Vertebral synovial chondromatosis. Report of two cases and review of the literature

Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules within the synovium, most commonly affecting large joints. Its involvement with the spine is rare; only six cases have been reported. The authors describe two patients with synovial chondromatosis involving the cervical spine. In the first case, synovial chondromatosis arose from the left C1-2 facet joint. This patient underwent a two-stage procedure including a posterior approach for tumor resection and occipitocervical fusion as well as a transmandibular circumglossal approach to the anterior craniocervical junction to complete the tumor removal. Interestingly, on histopathological examination, scattered foci of low-grade chondrosarcoma were intermixed within the synovial chondromatosis. To the authors' knowledge, this is the first report of secondary low-grade chondrosarcoma arising in vertebral synovial chondromatosis. In the second case, synovial chondromatosis involved the left C4-5 facet joint. Tumor resection and cervical fusion were performed via a posterior approach. In this report, the authors describe the clinical presentation, radiographic findings, operative details, histopathological features, and clinicoradiological follow-up data obtained in these two patients and review the literature pertaining to this rare entity.     

Vertebral synovial osteochondromatosis with compressive myelopathy.

STUDY DESIGN: A case report of vertebral synovial osteochondromatosis with compressive myelopathy. OBJECTIVES: To describe the clinical, radiologic, and histopathologic features of vertebral facet synovial osteochondromatosis with compressive myelopathy. SUMMARY OF BACKGROUND DATA: There has been only one previously reported case of synovial osteochondromatosis affecting the vertebral facet joint and no previous report of associated compressive myelopathy. METHODS: The case history, radiology, surgical findings, and histopathology are reviewed. RESULTS: Vertebral facet synovial osteochondromatosis is a potential and readily manageable cause of spinal cord compression. CONCLUSIONS: Synovial osteochondromatosis of the vertebral facet joint should be considered as a cause of compressive myelopathy.     

A case report; ganglion cyst of a cervical facet joint

Ganglion or synovial cyst typically occurs in peripheral joints and tendon sheaths such as elbow joint or wrist joint, but rarely in the spinal facet joint. From reported cases the most common site involved seems to be the lumbar facet joint. Only three cases of cervical ganglion or synovial cyst have so far been found in the literature. A case of cervical ganglion cyst was reported. The patient was a 2-year-old boy who was found to have a tumor in the midline of the nape. He had no history of trauma. Neurological and physical examination revealed no abnormalities. On CT scan a round low dense lesion with clear margin was found in the nape. Enhanced CT scan showed ring-like enhancement. Magnetic resonance (MR) imaging showed a well defined lesion of high intensity on T1- and T2-weighted images. At operation, the lesion was found to form a cyst containing old hematoma, and the cyst wall seemed to be fixed to the cervical spinal facet joint. The tumor was histologically diagnosed as ganglion cyst.     

Giant solitary synovial chondromatosis of the temporomandibular joint with intracranial extension

Synovial chondromatosis are rare entities but are well-described lesions in the literature that can affect many joint areas of the body. A case of tumoral synovial chondromatosis involving the temporomandibular joint with intracranial extension through mandibular fossa is reported. As long as there was significant infratemporal and extradural invasion of the middle and posterior fossa, a transtemporal and infratemporal approach was performed and total removal of the lesions was achieved. A brief review of skull base synovial chondromatosis is presented.     

Giant Solitary Synovial Chondromatosis of the Temporomandibular Joint with Intracranial Extension

Synovial chondromatosis are rare entities but are well-described lesions in the literature that can affect many joint areas of the body. A case of tumoral synovial chondromatosis involving the temporomandibular joint with intracranial extension through mandibular fossa is reported. As long as there was significant infratemporal and extradural invasion of the middle and posterior fossa, a transtemporal and infratemporal approach was performed and total removal of the lesions was achieved. A brief review of skull base synovial chondromatosis is presented.     

