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Nakano A, Hayama S, Fujishiro T, Nakaya Y, Obo T, Yano T, Baba I, Neo M. Preoperative Cyst Formation as a Predictive Feature of Spontaneous Regression of Retro-Odontoid Pseudotumor After Posterior Fusion. World Neurosurg 2021; 150:e491-e499. [PMID: 33744422 DOI: 10.1016/j.wneu.2021.03.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although the spontaneous regression of pseudotumors after posterior fusion has been reported, the predictive factors remain unclear. We examined the radiological features that predict for the regression of retro-odontoid pseudotumors after posterior fusion, with a specific focus on cyst formation. METHODS We included 28 patients with a diagnosis of retro-odontoid pseudotumor using preoperative magnetic resonance imaging. The radiographic parameters and pseudotumor thickness were measured pre- and postoperatively. The regression rate for each pseudotumor was calculated. The presence of a cyst around the retro-odontoid pseudotumor was investigated. If present, the cyst thickness was measured. To elucidate the predictors for the postoperative regression of pseudotumors, the patients were divided into 2 cohorts: the regression group with a regression rate >40% and the no-regression group with a regression rate of <40%. Multivariate logistic regression analysis, including the demographic data and preoperative radiographic parameters as independent variables, was performed. RESULTS The mean pseudotumor size had decreased significantly from 8.8 ± 3.6 mm preoperatively to 5.3 ± 2.0 mm postoperatively (P < 0.0001). The mean regression rate was 35.9% during a magnetic resonance imaging follow-up period of 8.6 months (range, 6-12 months). Cystic lesions were noted in 10 patients (35.7%) preoperatively. The mean cyst size was 4.7 ± 1.9 mm. All cysts were located dorsal to the pseudotumors and were involved at the maximum spinal compression levels. Nevertheless, all the cysts had disappeared postoperatively. Multivariate logistic regression analysis revealed that the pseudotumor regression group had had a significantly greater proportion of cysts (57.1% vs. 14.3%; odds ratio, 11.7; P = 0.013). CONCLUSIONS The presence of cystic lesions protruding from retro-odontoid pseudotumors might serve as a predictive factor for the spontaneous regression of pseudotumors after posterior fusion.
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Affiliation(s)
- Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Takuya Obo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Toma Yano
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Ichiro Baba
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Schomacher M, Jiang F, Alrjoub M, Witiw CD, Diamandis P, Fehlings MG. The posterior cervical transdural approach for retro-odontoid mass pseudotumor resection: report of three cases and discussion of the current literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:162-170. [PMID: 32296950 DOI: 10.1007/s00586-020-06405-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 03/02/2020] [Accepted: 03/30/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The treatment of a retro-odontoid pseudotumor mass associated with severe spinal cord compression is challenging due to the complex regional anatomy. Here, we present an attractive treatment option involving a single-stage posterior transdural microsurgical resection followed by instrumented cervical reconstruction. METHODS We describe three patients presenting with clinical signs of cervical myelopathy and an imaging finding of mucoid and fibrous soft or semi-soft retro-odontoid pseudotumor mass with significant spinal cord compression at the C1/C2 level. Given the severity of the symptoms, surgical decompression was planned and fusion was necessitated by the severe degenerative osteoarthritis seen at the C1/C2 level with signs of instability. Using a standard posterior approach to the spine, a suboccipital decompression by craniectomy and laminectomy of C1, C2 and C3 was performed. The masses were visualized and confirmed with ultrasound imaging, and intraoperative neurosurgical monitoring was applied. The dura was then opened from the level of C0-C2. Exiting C2-C3 nerve roots were identified and protected throughout the procedure, and the dentate ligament was cut to facilitate access. Incision of the anterior dura provided easy access to the lesion for resection without any spinal cord retraction. Multiple intraoperative samples were sent to pathology for tissue diagnosis. The dura was closed with sutures and an overlay of fibrin sealant with collagen matrix sponge. The fusion procedures were performed using a standard occipital cervical plate and screws technique with contoured titanium rods. CONCLUSIONS The posterior cervical transdural approach is a safe alternative procedure for mucoid and fibrous soft or semi-soft retro-odontoid pseudotumor mass removal. Preoperative CT scan can evaluate tissue characteristics and distinguish between a soft or ossified mass in front of the spinal cord. Local anatomical conditions facilitate less bleeding and adhesions, together with less spinal cord traction, in the intradural space. Cranio-cervical and suboccipital stabilization can be easily and safely performed with this exposure.
