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.     

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.     

Myeloradicular damage in traumatic cervical disc herniation.

BACKGROUND: The literature on pure traumatic disc herniation is now voluminous but diversity of opinion exists regarding frequency, pathogenesis and management of this type of lesion. As a further contribution to the solution of the question it is thus justified to report our series of cervical traumatic disc herniation. METHODS: During the period from January 1986 to December 1994, 41 patients (25 males and 16 females, between the ages of 24 and 51 years) with traumatic cervical disc herniations were operated on by anterior approach. Twenty-six (63.4%) patients presented with radicular syndrome, 3 (7.3%) with medullary symptoms and signs, and 12 (29.3%) with myeloradiculopathy. Disc herniation was at the C3/4 level in 4 (9.7%) cases, at the C4/5 level in 7 (17.1%) cases, at the C5/6 level in 24 (58.5%) cases, and at the C6/7 level in 8 (19.5%) cases. In 6 (40%) patients suffering from myelopathy (with or without radiculopathy) an area of high MR signal intensity was observed within the cervical cord on T2-weighted images; such area corresponded at the level of cord compression by disc and was not demonstrated on T1-weighted images. All patients underwent discectomy without bone grafting. RESULTS: Among patients with radiculopathy, 27 (71%) experienced complete relief of preoperative symptomatology, and 11 (29%) minor pain and/or neurological deficits without interference with work activities. The myelopathy completely disappeared in 11 (73.3%) cases whereas remained unchanged in 3 (20%); 1 patient with myelopathy experienced amelioration of preoperative specific symptoms and signs. CONCLUSIONS: The results of surgery for cervical radiculopathy due to traumatic disc herniation are satisfactory since 92 to 100% of the patients postoperatively regain prior activities, an observation we have confirmed with our own series. The results in cases of myelopathy are less satisfactory: although approximately 73% of our patients with myelopathy reported total relief of preoperative symptomatology, published reports indicate that a significant postoperative improvement is seen in 33 to 56% of patients.     

A case of cervical endodermal cyst

A very rare case involving an endodermal cyst of the cervical spinal canal was documented. In 1999, a 28-year-old male presented with mild tetraplegia due to a traffic accident and consequently, he was admitted to another hospital. Magnetic resonance imaging (MRI) performed at that time demonstrated a cervical cord cyst. He was treated conservatively and as a result, complete resolution of symptoms was achieved. Five years later, he presented with progressive right hemiparesis and was referred to our institute. MRI at the time of admission exhibited an intradural extramedullary cystic lesion on the ventral side of the spinal cord at the C5-6 levels, which was characterized by low intensity on T1-weighted, and by high intensity on T2-weighted images. The cyst, which had increased in size, compressed the spinal cord remarkably backward. The anterior central vertebrectomy approach was performed. Subtotal resection of the cyst wall was conducted due to its tight partical adhesion to the spinal cord. The vertebral defect was reconstructed with an autogenous iliac graft. According to histological findings the cyst wall consisted of a single layer of columnar epithelial cells with secretory granules and immunohistochemical examination revealed that the cyst wall was positive for cytokeratin 7. Symptoms improved immediately. Subsequently, the patient was discharged with good performance status. Endodermal cysts are very rare developmental cysts derived from the embryonic endodermal layer. Moreover, these lesions are usually located intradurally in the cervical and upper dorsal spine ventral to the spinal cord. Total removal of the cyst is recommended if it is possible. However, total resection is often difficult due to adhesion of the cyst wall to the neural tissue so invasive resection should be avoided. In such cases, follow-up MRI is necessary in order to exclude recurrence of the remnant lesion.     

