Symptomatic facet cysts of the subaxial cervical spine

Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review

Background

Calcified juxtafacet cysts in the cervical spine are extremely rate. Such symptomatic cysts commonly cause neck pain, radiculopathy, or even myelopathy. MR and CT studies typically document cord/ root compression. On occasion, some of these cysts will spontaneously regress, while many others may warrant surgical removal.

Case Description

A 70-year-old male presented with a 2-year history of a progressive tetraparesis. The preoperative MR/CT studies showed a C1-C2 left extradural mass occupying more than half of the spinal canal. On MR, it was homogeneously hypointense on both T1- and T2-weighted images, while the CT showed a calcified cyst. Intraoperative and histopathological findings documented a calcified cervical juxtafacet cyst (i.e. ganglion subtype) that was fully excised without sequelae.

Conclusion

C1-C2 juxtafacet cervical cyst should be considered when a patient presents with myelopathy due to a calcified MR/CT documented paraspinal lesion contributing to significant cervical cord/root compression.

Endoscopic Resection of Symptomatic Cervical Facet Cyst in Ankylosing Spondylitis

BACKGROUND

Extradural benign cysts located in close proximity to the facet joints are called juxtafacetal cysts. Only about 3.5% of such cysts occur in the cervical spine. To our knowledge, there has been no published article on the endoscopic resection of a cervical facet cyst, and this is the first report.

CASE DESCRIPTION

A 48-year-old male presented with a chief complaint of severe axial neck pain (visual analog scale score 9) and right scapular pain. The patient had no related radiculopathy or myelopathy, and neurologic status was intact. There was severe limitation of cervical spine movements. Plain radiographs indicated age-related degenerative changes with typical features of ankylosing spondylitis with a bamboo spine appearance and gross fusion of all the vertebrae. The only mobile cervical spinal level was C6-C7. Axial magnetic resonance imaging revealed a right-sided juxtafacetal lesion at C6-C7 level that was hyperintense on T2 and hypointense on T1 imaging. A percutaneous endoscopic posterior cervical foraminotomy at right-sided C7-T1 was performed under general anesthesia. The cyst was removed, and adequate decompression of the C7 root was achieved. Postoperative magnetic resonance imaging and computed tomography scan showed adequate foraminotomy and decompression of the neural structures. The patient had gross relief of neck pain (visual analog scale score 2).

CONCLUSIONS

The findings suggest that ankylosing spondylitis may cause formation of a juxtafacetal cyst at the mobile levels in a relatively less mobile cervical spine. The endoscopic resection of such cysts is a minimally invasive novel procedure that can cure such patients successfully without unwanted fusion surgery.

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

INTRODUCTION

Synovial 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 CASE

Here, 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.

DISCUSSION

Numerous 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.

CONCLUSION

Surgical treatment should be considered in cervical synovial cysts with neurologic deficit or with cord compression or when the conservative treatment is ineffective.

Recurrent atlantoaxial synovial cyst resection via a navigation-guided, endoscope-assisted posterior approach

Background:

Atlantoaxial cysts are rare, and only 46 histologically confirmed cases have been reported.

Case Description:

A 75-year-old male presented 2 years ago with headache, neck pain, loss of balance, and episodic dysphagia, for which he had undergone posterior cervical drainage of a left-sided atlantoaxial cyst. Although his original symptoms resolved, they recurred 2 years later and were correlated with an enhanced MR that showed a recurrent left C1-C2 synovial cyst causing marked cervical cord compression. It was successfully resected through a navigation-guided, endoscope-assisted posterior approach. The patient's symptoms/signs resolved completely, and he has remained symptom-free for over 30 months postoperatively, with no evidence of recurrence on MR or craniocervical instability.

Conclusions:

A patient who successfully underwent resection of a recurrent synovial cervical cyst using a navigation-guided, endoscope-assisted posterior approach has been reported here.