Cervical juxtafacet cysts: case report and literature review.

BACKGROUND: Juxtafacet cysts of the cervical and thoracic spine are rare and often present with myelopathy. Juxtafacet cysts are well recognized entities found commonly in the lumbar spine but are unusual in the cervical and thoracic spine. We present a case of a patient with gait disturbance and early myelopathy who was found to have a juxtafacet cyst at the cervico-thoracic junction. We further review the literature. PURPOSE: To describe a case of a cervico-thoracic juxtafacet cyst and review the literature. STUDY DESIGN: Case report and subject review. METHODS: One patient presenting with early myelopathy and pain underwent surgery for resection of the lesion. Pathologic analysis revealed a juxtafacet cyst. RESULTS: The patient recovered uneventfully with relief of his pain. Pubmed review revealed less than 30 similar cases in the literature. CONCLUSION: Juxtafacet cysts of the cervical spine are rare entities. These lesions comprise both synovial cysts and ganglion cysts. The benign lesions present with myelopathy and should be considered in patients with cystic lesions in the cervical spinal canal.     

Cervical and thoracic juxtafacet cysts causing neurologic deficits

STUDY DESIGN: Case reports and review of the literature. OBJECTIVES: To review the clinical features, treatment, and outcome of juxtafacet cysts. SUMMARY OF BACKGROUND DATA: There have previously been 4 reported cases of thoracic juxtafacet cysts and 19 cases of cervical juxtafacet cysts. Cervical cysts have usually originated from the cruciate ligament and caused myelopathy. Thoracic cysts are usually signaled by myelopathy. METHODS: The records of the Neurosurgery Department of Royal Adelaide Hospital from 1980 through 1995 were reviewed for cases of intraspinal juxtafacet cysts. RESULTS: Eight cases of intraspinal juxtafacet cysts were identified; six were in the lumbar spine. One patient had a cervical cyst related to a facet joint and had unilateral radiculopathy. A second patient with a thoracic cyst had the gradual onset of myelopathy. Both patients had surgical excision of the cyst without resection of the adherent dura. The symptoms and neurologic signs improved in each case. CONCLUSIONS: Cervical and thoracic juxtafacet cysts are rare lesions that are usually signaled by myelopathy. Results of surgery are excellent in most cases, even if the cyst is not completely excised.     

Bilateral synovial cyst of the thoracic spine causing paraparesis

Spinal synovial cysts are degenerative extradural lesions mostly found in the lumbar region, and more rarely at cervical or thoracic levels and in a bilateral presentation. We report a patient with a history of progressive paraparesis associated with bilateral cervicothoracic synovial cysts, causing spinal canal narrowing and cord compression, ultimately resulting in myelopathy. A review of the literature summarizes previous reports on this topic. Surgical excision of the extradural mass, decompression of the spinal canal and instrumented fusion were performed, improving lower limb deficit and gait. Post-surgical MRI showed evidence of complete cyst resection, and good arthrodesis consolidation with adequate sagittal balance. Surgical excision is indicated in case of medical treatment failure or increasing symptom severity. Given the strong pathophysiological link between synovial cysts and spinal instability, concomitant instrumented fusion may help improve outcome.     

Epidural hematoma secondary to a rupture of a synovial cyst.

BACKGROUND CONTENT: With modern advances in imaging studies, synovial cysts are becoming more evident as a common component of erosive lumbar degenerative disc disease causing spinal stenosis and radiculopathy. Whereas hemorrhage can occur inside the cyst and is reported, rupture causing epidural hematoma is a rare complication and finding of this disorder. PURPOSE: To report a rare clinical presentation of a synovial cyst and spinal stenosis, where rupture of the cyst leads to an early cauda equina syndrome. STUDY DESIGN: Case report with a review of literature. METHODS: Clinical history, physical findings, and magnetic resonance imaging studies of a patient with an intraspinal synovial cyst at L4-5 1 week before a sudden worsening of symptoms are reported. RESULTS: A case report is presented of a male with a known synovial cyst at L4-5, presenting initially with neurogenic claudication. This patient developed sudden worsening of symptoms with bilateral lower extremity pain, weakness, and radiculopathy with difficult voiding. The patient had developed an epidural hematoma, secondary to rupture of a synovial cyst, documented at surgical decompression. CONCLUSIONS: Although synovial cyst associated with erosive facet and erosive degenerative disc disease are common, rupture of the cyst is not. A case report of a ruptured synovial cyst leading to an early cauda equina syndrome is presented. This case illustrates the spectrum of clinical features and presentations possible with spinal stenosis complicated by lumbar synovial cyst formation.     

