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Takeuchi S, Hanakita J, Takahashi T, Kanematsu R, Suda I, Nakamura S, Minami M. Thoracic synovial cyst in patient with diffuse idiopathic skeletal hyperostosis. Surg Neurol Int 2022; 13:450. [PMID: 36324956 PMCID: PMC9610123 DOI: 10.25259/sni_804_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Spinal synovial cysts, attributed to degenerative changes of the facet joints, commonly occur at the sites of segmental spinal instability. Here, we present a patient with diffuse idiopathic skeletal hyperostosis (DISH) who developed a T10/T11 synovial cyst contributing to myelopathy that resolved following surgical cyst excision. Case Description: A 69-year-old male presented with progressive numbness and paraparesis for 2-month duration. The thoracic MR spine showed synovial cyst at the T10/T11 level, while the computed tomography confirmed DISH fusion between the T4 and T10 levels. Following a laminectomy with cyst excision, the patient’s symptoms resolved and he sustained no recurrent dynamic instability. Conclusion: A patient with DISH presented with the new onset of myelopathy attributed to a T10/T11 thoracic synovial cyst; following cyst excision, the patient’s myelopahty resolved.
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Kusakabe T, Aizawa T, Kasama F, Nakamura T, Sekiguchi A, Hoshikawa T, Koizumi Y. Surgical management of facet cysts in the thoracic spine: Radiological manifestations and results of fenestration. J Orthop Sci 2022; 27:995-1001. [PMID: 34364754 DOI: 10.1016/j.jos.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Facet cysts in the thoracic spine are a rare cause of thoracic myelopathy. We aimed to investigate the clinical/radiological features and surgical results of these lesions. METHODS Nine thoracic facet cysts in eight patients (seven men, one woman) were diagnosed based on magnetic resonance imaging (MRI) and computed tomography (CT) with facet arthrography findings and surgically treated. The mean patient age was 71 (59-83) years. The cysts were distributed as follows: one each at T8-9 and T9-10, two each at T1-2 and T11-12, and three at T10-11. The mean follow-up period was 1.8 (1-5) years. Clinical and radiological features were retrospectively investigated, and surgical outcomes were evaluated according to modified Japanese Orthopaedic Association (JOA) scores for thoracic myelopathy (full score: 11). RESULTS Neurological examination revealed progressive thoracic transverse myelopathy in all patients with a mean disease duration of 1.2 months (2 weeks-2 months). MRI revealed a total of nine cysts across the eight patients: four in the median region and five in the paramedian portion of the spinal canal. CT revealed degeneration in all involved facet joints. All the cysts were in communication with the neighboring facet joint confirmed by CT facet arthrography. All patients underwent bilateral fenestration, and the cysts were resected with the ligamentum flavum. The mean preoperative and postoperative modified JOA scores were 4.5 and 8.8, respectively. The mean recovery rate was 67.5%. Differences in the degree of local kyphosis were 2° or less between before and after surgery. On histopathology, synovial lining cells were not noted in any case. CONCLUSIONS Decompression surgery is recommended for treating progressive myelopathy in patients with cystic lesions. Our study suggests that thoracic facet cyst resection with satisfactory surgical outcomes would be possible through fenestration.
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Affiliation(s)
- Takashi Kusakabe
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, 981-8563, Japan.
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Fumio Kasama
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Tatsutayashiki, Sanezawa, Izumi-ku, Sendai, 981-3217, Japan
| | - Takeshi Nakamura
- Department of Orthopaedic Surgery, Tohoku Central Hospital, 3-2-5 Wago-machi, Yamagata, 990-8510, Japan
| | - Akira Sekiguchi
- Department of Orthopaedic Surgery, Osaki Citizen Hospital, 3-8-1 Furukawa-Honami, Osaki, Miyagi, 989-6183, Japan
| | - Takeshi Hoshikawa
- Department of Orthopaedic Surgery, Sendai Orthopaedic Hospital, 3-5-3 Izai, Wakabayashi-ku, Sendai, 984-0038, Japan
| | - Yutaka Koizumi
- Department of Orthopaedic Surgery, Sendai Nishitaga Hospital, 2-11-11 Kagitorihoncho, Taihaku-ku, Sendai, 982-8555, Japan
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A Rare T2-T3 Synovial Facet Cyst Causing Progressive Myelopathy. Case Rep Orthop 2021; 2021:2799749. [PMID: 34306785 PMCID: PMC8263280 DOI: 10.1155/2021/2799749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Intraspinal extradural synovial cysts are a rare occurrence at the spinal cord level and thus a rare cause of myelopathy. Synovial cysts usually present in the more mobile lumbar and cervical parts of the spine; however, they may also arise in the thoracic spine. We present a case of a 59-year-old male with a left upper thoracic synovial cyst at T2-3 causing disabling, progressive myelopathy, and an incomplete spinal cord injury syndrome with inability to ambulate. An urgent decompressive laminectomy with bilateral facetectomies, cyst excision, and posterior fusion was performed. Subsequently, the patient recovered full function. Synovial cysts should be considered in the differential diagnosis of progressive thoracic myelopathy. This is only the sixth reported case of a synovial cyst of this kind occurring between the levels of T1 and T7. Urgent surgical decompression is the recommended treatment.