A recurrent intradural cervical neurenteric cyst operated on using an anterior approach: a case report

The neurenteric cyst is an uncommon congenital lesion. In most reported cases, it has been operated on via a posterior approach using a laminectomy, despite the fact that the cyst is usually located ventral to the spinal cord. Reports have shown that early postoperative results have been good with the posterior approach, but very few studies of the long-term postoperative recurrence of neurenteric cysts have been conducted. Here, we report on a case of recurrent neurenteric cyst that was operated on using an anterior approach.A 42-year-old woman presented with a cervical neurenteric cyst that had recurred eight years after its partial removal via a posterior approach. The patient complained of pain on the lateral side of her upper arms, and an magnetic resonance imaging showed that the recurrent cyst was located ventral to the spinal cord and compressed the cord dorsally at the C4-6 level.The patient was operated on via an anterior approach using a vertebrotomy at the lower half of C5 and the upper half of C6. The cyst was attached to the spinal cord firmly and was subtotally removed, with the thickest portion adhering to the cord not being removed. The caudal end of the cyst was observed with the assistance of a rigid endoscope.A neurenteric cyst may recur after partial removal, and the patient's condition may deteriorate during postoperative follow-up. The anterior surgical approach provides good visualization and facilitates safe removal of the lesion.     

Cervical synovial cysts: case report and review of the literature

The 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. Received: 12 January 1998 Revised: 17 September 1998 Accepted: 19 October 1998     

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.     

Expansive laminoplasty for myelopathy in ossification of the longitudinal ligament

Laminectomy, which had long been used for treatment of cervical spondylotic myelopathy, including ossification of the longitudinal ligament in the cervical spine, had numerous complications such as postoperative malalignment of the cervical spine and vulnerability of the spinal cord caused by total removal of the posterior structures. In 1977 Hirabayashi devised an open door expansive laminoplasty, which is a relatively easier and safer procedure than laminectomy, that eliminated such problems by preserving the posterior elements. The decompression effect of the expansive laminoplasty against a compressed spinal cord is comparable with that of laminectomy and anterior decompression followed by fusion, whereas the expansive laminoplasty has no structural problems and adverse effects on adjacent disc levels that often are associated with anterior decompression followed by fusion. Average recovery rate of expansive laminoplasty for cervical spondylotic myelopathy has been reported to be approximately 60% (Japanese Orthopaedic Association score) and with long term stability. At present, authors consider all patients with cervical spondylotic myelopathy candidates for expansive laminoplasty except for those having preoperative kyphosis and single level lesion without canal stenosis. Two remaining problems of expansive laminoplasty to be solved are prevention of C5,C6 radicular pain and/or paresis, the most frequent complication that occurs in approximately 5% to 10% of the patients, although most complications resolve spontaneously within 2 years, and correction of nonlordotic alignment to lordosis which are essential for posterior decompression effect of expansive laminoplasty by allowing the spinal cord to shift dorsally.     

Clinical characteristics and surgical management for juxtafacet cysts of the lumbar spine

Retrospective analysis of 10 cases of resection of symptomatic lumbar juxtafacet cysts in nine patients (mean age 65.4 years) investigated the relationship between surgical method and progression of spinal spondylolisthesis or cyst recurrence. Patient characteristics, surgical methods, and postoperative course were reviewed. The most common preoperative symptom, painful radiculopathy, occurred in all cases, followed by motor weakness in five, sensory loss in four, and intermittent claudication in four. All patients underwent bilateral total (n = 6) or partial laminectomy (n = 4), with minimal (n = 3) or no (n = 7) facetectomy. Cysts were gross totally resected in eight cases and partially resected in two. Concomitant fixation was not performed. Painful radiculopathy, motor weakness, and sensory disturbance all resolved, resulting in good or excellent outcome in all patients. Postoperative symptomatic spondylolisthesis had not been noted at mean 52.1 months postoperatively. However, new juxtafacet cysts were later detected on the contralateral side to the initial lesion in two patients. Surgical removal of juxtafacet cysts is recommended for immediate symptomatic relief. Concomitant spinal fixation to prevent progression of spinal spondylolisthesis or cyst recurrence depends on cyst size, involvement of surrounding structures, degree of preoperative spondylolisthesis, and facet joint destruction.     

