-5 intervertebral level, and to a lesser extent at the L5-S1 and L3-4 intervertebral levels.…”

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confidence: 99%

Synovial Cysts of the Lumbar Spine

Ganau

Ennas

Bellisano

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Symptomatic lumbar synovial cysts (LSCs) are a rare cause of degenerative narrowing of the spinal canal, with thecal sac or nerve root compression. True synovial cysts have a thick wall lined by synovial cells, containing granulation tissue, numerous histiocytes, and giant cells. In contrast, pseudo-cysts lack specialized epithelium, have a collagenous capsule filled with myxoid material, and may be classified into ganglion cysts, originating from periarticular fibrous tissues, and ligamentous cysts, arising from the ligamentum flavum or even from the posterior longitudinal ligament. Here we present the surgical series of the Chair of Neurosurgery at the University of Cagliari (Italy) including a total of 17 LSCs. Surgical technique consisted of facet sparing excision of LSC, achieved by simple hemilaminectomy/laminectomy, and diagnosis was always confirmed by histological specimen examination, which detected the typical synovial epithelium, the intracystic presence of hemosiderin, histiocytes, and calcifications. Further immunohistochemical investigation revealed positive staining for cytokeratin: CK5, CK6, and AE1/AE3. Clinically, our cohort experienced rapid and complete resolution of symptoms, without perioperative complications, or recurrence of cysts or vertebral instability at a median follow up of 28 months, when the MacNab score was generally excellent. A review of the literature, retrieving articles published from 1973, collected a total of 101 articles concerning all the cases of LSC scientifically described to date. Both clinical and histological findings described in our study support the theory of degenerative microtraumatic pathogenesis of synovial cysts.

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Synovial Cyst of the Cervical Spine

Cited by 88 publications

References 0 publications

Haemorrhagic lumbar synovial cyst

Haemorrhagic lumbar synovial cyst

Transarticular fusion for treatment of cystic lesion arising from an odontoid fracture

Synovial Cysts of the Lumbar Spine

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