Far lateral extraforaminal facet cyst causing L5 radiculopathy

Most synovial cysts of the lumbar spine appear as intraspinal extradural masses adjacent to the facet joint. Almost all symptomatic synovial cysts are located within the spinal canal and or the neural foramen. To our knowledge, only 6 cases of symptomatic extraspinal synovial cysts have been described in the literature. The authors report a case of lumbar radiculopathy caused by a synovial cyst located in the far lateral extraforaminal area. The patient underwent decompression of the L5 nerve root with recapping right isthmectomy and facetectomy. Postoperative recovery was uneventful, and the patient was totally pain free with no motor deficit. Symptomatic synovial cysts are uncommon lesions that are associated with degenerative disease of the spine. Juxtafacet cysts should be considered in the differential diagnosis of space-occupying lesions at the extraforaminal areas. Recapping isthmectomy and facetectomy are useful procedures for a synovial cyst located in the far lateral extraforaminal area.     

Symptomatic intraspinal air entrapment

A 59-year-old man who had undergone the removal of a lipoma of the thoracic spine presented with progressive weakness of the lower limbs when lumbar puncture followed drainage of a subcutaneous collection of cerebrospinal fluid. Computed tomography showed entrapped intraspinal air which compressed the spinal cord. This rare, but serious complication can occur in a patient with altered intrathecal pressure following spinal surgery.     

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

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 hyper-motion or trauma of the spine. This is reinforced by the appearance of spinal synovial cysts most commonly at the level of L4/5; this being the region with the biggest weight-bearing function. The most common site of cervical cyst formation is at the level of C7/T1; this is a transitional joint subjected to unique stress and mechanical forces not present at higher levels. Treatment of a cervical synovial cyst at the level of the odontoid is challenging with little information available in the literature. The majority of cases appear to implement posterior surgical resection of the cyst, with fusion of adjacent cervical vertebrae to stabilise the fracture, resulting in restricted range of movement.

Case presentation

We describe a case concerning a 39-year-old female who presented with uncertain cause of odontoid fracture, resulting in a cystic lesion compressing the upper cervical spinal cord.

Outcome

Minimal invasive surgery of C1/C2 transarticular fusion was successfully performed resulting in significant improvement of neurological symptoms in this patient. At 1-year follow-up, the cyst had resolved without surgical removal and this was confirmed by radiological measures.     

A rare cause of root-compression: Subaxial cervical synovial cyst in association with congenital fusion

IntroductionSynovial cyst in the cervical spine is a very rare pathology that develops from the facet joint. When a synovial cyst emerges into the surrounding space, it can compress the nervous tissue and cause neurological symptoms. In the cervical area there is additionally the risk of spinal cord compression comparing to the more common presentation of synovial cysts in the lumbar spine.Presentation of caseHere, a cervical synovial cysts from the left facet joint grew into the spinal canal and compressed the C8 nerve root which led to root compressing symptoms. Interestingly we found this synovial cyst with congenital fusion. We identified only nine similar cases in the literature. The cyst was removed surgically and the patient discharged without complications.DiscussionNumerous theories have been established to explain the pathogenesis of synovial cyst. Biomechanical alterations of the spine play a significant role in the development of synovial cyst. However, the etiology is still unclear.ConclusionSurgical treatment should be considered in cervical synovial cysts with neurologic deficit or with cord compression or when the conservative treatment is ineffective.     

Synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation

Synovial cysts of the cervical spine causing myelopathy are rare. The pathogenesis of these cysts is often attributed to degenerative changes of the facet joints or microtrauma. The authors report a synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation without a congenital anomaly or inflammatory conditions. A 72-year-old man presented with a progressive right-sided myelopathy attributed to a C1-C2 synovial cyst accompanied by atlantoaxial subluxation and C3-C6 spondylosis. Magnetic resonance imaging of the cervical spine showed a large cystic mass compressing the spinal cord located at the C1-C2 junction. A C1 hemilaminectomy, complete evacuation of the cyst contents, and posterior atlantoaxial fusion were performed, and a double-door laminoplasty was also done at C3-C6. The patient showed significant improvement of paresthesia and motor weakness of the right upper and lower extremities immediately after the operation. Synovial cysts should be considered in the differential diagnosis of an extradural mass of the upper cervical spine. Posterior fusion combined with direct excision of the cyst may be the optimum treatment of a synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation.     