Cervical laminaplasty: its role in the treatment of cervical radiculopathy

Krita in 1968 described the use of laminaplasty for the treatment of cervical myelopathy. Since then, several authors have modified this technique, settling on the "expansive open door laminaplasty" as the technique of choice for cervical myelopathy. There have been no reports to date on the use of the cervical laminaplasty procedure for the treatment of cervical radiculopathy. The purpose of this paper is to report on the initial 16 patients undergoing this procedure for the surgical treatment of cervical radiculopathy due to cervical spondylosis and/or cervical spinal stenosis. There were 16 patients (8 males and 8 females) whose age ranged from 54 to 84 years, with a mean of 67.2 years. The follow-up average was 2.7 years, with a range of 2.1 to 5.5 years. Seven patients were categorized as having brachalgia-cord type myelopathy and nine patients were categorized as radiculopathy only. Arm pain was unilateral in seven patients and bilateral in nine patients. Of those with bilateral pain, eight patients had pain predominately in one arm, with one patient having equal left and right arm complaints. Cervical laminaplasty was carried out from C3-6 in six patients and C3-7 in six patients and one patient had each of the following: C4-7, C4-T1, C5-T1, and C3-T1. The results were excellent in five cases, good in nine, and poor in two. The results of patients with unilateral symptoms and signs were compared to those with bilateral findings using chi 2 analysis. There was no statistical difference when performing laminaplasty for patients with bilateral findings as opposed to unilateral symptoms and signs. The amount of spinal canal expansion obtained by the laminaplasty procedure ranged from 4 to 12 mm. The conclusions of this study were (a) laminaplasty appears to be an effective alternative to laminectomy or anterior cervical fusion for multilevel cervical spondylotic radiculopathy or myeloradiculopathy and (b) complications of anterior fusion and laminectomy are avoided with the laminoplasty procedure.     

Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy.

BACKGROUND CONTEXT: Intramedullary signal intensity changes on magnetic resonance imaging (MRI) in cervical spondylotic myelopathy are thought to be indicative of the prognosis. However, the prognostic significance of signal intensity changes remains controversial. PURPOSE: To determine the radiographic and clinical factors that correlate with the prognosis after surgery in patients with cervical spondylotic myelopathy and to investigate the factors affecting the outcome of intramedullary signal changes on MRI. STUDY DESIGN: A prospective study evaluating clinical parameters and MRI in consecutive patients operated on for cervical spondylotic myelopathy. PATIENT SAMPLE: A total of 146 consecutive patients with cervical spondylotic myelopathy operated on during a 2-year period (September 1999 to September 2001) formed the study group. OUTCOME MEASURES: Age, duration of symptoms, number of cervical prolapsed intervertebral discs, surgical approach, preoperative signal changes, residual compression and postoperative outcome of signal changes; clinical outcome (motor, sensory, autonomic and disability improvement). METHODS: The participants in this study underwent anterior cervical discectomy/corpectomy or laminectomy/laminoplasty for cervical spondylotic myelopathy. Clinical features and MRI findings were studied in detail and compared with postoperative clinical and radiological status. The spinal cord signal intensity changes were evaluated before and after surgery. The multifactorial effect of such variables as age, duration of symptoms, number of prolapsed intervertebral discs, surgical approach (anterior/posterior), preoperative cord changes on T1- and T2-weighted sequences and persistence/regression of cord changes on clinical outcome (motor/sensory/autonomic/disability improvement) was studied using stepwise logistic regression. The highlight of the study is the analysis of the factors affecting regression of cord changes and their effect on postoperative outcome. RESULTS: Preoperative intramedullary signal changes were present in 121 of 146 patients (82.9%); of these 121 patients, T1- and T2-weighted images were present in 81, and T2-weighted images were present in 40 (no patient had isolated T1 change). Postoperative MRI could be obtained in 44 of 121 patients (36.4%) with preoperative intramedullary signal changes; 14 had regression of cord changes. There was no significant difference in the clinical presentation of patients with and without cord changes. There was a significant correlation between the surgical outcome of patients and their age, duration of symptoms, number of cervical prolapsed intervertebral discs, surgical approach, preoperative signal changes, residual compression and postoperative outcome of signal changes. The patients with no intramedullary signal changes and signal changes only on T2-weighted images had a better outcome than patients with signal changes on both T1- and T2-weighted images. The patients with regression of intramedullary signal changes had significantly better outcome. There was no significant correlation between regression of signal changes and other factors. However, chronicity of disease, multiplicity of discs and postoperative residual compression relatively affect persistence of intramedullary signal changes. CONCLUSIONS: The presence of intramedullary signal changes on T1- as well as T2-weighted sequences on MRI in patients with cervical spondylotic myelopathy indicates a poor prognosis. However, the T2 signal intensity changes reflect a broad spectrum of spinal cord reparative potentials. Predictors of surgical outcomes are preoperative signal intensity change patterns of the spinal cord and their postoperative persistence/regression on radiological evaluations, age at the time of surgery, multiplicity of involvement and chronicity of the disease and surgical approach (anterior/posterior).     

