Synovial cyst of the upper cervical spine

Weymann, Catherine A.; Capone, Patrick M.; Kinkel, Peter R.; Kinkel, William R.

doi:10.1212/wnl.43.10.2151-a

Cited by 33 publications

(16 citation statements)

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“…MRI was carried out in nine cases; in all of them it identified the lesion, which was hypo/isointense on T1-weighted images in seven cases [9,14,20,41,55,59, our case], hyperintense on T2-weighted images in five cases [14,17,20,55,59] and hypointense on T2-weighted images in one case [9]. In one case the lesion was hyperintense on T2-weighted images with a hypodense rim [59].…”

Section: Review Of the Literaturementioning

confidence: 77%

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Cervical synovial cysts: case report and review of the literature

Lunardi

Acqui

Ricci

et al. 1999

European Spine Journal

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IntroductionSynovial cysts are cystic dilatations of the synovial sheaths; they are bordered not only by the connectival tissue structures of these sheaths but also by the mono-or pluri-stratified cuboid synovial epithelium. Anatomical continuity with the synovial sheaths of the joint cavities from which the cyst probably originates may not always be observed.While synovial cysts are quite a frequent occurrence in joints and tendon sheaths [3,10,23], especially in the joints of the hands and wrists [45], they are very rare in the spine [13,18,25,40,47,62]. In the lumbar spine 220 cases have been described [1,2,16,21,28,34,38,40,43,45,48,51,[54][55][56]60].The incidence of synovial cysts with a cervical location was evaluated, with reference to veterinary literature too [15], and was found to be an occurrence specific to humans, of which, to our knowledge, only 22 cases have been reported to date.We describe another case of cervical synovial cyst and discuss the pathological, etiopathogenetic, and clinical aspects of this rare pathology. Case reportA 58-year-old man was referred to us with a progressive spastic paraparesis, which had started 8 months earlier. About 2 months prior to admission, he had begun to suffer from genital-sphincteric ailments such as urinary retention and difficult erection.Examination revealed a severe motor deficit in the lower limbs (he was able to raise his legs while lying in bed for a few seconds only), as well as an increased response to knee and ankle jerks. There was superficial and deep hypoesthesia below C8 and apallesthesia below the iliac crests. There was also urinary retention, which required catheterization. AbstractThe authors describe the case of a 58-year-old man with a 6-month history of severe myelopathy. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at a right posterolateral site at the level of the articular facet. At operation the mass appeared to originate from the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. Once the mass had been removed, there was a significant amelioration of the patient's symptoms. As previously suspected, histological aspect was synovial cyst. Cervical synovial cysts are extremely rare and, as far as we know, only 22 cases have so far been described in the literature. Diagnostic radiological investigations used were CT scan and MRI. At CT scan the most important diagnostic findings are a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst. At MRI the contents of the cyst are iso/hypointense on T1-and hyperintense on T2-weighted images. There may also be a hypointense rim on T2-weighted images, which enhances after i.v. administration of gadolinium. Surgical treatment consists of removal of the mass. Fixation of the vertebral segments involved is not always necessary.

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Section: Review Of the Literaturementioning

confidence: 77%

“…In one case the lesion was hyperintense on T2-weighted images with a hypodense rim [59]. Two cases [9,59] displayed enhancement of the cyst wall.…”

Section: Review Of the Literaturementioning

confidence: 93%

Cervical synovial cysts: case report and review of the literature

Lunardi

Acqui

Ricci

et al. 1999

European Spine Journal

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“…There are several theories concerning the formation of these cysts including protrusion of the synovial membrane through defects in the joint capsule due to degeneration, resulting in the formation of a para-articular cavity filled with fluid 6) ; myxoid degeneration and cyst formation of the synovial tissue 12,18) ; and scar remodeling of the ligamentum flavum, accompanied by the formation of a cyst. 19) The fact that most juxtafacet cysts arise from the L4-5 level, the most mobile level of the vertebral column, together with the frequent association with spondylolisthesis, favors instability as a pivotal factor in cyst progression.…”

Section: Discussionmentioning

confidence: 99%

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

Moon

Kim

et al. 2010

Neurol. Med. Chir.(Tokyo)

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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.

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“…Sixteen cases of synovial cysts in the cervical spine have been reported [1][2][3][4]6,[8][9][10]13,14,16,17,[19][20][21]; eight located at the C1-2 levels (Table 1) Surgical treatment of these lesions may use vari ous approaches. The transoral approach was used to treat a lesion just behind the dens in one case.)…”

Section: Discussionmentioning

confidence: 99%

“…The transoral approach was used to treat a lesion just behind the dens in one case.) The posterior approach with C1-2 laminectomies was used in all other cases, 4,6,13,16,19,21) with additional foramen magnum decompression in two6,13) ( Table 1). We selected the transcondylar approach because we planned posterior craniocervical fixation after total removal of the ventrally located synovial cyst.…”

Section: Discussionmentioning

confidence: 99%