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Affiliation(s)
- M Schomacher
- Vivantes Neurochirurgie, Klinikum Neukoelln, Rudower Str. 48, 12351, Berlin, Germany
| | - F Jiang
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - M Alrjoub
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - C D Witiw
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - P Diamandis
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - M G Fehlings
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. .,Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada.
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Delavari N, Geh N, Hervey-Jumper SL, McKean EL, Sullivan SE. Transnasal and Transoral Approaches to Atlantoaxial Synovial Cysts: Report of 3 Cases and Review of the Literature. World Neurosurg 2019; 132:258-264. [PMID: 31518745 DOI: 10.1016/j.wneu.2019.08.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Synovial cysts are cystic masses lined with pseudostratified columnar cells and containing clear or xanthochromic fluid. Although they are commonly encountered in the lumbar spine, synovial cysts infrequently occur in the cervical spine and rarely involve the odontoid process. The causes of synovial cysts of the odontoid process are unknown, but growth of synovial rests, proliferation of multipotent mesenchymal cells, atlantoaxial instability, and trauma are thought to play a role. CASE DESCRIPTION We present 3 cases of atlantoaxial cysts with the associated radiographic features, surgical management, and clinical outcomes. No patient had rheumatoid arthritis. In all cases, preoperative differential diagnosis included neoplastic pathologic changes. Two patients underwent odontoidectomy through either an endonasal or a transoral approach, followed by posterior occipitocervical fusion. The third patient underwent an endoscopic transsphenoidal approach for cyst decompression. CONCLUSIONS Tissue diagnosis is important in confirming pathologic analysis because synovial cysts have radiographic characteristics similar to those of a wide variety of neoplasms of the craniovertebral junction.
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Affiliation(s)
- Nader Delavari
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA; Department of Neurosurgery, New York University, New York, New York, USA.
| | - Ndi Geh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Erin L McKean
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA; Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen E Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Salzmann SN, Lampe LP, Fernholz B, Härtl R, Patsalides A, Hughes AP. C2 Bone Erosion Secondary to Iatrogenic Pseudomeningocele: A Case Report and Description of a Novel Surgical Technique. World Neurosurg 2017; 106:1056.e1-1056.e4. [PMID: 28736355 DOI: 10.1016/j.wneu.2017.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pseudomeningoceles are a rare cause of bone erosions. Development of such erosions in the C2 vertebral body and the odontoid process can lead to life-threatening instability. Treatment options to regain stability include atlantoaxial and occipitocervical fusion. For patients with a history of Chiari decompression and large C2 lesions, common fusion techniques are not always feasible. In addition, fusion surgery sacrifices physiologic motion and is therefore a disabling procedure, especially for young and active patients. CASE DESCRIPTION We report a novel combined open operative and subsequent minimal invasive filling technique of several instable osteolytic/cystic areas within the C2 vertebra of a 28-year-old woman. The underlying cause for the lesions was a pseudomeningocele communicating with the vertebral body. This was an incidental finding 15 years after foramen magnum decompression with C1 and partial C2 laminectomy for Chiari malformation. Novel treatment included open posterior surgery with total laminectomy of the remaining C2 arch and refilling the odontoid with viscous beta tricalcium phosphate and polymethylmethacrylate bone cement. Postoperative 6- and 12-month follow-up computed tomography imaging showed a stable incorporation of the filling. CONCLUSIONS Life-threatening fractures at the occipitocervical junction are rare and often are due to high-impact trauma. Osteolytic changes at those bone compartments are a potential cause for pathologic fractures during normal daily activities. In this case, increased pressure on the bone due to a pseudomeningocele resulted in slow bone loss without symptoms. A novel combined technique of bone filling was applied successfully to stabilize the C2 vertebral bone.
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Affiliation(s)
- Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Lukas P Lampe
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Brian Fernholz
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | - Athos Patsalides
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA.
