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Lozouet M, Derrey S, Garrido E, Ould-Slimane M, Cantogrel P, Curey S. Intraspinal Extradural Degenerative Cervical Cyst Treated by Anterior Cervical Discectomy and Fusion: A Surgical Alternative to the Posterior Approach, about One Case. J Orthop Case Rep 2024; 14:68-72. [PMID: 38560330 PMCID: PMC10976530 DOI: 10.13107/jocr.2024.v14.i03.4290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/09/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Intraspinal extradural arthrosynovial cysts, which belong to the spectrum of degenerative spinal diseases are mainly located at lumbar level and their location at cervical level joint is therefore unusual. The most common surgical approach for symptomatic arthrosynovial cervical cyst remains a direct resection of the cyst by a cervical hemilaminectomy with or without a posterior arthrodesis. However, another surgical approach may also be discussed when considering the cyst as a result of a local spinal instability or hypermobility. Case Report We report in this work the case of a patient with cervical radiculopathy due to intraspinal extradural compressive arthrosynovial cervical cyst which was treated by anterior discectomy and fusion without direct resection of the cyst. The post-operative radiological control performed at 3 months showed a complete regression of the cyst with a patient pain-free. To the best of our knowledge, this is the first case of intraspinal cervical degenerative cyst at C7-T1 level treated by anterior approach and fusion without direct cyst resection. Conclusion For the treatment of a joint spinal cervical cyst, the anterior approach is a relevant option that gives the advantages to respect the posterior cervical muscles and articular structures.
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Affiliation(s)
- Mathieu Lozouet
- Department of Neurosurgery, Rouen University Hospital,
F-76000 Rouen, France
- Department of Spine surgery Rouen University Hospital,
Spine Institute, F76000 Rouen, France
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital,
F-76000 Rouen, France
- Department of Spine surgery Rouen University Hospital,
Spine Institute, F76000 Rouen, France
| | - Elisabeth Garrido
- Department of Neurosurgery, Rouen University Hospital,
F-76000 Rouen, France
- Department of Spine surgery Rouen University Hospital,
Spine Institute, F76000 Rouen, France
| | - Mourad Ould-Slimane
- Department of Spine surgery Rouen University Hospital,
Spine Institute, F76000 Rouen, France
- Department of Orthopaedic Surgery, Rouen University
Hospital, F76000 Rouen, France
| | - Pauline Cantogrel
- Department of Spine surgery Rouen University Hospital,
Spine Institute, F76000 Rouen, France
- Department of Orthopaedic Surgery, Rouen University
Hospital, F76000 Rouen, France
| | - Sophie Curey
- Department of Neurosurgery, Rouen University Hospital,
F-76000 Rouen, France
- Department of Spine surgery Rouen University Hospital,
Spine Institute, F76000 Rouen, France
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Yang DBY, Harms J, Iyer RK, Arnold P. Synovial cysts at the cervicothoracic junction: Illustrative series of three cases. Surg Neurol Int 2023; 14:196. [PMID: 37404504 PMCID: PMC10316244 DOI: 10.25259/sni_88_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/12/2023] [Indexed: 07/06/2023] Open
Abstract
Background Spinal synovial cysts are an uncommon pathology, estimated to affect 0.65-2.6% of the population. Cervical spinal synovial cysts are even rarer, accounting for only 2.6% of spinal synovial cysts. They are more commonly found in the lumbar spine. When they occur, they can compress the spinal cord or surrounding nerve roots resulting in neurological symptoms, particularly when they increase in size. Decompression and cyst resection are the most common treatment and typically result in resolution of symptoms. Methods The authors present three cases of spinal synovial cysts occurring at the C7-T1 junction. They occurred in patients aged 47, 56, and 74, respectively, and presented with symptoms of pain and radiculopathy. Diagnosis was made with computed tomography (CT) scan and magnetic resonance imaging (MRI). The cysts were managed with laminectomy, resection, and fusion. Results All patients reported full resolution of symptoms. There were no intra or postoperative complications. Conclusion Cervical spinal synovial cysts are an uncommon cause of radiculopathy and pain in the upper extremities. They can be diagnosed through CT scans and MRI, and treatment with laminectomy, resection, and fusion results in excellent outcomes.