Synovial cyst of the transverse ligament of the atlas in a patient with os odontoideum and atlantoaxial instability

STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To describe the diagnosis and successful treatment of a synovial cyst arising from the transverse ligament in a patient with os odontoideum and atlantoaxial instability. SUMMARY OF BACKGROUND DATA: Synovial cysts arising from the transverse ligament of the atlas are extremely rare. Development of a synovial cyst is thought to be attributable to degenerative changes of the C1-C2 facet joints or to microtrauma. Direct excision of the cyst is the only treatment cited in previous reports. METHODS: A synovial cyst arising from the transverse ligament of the atlas in a 45-year-old man with os odontoideum and atlantoaxial instability was treated surgically with posterior atlantoaxial fusion alone. The magnetic resonance images, surgical treatment, and related literature are reviewed. RESULTS: Preoperative magnetic resonance images of the cervical spine showed a large cystic mass located ventral to the cord arising at the level of the transverse ligament of the atlas: the mass was of low signal intensity on T1-weighted images, was of high signal intensity on T2-weighted images, and was enhanced marginally with gadolinium-DTPA on T1-weighted images. Spontaneous regression of the cyst was identified on the follow-up magnetic resonance images taken 3 months after C1-C2 posterior wiring and fusion. CONCLUSIONS: A patient with a synovial cyst arising at the C1-C2 junction ventrally at the level of the transverse ligament showed spontaneous regression of the lesion after C1-C2 posterior wiring and fusion.     

组合枢椎椎板螺钉及经枢椎椎板关节突螺钉固定技术的临床应用

目的探讨组合枢椎椎板螺钉及经枢椎椎板关节突螺钉(TLFS)固定技术治疗颈椎损伤的可行性和应用价值。方法自2005年10月～2008年10月,采用枢椎椎板螺钉及经枢椎TLFS固定技术治疗颈椎损伤36例。结果本组获随访13~32个月,平均18个月。30例行自体髂骨植骨,6例行异体骨植骨,获得了良好的骨性愈合。术后CT示枢椎椎板螺钉及经枢椎TLFS位置良好,未侵犯椎管和脊髓。结论枢椎椎板螺钉及经枢椎TLFS固定技术不受C2横突孔中椎动脉的位置和C2椎弓根大小限制,避免了螺钉置入过程中损伤椎动脉的风险,所以该方法可作为传统枢椎后路螺钉固定技术的补充。     

Synovial chondromatosis of the metacarpophalangeal joint of the ring finger

Synovial chondromatosis is an uncommon condition, characterized by multinodular cartilagineous proliferation of the joint synovium. There are only a few case reports of synovial chondromatosis involving the hand in the literature. A case of synovial chondromatosis of the ring finger is reported in this paper.     

Cervical intraspinal extradural ganglion cyst: a case report and review of literature

Intraspinal extradural ganglion cysts rarely occur in the cervical spine, and their etiology is unknown. A 77-year-old female complaining of right upper extremity weakness presented with a cystic mass located in the spinal canal of the right C3-4 facet joint. A C3-4 right hemilaminectomy and excision of the cysts were performed. The cyst contained a translucent viscous material and was easily decompressed. No communication between the cyst and facet joints was found in the surgical field. The neurologic symptoms improved rapidly after surgery. The histology examination showed that the cystic wall was composed of dense fibrous tissue without a synovial cell lining concordant with a ganglion cyst. This report describes a rare case of a ganglion cyst of the cervical spine arising at the C3-4. This case highlights the need to consider a ganglion cyst as one of the causes of cervical radiculo-myelopathy.     

Recurrent synovial chondromatosis of the wrist: case report and literature review

Synovial chondromatosis of the wrist is rare. We report the case of a 35-year-old man with synovial chondromatosis of the left wrist with an 8-year follow-up. Frequent recurrences finally resulted in total wrist arthrodesis. A review of the literature produced 24 case reports of synovial chondromatosis of the wrist with only three cases showing recurrence.     

Cervical spinal cord compression attributable to a calcified intervertebral disc in a patient with X-linked hypophosphatemic rickets: case report and review of the literature

OBJECTIVE AND IMPORTANCE: X-linked hypophosphatemic rickets is a common inherited phosphate-wasting disorder, but it is a rare cause of spinal cord compression. We present the first reported case of a calcified intervertebral disc causing spinal canal stenosis in X-linked hypophosphatemic rickets. CLINICAL PRESENTATION: A 44-year-old woman presented with paresthesia of her left arm and a loss of grip in both hands. Magnetic resonance imaging revealed a calcified intervertebral disc, as well as a posterior osteophytic bar causing marked cervical cord compression at C6/C7. INTERVENTION: An anterior cervical discectomy at C6/C7 and fusion with autologous bone graft were performed. The patient then exhibited significant improvement. CONCLUSION: A review of the 16 published cases demonstrates that thickening of the vertebral laminae, facet joint hypertrophy, and ossification of the intervertebral discs, posterior longitudinal ligament, and/or ligamentum flavum contribute to spinal canal stenosis in X-linked hypophosphatemic rickets. Those changes are caused by the disease itself and are unlikely to be related to long-term vitamin D treatment. Eleven of 16 patients were reported to have experienced favorable outcomes after surgery.     