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Retro-odontoid mass without atlantoaxial instability causing cervical myelopathy: a case report of transdural surgical resection. Spinal Cord Ser Cases 2016; 2:16025. [PMID: 28053768 DOI: 10.1038/scsandc.2016.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/19/2016] [Accepted: 08/13/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Retro-odontoid mass rarely occur in patients with noninflammatory retro-odontoid lesions without atlantoaxial instability. We describe a rare case of retro-odontoid mass without atlantoaxial instability operated on by a transdural approach. CASE PRESENTATION The patient was an 83-year-old man who presented with a retro-odontoid mass causing symptomatic cervical myelopathy. Preoperative magnetic resonance imaging (MRI) revealed that the mass was severely compressing the spinal cord. We operated on it via a C1 laminectomy and performed tumor resection by a transdural approach. Pathological findings from the operative specimen confirmed the diagnosis; histopathological examination revealed that the mass contained fibrinoid material, and collagenous tissue with myxoid changes, but no granulation or a granulomatous lesion. Postoperative MRI confirmed spinal cord decompression. The patient's symptoms were alleviated, and he has not had a recurrence or cervical instability in the 7 years since his surgery. DISCUSSION We successfully used a transdural approach in the present case and have observed no recurrence for 7 years postoperatively. C1 laminectomy is reportedly beneficial, especially for elderly patients, given the risk of other surgical options using an anterior transoral approach or posterior fusion. However, most tumors do not attenuate after C1 laminectomy alone; hence, we think that tumor resection by the transdural approach is one effective method to perform enucleation of the tumor after C1 laminectomy.
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Oliveira J, Silva PS, Pereira P, Vaz R. Paraparesis as the Presenting Form of a Lumbar Hemorrhagic Synovial Cyst: A Case Report and Review of the Literature. JBJS Case Connect 2013; 3:e136. [PMID: 29252292 DOI: 10.2106/jbjs.cc.m.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Joana Oliveira
- Neurosurgery Department, Hospital São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
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Lee CY, Lai HY, Lee ST. Ganglion cyst of the cruciate ligament with atlantoaxial subluxation. Acta Neurochir (Wien) 2013; 155:1917-21. [PMID: 23942863 DOI: 10.1007/s00701-013-1803-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 06/21/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ganglion cysts of the cruciate ligament are rare and sometimes asymptomatic. The authors present three cases of ganglion cysts of the cruciate ligament with atlantoaxial subluxation, which has rarely been reported previously. METHODS Generally, ganglion cysts of the cruciate ligament are reported as case reports. Several theories regarding the process of cyst formation and the development of treatment options have been described. However, trans-oral decompression with total removal of the cyst may be one of the options for treatment of this kind of disease. RESULTS A retrospective review of three patients, two female and one male patient, with a mean age of 68 years was conducted. The operation performed was a trans-oral decompression with cyst removal for all patients. Clinical outcomes were evaluated after the operation. All patients underwent trans-oral decompression with total removal of the cyst, followed by posterior fusion and pathologic examination of the cyst, revealing myxoid stroma with an absence of synovial linings. CONCLUSION The ganglion cysts and synovial cysts of the cruciate ligament are two different diseases with different presentation, pathogenesis, pathophysiology, and pathologic findings.
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Affiliation(s)
- Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taipei, Taiwan
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Lin JD, Koehler SM, Garcia RA, Qureshi SA, Hecht AC. Intraosseous ganglion cyst within the L4 lamina causing spinal stenosis. Spine J 2012; 12:e9-12. [PMID: 23158970 DOI: 10.1016/j.spinee.2012.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/27/2012] [Accepted: 10/13/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There are rare reports of intraosseous ganglion cysts in the cervical spine. However, to our knowledge, there are no previous reports of these cysts occurring in the lumbar spine. PURPOSE To report a case of symptomatic lumbar spinal stenosis caused by an intraosseous ganglion cyst of the L4 lamina that communicated with the spinal canal. STUDY DESIGN Case report. METHODS An 86-year-old woman was referred to our spine service for a 2-year history of anterior thigh and leg pain. Magnetic resonance imaging revealed a benign-appearing intraosseous cyst in the left L4 lamina communicating with a posterior epidural cyst at L4-L5 causing marked spinal stenosis. The patient was treated successfully with a laminectomy and resection. RESULTS The patient underwent partial laminectomies of L4 and L5 preserving the interspinous ligaments between L5-S1 and L3-L4. The cyst was removed en bloc without violation of the cyst wall. Histopathologic examination revealed focal myxoid changes without a cellular lining of the cyst wall, confirming the diagnosis of intraosseous ganglion cyst. CONCLUSIONS This is the first report to describe an intraosseous ganglion cyst occurring in the lumbar spine. Although spinal stenosis is commonly a result of degenerative joint or disc disease, it occasionally may result from more obscure causes. This case illustrates a patient with an intraosseous ganglion cyst within the spinal lamina resulting in spinal stenosis, treated successfully with a laminectomy and resection.