Re-aggravation of myelopathy due to intramedullary lesion with spinal cord enlargement after posterior decompression for cervical spondylotic myelopathy: serial magnetic resonance evaluation

STUDY DESIGN: A case report. OBJECTIVES: To report a case of swelling of the spinal cord and an intramedullary lesion occurring after expansive laminoplasty for cervical spondylotic myelopathy. SETTING: A university hospital in Japan. METHODS: Clinical evaluation, radiography, MR imaging. RESULTS: A 65-year-old man with a cervical spondylotic myelopathy in whom symptoms were improved immediately after expansive laminoplasty, but became aggravated 2 weeks later. Magnetic resonance images demonstrated swelling of the spinal cord and an intramedullary lesion that extended from the medulla oblongata to C7. Nine months after surgery, the lesion was reduced to C2-6, but neurological deterioration had not improved. Six years after surgery, the patient remains confined to bed. CONCLUSION: Patients with such disease conditions are rare, and it is difficult to predict postoperative swelling of the spinal cord before surgery. Spine surgeons should be aware of such rare disease conditions involving the spinal cord.     

Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine

The radiographic characteristics of the cervical spine among older individuals were investigated in 100 normal subjects and compared with those of younger subjects. The cervical spine of the older subjects displayed narrowing of intervertebral discs and osteophytoses (posterior osteophytes as well as anterior osteophytes) at the levels of C5-6 and C6-7, where the range of motion was decreased. Such degenerative changes resulted in vertebrolisthesis, especially retrolisthesis, predominantly at the levels of C3-4 and C4-5, where intervertebral disc space was well maintained and mobility was well preserved. Both static and dynamic anteroposterior canal diameter decreased with age. Throughout the aging process the dynamic canal became much narrower than the static canal, except at C2-3. Posterior osteophytes at C5-6 or C6-7 and retrolisthesis at C3-4 or C4-5 were major levels of stenosis associated with changes in the dynamic canal. Following the same evaluation system, 20 elderly patients with cervical spondylotic myelopathy were assessed. Based on the above-noted characteristics of the aging process, patients with myelopathy had smaller static and dynamic canal measurements than normal subjects. The development of cervical myelopathy, however, was not always based on critical static or dynamic canal stenosis (10% in this series) and might involve other factors.     

Soft cervical disc herniation. An analysis of 187 cases

METHODS: During the period from January 1986 to December 1994, 187 consecutive patients (102 males and 85 females, between the ages of 24 and 63 years) with soft disc herniations of the cervical spine were operated on by anterior approach. RESULTS: One hundred and twenty-seven (67.9%) patients presented pure radicular syndrome, 17 (9.1%) with pure medullary syndrome, and 43 (23%) with myeloradiculopathy. Disc herniation was at the C3/4 level in 8 (4.3%) cases, at the C4/5 level in 17 (9.1%) cases, at the C5/6 level in 101 (54%) cases, and at the C6/7 level in 87 (46.6%) cases. In 18 (30%) patients suffering from myelopathy (with or without radiculopathy) an area of high MR signal intensity was observed within the cervical cord on T2-weighted images; such area corresponded at the level of cord compression by the herniated disc and was not demonstrated on T1-weighted images. All patients underwent microdiscectomy without bone grafting. Complete or almost complete relief of preoperative symptomatology was observed in 95.6% of patients with radiculopathy and in 83.3% of those with myelopathy.     