Articular synovial chondromatosis of the finger

Abstract

A 40-year-old woman presented with a six-month history of synovial chondromatosis of the metacarpophalangeal joint of the right ring finger, which was resected through both dorsal and volar incisions. To our knowledge there have been only 17 reported cases of articular synovial chondromatosis of the digital joint so far. We present a case affecting the metacarpophalangeal joint with a review of scattered information found in other 17 reports.     

Recurrent synovial chondromatosis of the knee after radical synovectomy and arthrodesis

We describe a case of highly refractory synovial chondromatosis, which recurred despite four arthroscopic synovectomies, a chemical synovectomy, two open synovectomies and an arthrodesis. A review of the literature revealed one similar case. Both presented with marked joint stiffness suggesting a poor prognosis. Although arthrodesis may relieve short-term symptoms it does not prevent further recurrence of disease.     

Stones around bones! atypical giant synovial chondromatosis: a rare case report

We report a case of a 56-year-old man with painless synovial chondromatosis presenting as extremely large masses with smooth surfaces at the suprapatellar region on both side related to the right knee joint. The large masses at the suprapatellar region both in the medial and in the lateral aspect of the knee along with restriction of movements were the main complaints reported by the patient. Plain X-ray studies revealed punctate calcifications anteriorly and on both sides of the knee joint. Surgery was performed subsequently which showed multiple rocky hard giant chondroid masses around the knee without any nodularity. Synovial chondromatosis usually present with small nodular masses, but in our case the masses were very large and had smooth surfaces which were very unusual. After 6 months following the surgery, the patient had full range of motion and no complaints. We suggest that synovial chondromatosis may present as huge masses with smooth surfaces which can mimic as tumors. The Surgeon should be aware of this pattern of appearance of synovial chondromatosis.     

Immunohistochemical demonstration of nerve fibers in the synovial fold of the human cervical facet joint.

The role of the intra-articular synovial fold as a source of facet joint pain is unclear, because the nature of nociceptive innervation in lumbar synovial folds is controversial, and there have been no such studies in cervical synovial folds. The present study aimed to demonstrate the presence of nerve fibers including nociceptive fibers in synovial folds of human cervical facet joints using immunohistochemistry. Synovial folds of cervical facet joints removed from patients undergoing cervical spine laminoplasty were analyzed immunohistochemically using antibodies to protein gene product 9.5, beta III-tubulin, substance P and calcitonin gene-related peptide. Many nerve fibers immunoreactive for protein gene product 9.5 and beta III-tubulin were demonstrated both around blood vessels and as free fibers in the stroma of the synovial fold. Also. immunostaining showed the presence of free nerve fibers immunoreactive for substance P and calcitonin gene-related peptide in the stroma. The presence of putative nociceptive fibers in cervical synovial folds supports a possible role for these structures as a source of cervical facet joint pain.     

Pigmented villonodular synovitis of lumbar facet joint: a rare cause of nerve root entrapment.

STUDY DESIGN: A case report of nerve root entrapment due to pigmented villonodular synovitis of lumbar facet joint is reported for which excision was performed. OBJECTIVE: To report a rare cause for nerve root claudication. SUMMARY OF BACKGROUND DATA: Pigmented villonodular synovitis is an uncommon synovial abnormality with an estimated incidence of 1.8 cases per million. Large joints, such as knee and hip, are commonly affected. Involvement of the facet joint is very rare. In our case a high index of suspicion from CT and MRI helped us in the appropriate management. METHODS: A 71-year-old man presented with severe back pain and right-sided L5 sciatica. CT and MRI scans showed a cystic lesion arising from the L5-S1 facet joint. Excision and adequate decompression in the form of undercutting facetectomy were done. RESULTS: The patient had symptomatic improvement with surgery, and at the 3-year follow-up he showed no signs of recurrence. CONCLUSION: Unless pigmented villonodular synovitis is considered in the differential diagnosis of tumors of the vertebral column causing nerve root claudication, it may be overlooked.     