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Affiliation(s)
- James D Lin
- Leni and Peter W. May Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 East 98th St, 9th Floor, New York, NY 10029, USA
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9
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Machino M, Yukawa Y, Ito K, Kanbara S, Kato F. Spontaneous hemorrhage in an upper lumbar synovial cyst causing subacute cauda equina syndrome. Orthopedics 2012; 35:e1457-60. [PMID: 22955421 DOI: 10.3928/01477447-20120822-41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lumbar spine synovial cysts are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. They are common in lower lumbar lesions but rare in upper lumbar lesions. Several cases of hemorrhage into lower lumbar juxtafacet cysts after trauma or anticoagulation therapy have been reported in the literature. This article describes a case of subacute cauda equina syndrome resulting from spontaneous hemorrhage into an upper lumbar synovial cyst. A 65-year-old man presented with a 3-month history of intermittent bilateral lumbar pain. One week before, he experienced a sudden exacerbation of lumbar pain and began falling frequently; he also reported weakness and tingling in his lower limbs. A hematic collection associated with a large juxtafacet cyst at L2-L3 was suspected on magnetic resonance imaging. He underwent surgical decompression, and the cyst was resected. Microscopic examination was consistent with the diagnosis of a synovial cyst. Two days postoperatively, he was walking independently. Although several descriptions exist of hemorrhagic lumbar juxtafacet cysts after trauma or anticoagulant therapy, to the authors' knowledge, this is the first documented case of hemorrhage in an upper lumbar synovial cyst with no previous traumatic event or medication use. Magnetic resonance imaging was essential in making the preoperative diagnosis. Surgical removal of the cyst was an effective treatment.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan.
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Takeuchi M, Yasuda M, Takahashi E, Funai M, Joko M, Takayasu M. A large retro-odontoid cystic mass caused by transverse ligament degeneration with atlantoaxial subluxation leading to granuloma formation and chronic recurrent microbleeding case report. Spine J 2011; 11:1152-6. [PMID: 22177924 DOI: 10.1016/j.spinee.2011.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 09/03/2011] [Accepted: 11/15/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Noninfectious nontumorous retro-odontoid masses are rare, and masses have not been reported to extensively compress the spinal cord. We encountered a case of a large retro-odontoid lesion that extensively compressed the spinal cord. CASE REPORT A 76-year-old-man reported experiencing a sudden onset of neck pain, hand and foot paresthesia, dysarthria, and dysphagia. When symptoms had not eased by 10 days of treatment with external stabilization and bed rest, he was referred to our hospital. Dynamic radiographs of the cervical spine showed that the atlantodental interval widened from 2 mm on extension to 7 mm on flexion. Computed tomography did not reveal abnormality of the odontoid process or the presence of a high-density area that could suggest calcification in or near the cystic mass. Fluid-attenuated inversion recovery axial magnetic resonance image showed a mass that was 3.0-cm wide, 2.7-cm high, and 2.5-cm thick that severely compressed the lower brain stem. T2-weighted magnetic resonance imaging showed that the mass contained a solid part posterior to the C2 dense area, extending rostrally, compatible with the presence of degenerated and hypertrophic ligaments. We performed surgical decompression of the lesion combined with atlantoaxial fixation. The partly cystic mass, which was located extradurally, had xanthochromic content, indicating microbleeding. Dysarthria and dysphagia immediately disappeared, and neurologic symptoms disappeared by 1 month. At 1-year follow-up, the patient remained symptom free, and computed tomography scans did not show recurrence of the mass. The pathologic diagnosis of degenerative ligament tissue with chronic recurrent microbleeding and associated granulation was made. DISCUSSION A possible explanation why the cyst grew to an exceptionally large size is that the transverse ligament of axis became degenerated and hypertrophic because of chronic mechanical stress by atlantoaxial subluxation. Then, a part of the ligament developed reactive granulation with small vessel formation. Finally, rupture of these small vessels caused repeated episodes of microbleeding, resulting in formation of a large cyst. The observation of degenerative ligament tissue, granulation formation, and microbleeding differentiated it from a synovial cyst or a ganglion cyst. The presence of hemosiderin deposits suggested chronic recurrent microbleeding. Taking all our findings together, we believe that our case of retro-odontoid cystic mass is different from the others that have been reported. Atlantoaxial instability may cause a large mass, such as we described here, so that careful observation is important.