Cervical flexion myelopathy in a patient showing apparent long tract signs: a severe form of Hirayama disease

We describe an 18-year-old male with cervical flexion myelopathy with Hirayama disease-like features who showed apparent long tract signs. He first experienced insidious-onset hand muscle weakness and atrophy at the age of 15. Subsequently, he developed sensory disturbance in his lower limb. Neurological examination revealed atrophy and weakness in the right hand and forearm, pyramidal signs in the right lower extremity, and disturbance of superficial sensation in the lower left half of the body. Cervical magnetic resonance images and computed tomographic myelography revealed anterior displacement with compression of the cervical cord in flexion that was more apparent in the right side. The right side of the cervical cord showed severe atrophy. The mechanisms of myelopathy in our patient appeared to be same as that of "tight dural canal in flexion," which has been reported to be the mechanism of juvenile muscular atrophy of the unilateral upper extremity (Hirayama disease). Patients with Hirayama disease generally show minimal sensory signs and no pyramidal signs. An autopsy case of Hirayama disease revealed confined necrosis of the cervical anterior horn without obvious changes in the white matter. Our patient's disease progression suggests that cervical flexion myelopathy patients with severe cervical cord compression in flexion may develop extensive cervical cord injury beyond the anterior horn.     

New evaluation method using preoperative magnetic resonance imaging for cervical spondylotic myelopathy

A new method based on the score of preoperative magnetic resonance images (MRI) was devised to evaluate cervical spondylotic myelopathy and predict the results of cervical laminoplasty. On T1- and T2-weighted sagittal MRI, the intervertebral disc spaces at each level from the axis to the first thoracic spine were examined as to whether the anterior or posterior subarachnoid space would be maintained or not, and for the presence or absence of spinal cord deformity. The data were divided into six grades and rated, and the total score for all sites was regarded as the preoperative MRI cumulative score. In conclusion, our method was highly reliable and useful for a preoperative evaluation and prediction of results after cervical laminoplasty for cervical spondylotic myelopathy. Received: 18 December 2000     

Predicting C5 palsy via the use of preoperative anatomic measurements

Background contextC5 nerve root palsy (C5P) is a relatively rare complication after anterior and posterior cervical decompression surgery that leads to a variety of debilitating symptoms. The precise etiology remains obscure, and a clear understanding of preoperative risk factors for C5P development does not exist.PurposeTo determine whether postoperative C5P can be predicted from preoperative anteroposterior diameter (APD), foraminal diameter (FD), and/or cord-lamina angle (CLA).Study designRetrospective review.Patient sampleConsecutive patients who underwent either anterior or posterior decompression surgery at C4–C5 for cervical spondylotic myelopathy.Outcome measuresDevelopment of C5P.MethodsBlinded reviewers retrospectively assessed magnetic resonance images for each included patient's C4–C5 interspace, including the midline APD, the left and right FDs, and the left and right CLA. Multivariable logistic regression was used to model the probability of palsy on the basis of one or more predictors. A jackknife validation was performed to internally validate the model and assess its generalizability.ResultsA total of 98 patients fit the inclusion criteria; 12% had developed symptoms of C5 palsy postoperatively. Using the three variables in a predictor-model, we found that the odds ratio of having palsy for APD, FD, and CLA was 0.3, 0.02, and 1.4, respectively. For every 1-mm increase in APD and FD, the odds of developing palsy decrease 69% (p<.0001) and decrease 98% (p<.0003), respectively. In contrast, for every 1-degree increase in CLA, the odds of developing palsy increase by 43% (p<.0001). The receiver-operating characteristic curve for this three-variable model predicting development of palsy has an area under the curve (concordance index) of 0.97. After implementing a jackknife validation, the area under the curve was 95%.ConclusionsThis study is the first to use the combination of APD, FD, and CLA to predict development of postoperative C5 palsy after decompression surgery for patients with spondylotic myelopathy. This prediction formula may allow for better patient selection and to prepare patients that have an increased probability of developing this complication.     