Types of synovial fold in the cervical facet joint

Few detailed studies of synovial folds of cervical facet joints exist at the moment. This study was performed to provide anatomical data for each synovial fold in the cervical facet joints, using 20 cervical spines from C2 to C7 for dissection. Anatomic evaluation of the synovial folds included the gross morphology, in three dimensions, and the histology. Also, degenerative changes of the lower facet surface on which synovial folds occurred were evaluated. On the basis of gross morphology and histological composition, three types of synovial folds were identified. Type-1 synovial folds, shaped like a crescent, consisted principally of adipose tissue. Type-2 synovial folds had an apical region made up of dense fibrous tissue, with the base and middle region consisting of adipose tissue. In type-2 folds, the size and shape varied, including some elliptic-shaped synovial folds projecting well into the joint cavity. Type-3 synovial folds were thin with ragged free borders, and were formed exclusively of fibrous tissue. This study shows the variable appearance of synovial folds. Speculation was raised that the articular facet impingement of a large synovial fold and the subluxation of a smaller structure may play a possible role in the pathology of some disorders of the neck. Received: September 30, 1999 / Accepted: March 13, 2000     

New-Onset Synovial Chondromatosis After Total Knee Arthroplasty

Total joint arthroplasty is commonly recommended as a definitive treatment for synovial chondromatosis refractory to other treatment. We describe a unique case of synovial chondromatosis developing after total joint arthroplasty in a patient presenting 5 years after total knee arthroplasty for osteoarthritis. This case illustrates that the diagnosis of synovial chondromatosis cannot be excluded in a patient with chronic, painful swelling of a joint, even after total joint arthroplasty.     

Vertebral artery anomaly with atraumatic dissection causing thromboembolic ischemia: a case report

STUDY DESIGN: A case report is presented. OBJECTIVES: To illustrate a rare cause of atraumatic vertebral artery dissection resulting from anomalous entry of the vessel at the C3 transverse foramen induced by normal physiologic head and neck motion, and to review vertebral artery anatomy and mechanisms whereby it is vulnerable to pathologic compression. SUMMARY OF BACKGROUND DATA: The vertebral artery usually enters the transverse foramen at C6. Rarely, the artery enters at C5 or C4. Only one prior case with entry at C3 has been reported. That patient experienced recurrent quadriplegia and locked-in syndrome caused by vertebral artery obstruction. A 27-year-old woman with a history of classic migraine experienced neurologic symptoms on three occasions related to physiologic neck and arm movements. Magnetic resonance angiogram was not diagnostic, but standard arteriography demonstrated anomalous vertebral artery entry into the C3 transverse foramen and focal dissection. METHODS: Pertinent literature and the patient's history, physical examination, and radiologic studies were reviewed. RESULTS: Standard cervico-cerebral arteriogram demonstrated focal dissection at C4 and thromboembolic complications in distal vertebral and basilar arteries. Initially, diagnosis by magnetic resonance angiogram was elusive. However, arteriography allowed prompt diagnosis followed by anticoagulation with resolution of neurologic symptoms. CONCLUSIONS: Vertebral artery dissection without trauma is rare, but should be considered when neurologic symptoms accompany physiologic cervical movements. For cases in which vertebrobasilar thromboembolic ischemia is suspected, magnetic resonance angiogram may prove inadequate for demonstrating the causative vascular pathology. Therefore, standard cervico-cerebral arteriography should be performed.     

Synovial chondromatosis of the glenohumeral joint: a rare condition

The case of a 22-year-old man with synovial chondromatosis (SC) of the shoulder joint is described. A literature review confirmed that SC of the glenohumeral joint is very rare and that the etiology of the disease is still unknown. The diagnosis is often delayed, and the preferred form of management remains controversial. We consider magnetic resonance imaging (MRI) a valuable tool in detecting SC at an early phase and estimating the intrasynovial extent of the disease. Shoulder arthroscopy today represents an elegant treatment option for removing the chondromas and performing a partial synovectomy. It might, however, be insufficent in cases of involvement of the bicipital tendon sheath and other recesses of the joint.