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Affiliation(s)
- Mikinobu Takeuchi
- Department of Neurosurgery, Aichi Medical University Hospital, Nagakute, Aichi-gun, Aichi, Japan.
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Julien TP, Schoenfeld AJ, Barlow B, Harris MB. Subchondral cysts of the atlantoaxial joint: a risk factor for odontoid fractures in the elderly. Spine J 2009; 9:e1-4. [PMID: 19535297 DOI: 10.1016/j.spinee.2009.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 03/16/2009] [Accepted: 04/20/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Scholars have postulated that cervical degeneration can predispose the upper cervical spine to injury after minor trauma. Subchondral cysts have previously been recognized as potentiators of fracture in the hip and knee but no cases of cervical degenerative cysts contributing to fracture have been reported. PURPOSE This report documents a case series in which patients sustained significant injury to the upper cervical spine in the setting of subchondral cervical cysts. STUDY DESIGN/SETTING Case series/academic level I trauma center. METHODS Between 2004 and 2008, six patients (ages 73-91 years) with cervical pathology were admitted to the trauma service at our Level I trauma center. The most common mechanism of injury was a low velocity fall, which occurred in 5 out of 6 patients. All patients suffered an odontoid fracture. In all cases, there was radiographic evidence of cyst formation, and computed tomographic imaging demonstrated fracture communication with the subchondral cyst. RESULTS Of the six cases, four were treated definitively with immobilization in a cervical orthosis and two required surgery. One patient was treated with an occipital-cervical fusion, whereas the other underwent Brooks wiring. All patients ultimately went on to heal their fractures. CONCLUSIONS Degenerative changes in the cervical spine have previously been recognized to potentiate injury. This report raises the question of whether degenerative processes at the C1-C2 articulation predispose elderly patients to injury at this level. The presence of cystic degeneration at the atlantoaxial joint should be recognized as a potential risk factor for cervical injury after relatively minor trauma.
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Affiliation(s)
- Terrill P Julien
- Harvard Combined Orthopaedic Program, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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12
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Cho SM, Rhee WT, Choi SJ, Eom DW. Lumbar intraspinal extradural ganglion cysts. J Korean Neurosurg Soc 2009; 46:56-9. [PMID: 19707495 DOI: 10.3340/jkns.2009.46.1.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 12/30/2008] [Accepted: 06/29/2009] [Indexed: 11/27/2022] Open
Abstract
The lumbar intraspinal epidural ganglion cyst has been a rare cause of the low back pain or leg pain. Ganglion cysts and synovial cysts compose the juxtafacet cysts. Extensive studies have been performed about the synovial cysts, however, very little has been known about the ganglion cyst. Current report is about two ganglion cysts associated with implicative findings in young male patients. We discuss about the underlying pathology of the ganglion cyst based on intraoperative evidences, associated disc herniation at the same location or severe degeneration of the ligament flavum that the cyst originated from in young patients.
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Affiliation(s)
- Sung Min Cho
- Department of Neurosurgery, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Korea
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a case of a subacute radiculopathy resulting from a spontaneous hemorrhage into a lumbar ganglion cyst. SUMMARY OF BACKGROUND DATA Ganglion and synovial cysts of the lumbar spine are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. Few cases of hemorrhage into lumbar juxtafacet cysts after trauma or anticoagulation therapy have been described in the literature. METHODS A case of a spontaneous hemorrhage in a lumbar ganglion cyst is presented. RESULTS A 61-year-old man presented with a 2-month history of intermittent bilateral lumbar ache. Eight days before admission he had a sudden exacerbation of the lumbar pain and began to fall frequently and noticed weakness and tingling in his lower members, mainly in the right leg. Magnetic resonance imaging scan revealed a hematic collection associated with a large juxtafacet cyst at the L4-L5 level. He was submitted to surgery and the cyst was totally removed. Microscopic examination was consistent with the diagnosis of a ganglion cyst. Two days after surgery he had already an independent gait. CONCLUSION Although, there are a few descriptions of hemorrhagic lumbar justafacet cysts after trauma or anticoagulant therapy, this is the first case of a hemorrhagic ganglion cyst with no previous traumatic event or use of medication. Magnetic resonance imaging was essential for making the preoperative diagnosis. Neurosurgical cyst removal proved to be an effective treatment.