Hemorrhagic lumbar synovial facet cyst secondary to anticoagulation therapy.

BACKGROUND CONTEXT: Acute onset of radicular symptoms has been reported following hemorrhage into lumbar synovial cysts after trauma or in cases of spinal instability. No previous cases have been linked to anticoagulation therapy. PURPOSE: To present a case of symptomatic hemorrhagic lumbar synovial cyst occurring after anticoagulation therapy. STUDY DESIGN: A case report and review of the literature. METHODS: A patient presented with low back and radicular pain secondary to a large synovial facet cyst. Magnetic resonance imaging revealed a large facet cyst compressing the thecal sac and L3 exiting nerve root. RESULTS: The synovial cyst was excised during a lumbar decompression and fusion. Gross blood was present in the cyst. CONCLUSIONS: This is the first reported case of symptomatic hemorrhagic lumbar facet cyst associated with anticoagulation therapy.     

Root and spinal cord compression from methylmethacrylate vertebroplasty.

STUDY DESIGN: Case report and literature review. OBJECTIVES: Clinicians use methylmethacrylate vertebroplasty to treat vertebral hemangiomas, metastases, and osteoporotic fractures. Cement may leak out of the vertebral body and compress the adjacent spinal cord and nerve roots. We review a case of nerve-root and cord compression from methylmethacrylate extrusion during vertebroplasty. SUMMARY OF BACKGROUND DATA: A 50-year-old female presented with disabling thoracic back pain. A metastasis to T1 was discovered, with collapse of the vertebral body but without cord compression. Methylmethacrylate vertebroplasty was performed. After injection, portable computed tomography (CT) showed a leakage of methylmethacrylate into the C8 and T1 foramina and spinal canal. Radiculopathy and myelopathy developed. Surgical decompression using the anterior approach was necessary. METHODS: Case report. RESULTS: Early surgical intervention decompressed the neural elements and relieved the neurological deficits. CONCLUSIONS: Neurologic complications of methylmethacrylate vertebroplasty necessitate active involvement of spine surgeons in patient evaluation and management.     

Idiopathic spinal cord herniation: report of three cases and review of the literature

STUDY DESIGN: Three case reports and a literature review are presented. OBJECTIVE: To describe characteristic clinical and radiographic findings of idiopathic spinal cord herniation. SUMMARY OF BACKGROUND DATA: Idiopathic spinal cord herniation is a rare disease, with only 26 cases reported before the current study. METHODS: Three cases of idiopathic spinal cord herniation are reported, and previous reports on this subject are reviewed. RESULTS: The responsible regions were in the thoracic spine from T2 to T7. Symptoms were mainly unilateral muscle atrophy in the lower extremity and sensory disturbance below the thoracic level. These symptoms had been progressing gradually. Magnetic resonance imaging demonstrated a unique feature: The spinal cord shifted anteriorly in a few segments. Computed tomographic myelogram showed another distinctive picture: There was no subarachnoid space anterior to the spinal cord. CONCLUSIONS: Because idiopathic spinal cord herniation is out of the concept of "compression myelopathy," this condition may be a pitfall in the diagnosis. Idiopathic spinal cord herniation should be recognized as one of the treatable causes for thoracic myelopathy.     

Synovial cyst of the cervical spine

A case of acute posttraumatic myelopathy resulting from hemorrhage into synovial cysts bilaterally at the C-6, C-7 facet joints is presented. The pathogenesis of synovial cysts remains unclear, although reports in the literature have implicated trauma leading to cyst enlargement. Hemorrhage into the cavity of the synovial cysts resulted in epidural compression of the spinal cord in this patient. Because spinal synovial cysts cannot be unequivocally diagnosed preoperatively, other more common conditions must be considered in the differential diagnosis. Radiographic analysis including plain films, computed axial tomography, and metrizamide myelography are of value in establishing a neurological diagnosis. Surgical decompression and excision of the lesion may result in significant neurological improvement.     