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Affiliation(s)
- Darrion Bo-Yun Yang
- Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign
| | - James Harms
- Department of Neurosurgery, Carle Neuroscience Institute, Carle Foundation Hospital
| | - Ravishankar K. Iyer
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign
| | - Paul Arnold
- Department of Neurosurgery, Carle Illinois College of Medicine, Urbana, Illinois, United States
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Kim J, Heo DH, Lee DC, Park CK, Chung H. Surgical Removal of Cervical Extradural Cysts Using the Biportal Endoscopic Approach. World Neurosurg 2022; 164:228-236. [PMID: 35580779 DOI: 10.1016/j.wneu.2022.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptomatic intraspinal extradural cysts of the cervical spine are uncommon; however, they are usually treated using conventional posterior decompression. Biportal endoscopic surgery is widely used to treat degenerative cervical pathological conditions. This study presented an optimized surgical technique for a biportal endoscopic posterior approach for removal of cervical intraspinal extradural cysts that caused cervical radiculomyelopathy. METHODS A broad laminotomy was performed, which was wider than the outer contour of the cysts. The ligamentum flavum was detached from the bony margin and removed after an epidural dissection, and a dense adhesive tissue entrapped the extradural cysts. A spinal endoscope was placed close to the dissection plane and offered a high-resolution magnified view. The cyst capsule was safely dissected from the dura and removed en bloc without dural injury. RESULTS Postoperatively, neurological deficits, including cervical myelopathy, radiating arm pain, and upper back pain improved in both patients. CONCLUSIONS We successfully removed an extradural cervical cystic mass lesion by using a biportal endoscopic posterior cervical approach without complications. The biportal endoscopic approach may have advantages, such as minimizing trauma to the normal structures of the posterior cervical region, magnified endoscopic view, and early recovery after the surgery. Biportal endoscopy may be used as an alternative surgical treatment for symptomatic cervical intraspinal extradural cystic lesions.
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Affiliation(s)
- Jiyeon Kim
- Department of Neurosurgery, Spine Center, Wiltse Memorial Hospital, Anyang, South Korea
| | - Dong Hwa Heo
- Department of Neurosurgery, Spine Center, Seoul Bumin Hospital, Seoul, South Korea.
| | - Dong Chan Lee
- Department of Neurosurgery, Spine Center, Wiltse Memorial Hospital, Anyang, South Korea
| | - Choon Keun Park
- Department of Neurosurgery, Spine Center, Wiltse Memorial Hospital, Anyang, South Korea
| | - Hungtae Chung
- Department of Neurosurgery, Spine Center, Seoul Bumin Hospital, Seoul, South Korea
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Ruggeri L, Brunasso L, Urrico G, Alessandrello R, Cinquemani G, Lipani R, Mandelli J, Nobile F, Iacopino DG, Maugeri R. Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review. Surg Neurol Int 2021; 12:369. [PMID: 34513136 PMCID: PMC8422454 DOI: 10.25259/sni_574_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/25/2021] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Luca Ruggeri
- Department of Neurosurgery, S. Elia Hospital, Caltanissetta, Italy
| | - Lara Brunasso
- Department of Neurosurgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | - Giovanni Urrico
- Department of Pathology, S. Elia Hospital, Caltanissetta, Italy
| | | | | | - Rita Lipani
- Department of Neurosurgery, S. Elia Hospital, Caltanissetta, Italy
| | - Jaime Mandelli
- Department of Neurosurgery, S. Elia Hospital, Caltanissetta, Italy
| | | | - Domenico Gerardo Iacopino
- Department of Neurosurgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Department of Neurosurgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
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Spontaneous regression of a subaxial cervical facet cyst. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tanishima S, Mihara T, Takeda C, Ogawa S, Nagashima H. Fast-Growing Cervical Juxtafacet Cyst Mimicking Epidural Hematoma: A Case Report. JBJS Case Connect 2020; 10:e20.00237. [PMID: 32960018 DOI: 10.2106/jbjs.cc.20.00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 75-year-old man, who was a carpenter, experienced neck pain and numbness in the upper and lower extremities while hammering a nail and later developed a gait disturbance. Initial magnetic resonance imaging (MRI) revealed a tumor-like mass at the C5 epidural space compressing the spinal cord. The first diagnosis was cervical epidural hematoma. The following day, the patient's symptom deteriorated. A second MRI revealed an increase in the size of the mass, and surgery was performed. Operative findings included a juxtafacet cyst. CONCLUSION Repeated job-related load on the facet joint in this patient caused rapid progression of facet cysts, causing myelopathy similar to an epidural hematoma.