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Surgical treatment of nonrheumatoid atlantoaxial degenerative arthritis producing pain and myelopathy. Spine (Phila Pa 1976) 2007; 32:3067-73. [PMID: 18091503 DOI: 10.1097/brs.0b013e31815d004c] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review. OBJECTIVE The purpose of this study was to evaluate the clinical and pathologic findings and surgical treatment outcomes for atlantoaxial osteoarthritis. SUMMARY OF BACKGROUND DATA Nonrheumatoid atlantoaxial osteoarthritic degeneration can occur at either the atlantodental articulation or lateral mass articulations. This condition may present with neck pain or myelopathy in the setting of a compressive degenerative pannus. There is a paucity of literature on this topic with only case reports and small case series. METHODS A retrospective chart review was performed to identify patients treated for C1-C2 osteoarthritis. Patient demographics, clinical presentation, neurologic examination, visual analog pain scores, radiographic findings, surgical treatment, outcomes, and complications were recorded for each patient. RESULTS Twenty-six patients (18 with pannus at the atlantodental articulation and 8 primarily with lateral mass articulation arthritis; 10 men, 16 women; mean age 74 years) were surgically treated for atlantoaxial osteoarthritis. Eleven patients presented primarily with complaints related to myelopathy (all with a degenerative pannus) and 15 presented with cervicalgia only. All patients were treated with posterior atlantoaxial arthrodesis, and 13 patients with myelopathy or severe canal compromise from an irreducible subluxation also had transoral odontoidectomy. All myelopathic patients had improvement in neurologic function (10 of 11 improved 1 Ranawat grade). Neck pain improved in 93% of patients with preoperative neck pain complaints (mean visual analog score before surgery = 7.0, follow-up = 1.3). Fusion was demonstrated in all patients with adequate follow-up. CONCLUSION Atlantoaxial osteoarthritis can result in neck pain and myelopathy. In the setting of a degenerative pannus and myelopathy, most patients will improve neurologically after transoral decompression and arthrodesis. Patients with pannus and no myelopathy were effectively treated with posterior fusion alone, although 2 with irreducible subluxation required an initial transoral decompression to allow realignment before fusion. Posterior arthrodesis alone provided significant pain relief in most patients.
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Cheng WY, Shen CC, Wen MC. Ganglion cyst of the cervical spine presenting with Brown-Sequard syndrome. J Clin Neurosci 2006; 13:1041-5. [PMID: 17113987 DOI: 10.1016/j.jocn.2005.07.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 07/14/2005] [Indexed: 11/22/2022]
Abstract
Ganglion cysts of the spine are uncommon. They occur mostly in the dorsolateral trunk and arise with the greatest frequency in the lumbar spine. However, they are rarely symptomatic. We report a rare case of a patient with a ganglion cyst of the lower cervical spine presenting with acute Brown-Sequard syndrome. The patient had no history of trauma. Magnetic resonance imaging of the cervical spine showed a cystic lesion connecting to the synovial joint C6-7 and compressing the posterior aspect of the spinal cord. The patient underwent emergent C6-7 laminectomy with total removal of the cyst. Neurological function recovered completely 4 months after operation. Ganglion cysts should be considered in the differential diagnosis of an extradural mass of the cervical spine. Magnetic resonance imaging provides a rapid and correct diagnosis, and laminectomy with removal of the cyst results in good neurological recovery.