Stab injury of the spinal cord surgically treated

The authors report a case of thoracic spinal cord stab injury with neurologic impairment that was treated surgically after injury. A literature review and case analysis indicate that surgical extraction of foreign bodies retained within the spinal canal is indicated to avoid infection, delayed myelopathy, and neurologic loss. The amount of motor and functional recovery for incomplete injuries after spinal cord stab wound can be strikingly good despite pathologic changes to severely damaged areas, and removal of retained intraspinal metallic fragment can improve this neurologic outcome. Open removal of the knife seems preferable to avoid bleeding and infection.     

Idiopathic herniation of the thoracic spinal cord: report of three cases

STUDY DESIGN: Cases are reported and the literature is reviewed. OBJECTIVE: To present three cases involving idiopathic herniation of the thoracic cord. SUMMARY OF BACKGROUND DATA: Idiopathic spinal cord herniation is a very rare condition. Only 20 cases have been reported. The radiographic and intraoperative findings concerning this herniation remain insufficient, and its pathophysiology is less understood. METHODS: Idiopathic herniation of the thoracic spine was managed operatively in the three cases. The clinical, radiologic, and intraoperative features in these cases are described, and the pathophysiology of this disorder is discussed from a review of the literature. RESULTS: Two of the three patients had a defect in the inner layer of the duplicated ventral dura mater through which the spinal cord was herniated. The third patient had a ventral epidural cyst into which the spinal cord had protruded. Operative reduction of the spinal cord improved motor power in all three patients, although sensory disturbance remained unchanged. CONCLUSIONS: There should be several types of idiopathic spinal cord herniation. This is the first report of this herniation that focuses the abnormalities of the ventral dura mater, together with image and intraoperative findings.     

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report

A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patients myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. Association between degenerative intraspinal cysts and listhesis is discussed. To our knowledge, this is the first case of cyst of the ligamentum flavum associated with cervical subluxation.     

Spinal cord compression caused by unusual location and extension of ossified ligamenta flava in a Caucasian male. A case report and literature review

STUDY DESIGN: A case report of a spinal cord compression caused by ossification of the ligamenta flava is presented together with a review of the literature. OBJECTIVE: To present the diagnosis of ossification of the ligamenta flava in a Caucasian man with a proximal thoracic myelopathy. SUMMARY OF BACKGROUND DATA: This case shows that the upper parts of the thoracic spine can be involved in ossification of the ligamenta flava, which never before has been reported in Caucasian individuals. Furthermore, it is advised that computed tomography scanning and magnetic resonance imaging be combined to provide an accurate diagnosis and proper preoperative evaluation of the bony changes, spinal cord, and compression of the spinal cord. METHODS: A patient with a thoracic spinal cord compression caused by ossification of the ligamenta flava was treated surgically and made a good clinical recovery. Imaging studies, surgical findings, and results of histopathologic investigations were analyzed to substantiate the diagnosis. RESULTS: The results of the surgical findings seemed to be in contrast with those of the imaging studies. This contrast was occasioned by the uncommon perioperative finding of a fusion of the completely ossified upper and lower parts of the involved adjacent ligamenta flava. Ossification of the ligamenta flava was diagnosed by histopathologic examination, which revealed endochondral ossification and lamellar bone formation without fragments of ligamenta flava. CONCLUSION: Although rarely reported in whites, ossification of the ligamenta flava should be considered in all patients presenting with a spinal cord compression, even at high thoracic levels. The prognosis after decompressive surgery can be good, especially if intramedullary hyperintensities are absent on preoperatively performed T2-weighted magnetic resonance images.     

Multifocal extensive spinal tuberculosis (Pott's disease) involving cervical, thoracic and lumbar vertebrae

An unusual case is reported of a 53-year-old woman presenting with spinal tuberculosis involving cervical, thoracic and lumbar vertebrae. The patient originally presented with progressive quadriparesis, fever, night sweats and weight loss. Imaging studies demonstrated vertebral body destruction with and without paraspinal and/or intraspinal abscess in cervical, thoracic and lumbar regions. The laboratory studies confirmed the diagnosis of Pott's disease and the patient was placed on anti-tuberculosis chemotherapy. The anterior approach was used for removal of the infected necrotic material, bone grafting and instrumentation, in both cervical and thoracic vertebrae. The postoperative course was uneventful and the patient made an excellent neurological recovery. The present report is of the first published case of an extensive spinal tuberculosis involving cervical, thoracic and lumbar spine.