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Affiliation(s)
- Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Tokumitsu Mihara
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Chikako Takeda
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shinya Ogawa
- Department of Orthopedic Surgery, Masuda Red Cross Hospital, Masuda, Japan
| | - Hideki Nagashima
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan
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Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Godolias G, Komp M. Surgical treatment of cervical subaxial intraspinal extradural cysts using a full-endoscopic uniportal posterior approach. J Orthop Surg (Hong Kong) 2019; 26:2309499018777665. [PMID: 29793373 DOI: 10.1177/2309499018777665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Symptomatic intraspinal extradural cysts of the cervical subaxial spine are rare, but usually require surgery. Conventional posterior decompression is the gold standard. However, there is increasing experience with endoscopic surgical techniques. The purpose of the study is to evaluate the technical implementation and outcomes of a full-endoscopic uniportal technique via the posterior approach in patients with symptomatic intraspinal extradural cysts of the cervical subaxial spine. METHODS Seven consecutive patients with a subaxial location of symptomatic intraspinal extradural cysts were decompressed in a full-endoscopic uniportal technique via the posterior approach between 2009 and 2015. Imaging and clinical data were collected in follow-up examinations for 18 months. RESULTS In all cases, the cyst was completely removed and adequate decompression was achieved using the full-endoscopic uniportal technique. One patient developed a dural leak that was sutured and covered intraoperatively. No other complications requiring treatment were observed. All patients had a good clinical outcome with stable regression of the radicular and central nerve pain or neurological deficits. The imaging follow-up showed sufficient decompression in all cases. No evidence was found of increasing instability during the follow-up period. CONCLUSION The full-endoscopic uniportal operation with a posterior approach allows the resection of the cyst and can minimize trauma and destabilization and has technical benefits and a low complication rate. It is an alternative surgical method that can offer advantages and is considered by the authors to be the surgical technique of choice for cervical subaxial intraspinal extradural cysts.
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Affiliation(s)
- Sebastian Ruetten
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Patrick Hahn
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Semih Oezdemir
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Xenophon Baraliakos
- 2 Center for Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr University of Bochum, Bochum, Germany
| | - Georgios Godolias
- 3 Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University Bochum/Marien Hospital Witten, Herne, Germany
| | - Martin Komp
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
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Hohenberger C, Brawanski A, Ullrich OW, Höhne J, Zeman F, Schebesch KM. Degenerative symptomatic spinal synovial cysts: Clinical presentation and functional outcome. J Clin Neurosci 2018; 62:112-116. [PMID: 30580916 DOI: 10.1016/j.jocn.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/29/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023]
Abstract
Spinal synovial cysts (SSC) are a rare but important differential diagnosis for degenerative or space-occupying spinal lesions. There is controversy about the most beneficial treatment, which can be conservative or surgical. We provide a review of our surgical data for purposes of quality assessment and improvement. 5313 patients with surgically treated degenerative spinal diseases were analyzed retrospectively. The incidence of SSC was 1.14%. 61 patients (31 women, 30 men; mean age 65.3 years) with SSC were included in this study. The charts, surgical reports, and radiographic data were reviewed for demographics, duration of symptoms, size of SSC, anatomical site, surgical approach, Visual Analog Scale (VAS), and neurological performance including the Japanese Orthopedic Association Score (JOA score) and the Frankel score. Laminotomy was the most common surgical approach in 93.4% of the patients followed by hemilaminectomy in 6.6%. The predominant site of SSC was the lumbar spine in 86.9%. 95.1% had experienced local and radicular pain as the predominant symptom and 47.5% preoperative sensory and motor deficits. At discharge, the JOA score was significantly increased compared to admission (median value of 17). At follow-up, 94.4% had normal neurological function and 5.6% showed grade 1 neurological deficits. Leg pain had decreased in 94.4% and back pain in 70.6%. At long-term follow-up, all patients presented neurologically stable. The median value for pain classified with the VAS had decreased from 6 at admission to 1 at long-term follow-up. During long-term follow-up, 6 patients (9.8%) had developed spinal instability requiring stabilization, 5 patients had received facet joint infiltration due to symptomatic facet joint syndrome. The epidemiological and clinical patterns of symptomatic SSC are similar to those of other degenerative spinal diseases. Thus, SSC should always be considered as a rare but important differential diagnosis. Surgical outcome was excellent with immediate symptom relief and recovery, which further improved over time. Our data support the benefit of surgical treatment and may be useful in recommending neurosurgical therapy to patients with SSC.
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Affiliation(s)
- Christoph Hohenberger
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Alexander Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Odo Winfried Ullrich
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
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Themistoklis KM, Papasilekas TI, Boviatsis KA, Giakoumettis DA, Vlachakis EN, Themistocleous MS, Sakas DE, Korfias SI. Spinal synovial cysts. A case series and current treatment options. J Clin Neurosci 2018; 57:173-177. [DOI: 10.1016/j.jocn.2018.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
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Breckwoldt T, Oktenoglu T, Sasani M, Suzer T, Ozer AF. A rare cause of root-compression: Subaxial cervical synovial cyst in association with congenital fusion. Int J Surg Case Rep 2015; 16:90-2. [PMID: 26433927 PMCID: PMC4643443 DOI: 10.1016/j.ijscr.2015.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/18/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Tabea Breckwoldt
- University of Fribourg, Faculty of Sciences, Fribourg, Switzerland
| | - Tunc Oktenoglu
- American Hospital, Neurosurgery Department, Istanbul, Turkey.
| | - Mehdi Sasani
- American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Tuncer Suzer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
| | - Ali Fahir Ozer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
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