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Affiliation(s)
- Wen-Yu Cheng
- Department of Neurosurgery, Taichung Veterans General Hospital, 160, Sec. 3, Taichung-Kang Road, Taichung, Taiwan
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Quigley KJ, Cortese CM, Place HM. Cervical degenerative cyst located within the body of C2: a case report and review of the literature. Spine (Phila Pa 1976) 2006; 31:E237-40. [PMID: 16622369 DOI: 10.1097/01.brs.0000210251.56703.d4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and review of the literature are presented. OBJECTIVES To describe the clinical course and treatment of a patient with an unusual intraosseous degenerative cyst within the body of the axis, as well as review the literature regarding these lesions. SUMMARY OF BACKGROUND DATA Intraosseous degenerative cysts of the cervical spine are extremely rare. To our knowledge, only 4 prior case studies have described these lesions, 2 of which were seen in the body of C2. METHODS A case report of a 58-year-old patient with neck pain and an intraosseous cyst within the axis is presented with a review of the pertinent literature. RESULTS History, examination, radiographic evaluation, and histology revealed this lesion to be an intraosseous degenerative cyst within the body of C2. The patient was treated with anterior surgical biopsy/curettage and posterior stabilization with structural graft enhancement. CONCLUSION Although rare, intraosseous cervical degenerative cysts should be present in any differential diagnosis of cystic lesions seen in the cervical spine.
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Affiliation(s)
- Kevin J Quigley
- Department of Orthopaedic Surgery, St. Louis University Health Sciences Center, St. Louis, MO 63110, USA.
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17
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Emura T, Yokomori K, Obana K, Tanaka Y. Ganglion of the groin in a child: an unusual cause of soft-tissue swelling of the groin. Pediatr Surg Int 2005; 21:227-9. [PMID: 15592851 DOI: 10.1007/s00383-004-1326-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2003] [Indexed: 11/28/2022]
Abstract
A case of groin ganglion with asymptomatic compression of the femoral vein is described. A 2-year-old girl was referred because of a symptomless groin mass. A mass was palpable in the right femoral triangle. Computed tomography and ultrasonography revealed a cystic lesion compressing the femoral vein ventrally. Prompt surgical removal of the cystic lesion was done without complications. Histopathological examination showed a benign structure similar to that of a ganglion.
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Affiliation(s)
- Takaki Emura
- Department of Pediatric Surgery, Japan Red Cross Medical Center Hiroo, 4-1-22 Tokyo, Sibuya-ku, Japan
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18
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Miwa M, Doita M, Takayama H, Muratsu H, Harada T, Kurosaka M. An Expanding Cervical Synovial Cyst Causing Acute Cervical Radiculopathy. ACTA ACUST UNITED AC 2004; 17:331-3. [PMID: 15280765 DOI: 10.1097/01.bsd.0000095892.46978.6e] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Masahiko Miwa
- Department of Orthopaedic Surgery, Hyogo Prefectural Kakogawa Hospital, Hyogo, Japan
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19
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Giger R, Szalay-Quinodoz I, Haenggeli A, Dulguerov P. Ganglion cyst of the spinal anterior longitudinal ligament presenting as a retropharyngeal mass. Am J Otolaryngol 2002; 23:390-3. [PMID: 12430135 DOI: 10.1053/ajot.2002.126323] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cervical spinal synovial and/or ganglion cysts can occur at various periarticular sites and should be considered in the differential diagnosis of intraspinal-extradural or paraspinal masses of the cervical spine. The first report of a ganglion cyst of the cervical anterior longitudinal ligament presenting as a retropharyngeal mass, is presented. The histopathology, etiology, and clinical aspects of synovial and ganglion cysts of the cervical spine are briefly reviewed.
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Affiliation(s)
- Roland Giger
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, 24 rue Micheli-du-Crest, CH-1205 Geneva, Switzerland
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Cai CY, Palmer CA, Paramore CG. Exuberant transverse ligament degeneration causing high cervical myelopathy. JOURNAL OF SPINAL DISORDERS 2001; 14:84-8. [PMID: 11242280 DOI: 10.1097/00002517-200102000-00014] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Two patients with cervical myelopathy and C1-C2 retro-odontoid masses were examined. Preoperative magnetic resonance imaging studies suggested soft tissue pannus, as might be seen in rheumatoid arthritis; however, the results of serologic testing for rheumatoid factor were negative in both patients. Intraoperative findings and pathologic examination revealed degenerative fibrocartilage without inflammation or neoplasia. Similar lesions reported in the literature have been described as retro-odontoid disk hernia, damaged transverse ligaments, transverse ligament degeneration, synovial cysts, ganglion cysts, and degenerative articular cysts. These lesions may share a common pathophysiologic origin and represent a single disease process, namely exuberant degeneration of the transverse ligament.
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Affiliation(s)
- C Y Cai
- Department of Surgery, the University of Alabama at Birmingham, USA
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