An expanding cervical synovial cyst causing acute cervical radiculopathy

Synovial cysts of the cervical spine occur infrequently in the spinal canal and are most often associated with degenerative facet joints. Despite the prevalence of degenerative spinal disease, symptomatic synovial cysts are extremely uncommon. We report a rare case that showed an exacerbation of a cervical radiculopathy due to an acute expansion of the synovial cyst. Magnetic resonance (MR) images originally revealed a small cystic extradural lesion when the patient presented with neck pain and slightly numbness in the right hand. The patient's complaints subsequently subsided after administration of pain killers. However, 2 weeks after this, the patient experienced a spontaneous, sudden, severe radiating pain into the right arm without any accompanying cervical injury. MR images showed that the cyst had become markedly increased in size in the intervening 4 weeks and compressed the spinal cord laterally. Because the arm pain was so severe and neurologic examinations revealed the paralysis of the C8 nerve root, the synovial cyst was excised surgically and a good clinical outcome achieved. Thus, even if symptoms are mild and the size of the synovial cyst is small, acute expansion of the cyst might be rarely observed and careful management, including surgical consideration, is needed.     

异体腓骨移植在脊髓型颈椎病治疗中的应用

目的　探讨冻干异体腓骨移植替代髂骨进行颈椎前路减压融合治疗颈椎病的可行性。方法　回顾性分析了 38例采用经颈椎前路减压冻干异体腓骨移植融合结合前路钛钢板固定治疗颈椎病的临床效果。平均随访 (9 5± 3 4 )个月 ,按JOA评分及Nurick分级评定手术效果 ,颈椎正、侧位及屈、伸侧位X线检查判定融合效果。　结果　JOA评分从术前的 (12 5 4± 1 6 2 )分提高到 (16 0 7±1 13)分 (P <0 0 5 ) ;Nurick分级从术前的 (2 4 6± 0 4 3)级提高到术后的 (0 72± 0 37)级 (P <0 0 5 )。经X线检查证实椎间隙高度得到恢复、颈椎生理前凸部分恢复、植骨块无移位、脱落、塌陷 ,钛钢板及螺丝钉无移位及松脱。 5个月后植骨全部融合。　结论　在颈椎病前路手术中冻干异体腓骨移植融合结合前路钛钢板固定术可替代自体骨移植融合术。此手术方法短期效果可靠 ,减少了取髂骨的并发症 ,椎间隙及颈椎的生理前凸可以得到恢复     

Tumeur à cellules géantes de C2 colonisée par un kyste anévrismal. À propos d’un cas

Giant cell tumor is colonized by aneurismal bone cyst in only 15% of cases and cervical localisation accounts for less than 1% of giant cell tumors. We are reporting a rare case of a C2 hypervascularized giant cell tumor colonized by an aneurismal bone cyst treated with an effective preoperative Onyx embolization followed by a full tumor resection. The patient experienced a moderate cervical spine injury 2 months prior admission followed by a progressive stiff neck and cervicalgia. CT and MRI identified a lytic lesion of the body and lateral masses of the C2 with encasement of both vertebral arteries. The angiography showed a hypervascularization of the lesion from the vertebral and external carotid arteries as well as a thrombosis of the V3 segment of the right vertebral artery at the C1 level. A posterior occipito-C3/C4 fixation and a tumor biopsy were performed. Histopathological examination concluded to a giant cell tumor colonized by an aneurismal bone cyst. Three weeks later, the patient developed a right upper extremity deficit. The MRI showed an increased C1-C2 stenosis and an increase of the hypervascularization. Three sessions of embolization by the onyx were performed. During surgery a near total tumor devascularisation was observed and a complete resection of the tumor was achieved through an anterolateral approach. Reconstruction consisted of a cementoplasty of the C2 body and odontoïd process with an anterior C3-prosthesis plate. The postoperative course was uneventful.