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Velagapudi L, Matias CM, Elia C, Stolzenberg D, Largoza G, Feld R, Curtis M, Harrop JS. Spinal ganglion cyst presenting with radiculopathy: diagnostic challenges and differential. Spinal Cord Ser Cases 2021; 7:6. [PMID: 33468998 DOI: 10.1038/s41394-020-00373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Ganglion cysts are benign soft tissue lesions, usually arising from periarticular connective tissue. These are very rarely reported in the spine, but when seen can cause radiculopathy or myelopathy. CASE PRESENTATION A 68-year-old female patient presented with worsening radiculopathy and right foot drop and imaging noted a right L5-S1 foraminal mass. The lesion was gross totally resected. Histological analysis revealed myxoid degeneration and inflammation, without a synovial lining, consistent with ganglion cyst. DISCUSSION While uncommon, intra-foraminal ganglion cysts can be distinguished from synovial cysts through imaging and histology and are typically amenable to surgical resection. Greater knowledge and insight about differentiating ganglion versus synovial cyst may prevent resection of facet joints and prevent a fusion procedure.
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Affiliation(s)
- Lohit Velagapudi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Caio M Matias
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Elia
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Stolzenberg
- Rothman Orthopedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Garrett Largoza
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rick Feld
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Curtis
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
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Radhouane K, Dridi H, Mansouri N, Yedeas MD, Harbaoui A, Chkili R. Hemorrhagic synovial cyst: An unexpected cause of acute cervical spinal cord compression. Case report. Int J Surg Case Rep 2020; 77:527-530. [PMID: 33395838 PMCID: PMC7704358 DOI: 10.1016/j.ijscr.2020.11.040] [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: 08/28/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic inflammation of the synovial cyst induces neovascularization of its wall leading to a possible intra-cystic bleeding. The different signal modulations on MRI are due to the variable consistency and density of the cystic fluid. Synovial cyst hemorrhage produces a sudden increase in the size of the lesion with compression of the spinal cord and nerve roots. Surgery is the appropriate treatment in case of synovial cyst with spinal cord compression.
Introduction Cervical synovial cysts are uncommon. They are most often responsible for a chronic clinical picture. Rarely, intracystic hemorrhage occurs, and may acutely present as radicular – or even spinal cord compression syndrome leading to irreversible neurological impairment. Case We reported a case of bleeding synovial cyst located in the cervico-thoracic spine causing spastic paraparesis in a 68-year-old male patient. MRI revealed narrowing of perimedullary subarachnoid space by a well circumscribed, extra-axial, homogeneous mass located posterolaterally to the right of the spinal cord at the level C7-T1. The cyst was removed thoroughly by laminectomy. Pathological findings were consistent with the diagnosis of hemorrhagic synovial cyst. The patient had an excellent recovery. Discussion Synovial cysts of the spine are rare and usually asymptomatic. It is extremely rare for intracystic bleeding to occur and be responsible for an abrupt presentation. Diagnosis of spinal synovial cyst relies on MRI but may not be evident as it depends on consistency and density of the cystic fluid. Surgery remains the best therapeutic alternative, especially in the case of neurological impairment. Conclusion Surgery should be considered for any cervical synovial cyst. This is motivated by the risk, although rare, of bleeding and the resulting irreversible neurological damage that may occur.
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Affiliation(s)
- Khaled Radhouane
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia.
| | - Hadhemi Dridi
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia.
| | - Nada Mansouri
- Department of Pathology, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia.
| | - Mohamed Dehmani Yedeas
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia.
| | - Ahmed Harbaoui
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia.
| | - Ridha Chkili
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia.
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Schmidt BT, Strayer AL, Stadler JA. Upper Thoracic Spine Synovial Cyst Resulting in Paraplegia Following Transient Hypotension. Cureus 2020; 12:e9870. [PMID: 32963911 PMCID: PMC7500725 DOI: 10.7759/cureus.9870] [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: 07/01/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022] Open
Abstract
Development of synovial cysts in the rigid thoracic spine is rare. Additionally, synovial cysts with compression of nerve roots typically cause subacute or chronic radiculopathy. We present a patient who had a new diagnosis of upper thoracic (T1-2) synovial cyst that caused acute paraplegia while hospitalized for therapies and surgical planning. The patient is a 56-year-old male with a history of congestive heart failure secondary to alcoholic cardiomyopathy. He presented with a progressive bilateral lower extremity discoordination, urinary incontinence, and altered perineal sensation. His examination revealed intact strength to bedside assessment, intact rectal tone, but upgoing toes on Babinski testing. Given concern for myelopathy, MRI thoracic spine was obtained and demonstrated large T1-2 synovial cyst causing severe compression with associated T2 signal change within the spinal cord. He underwent expedited cardiac optimization that included resumption of outpatient antihypertensive medications and the addition of a single dose of intravenous diuretic. The patient had subsequent transient hypotension following significant diuresis and developed acute paraplegia in his bilateral lower extremities. Fluids and vasopressors were initiated, and he underwent emergent surgery for decompression and synovial cyst resection. The patient did very well and had normalization of his neurological exam within 24 hours. We present a case of acute paraplegia secondary to hypotension and spinal cord hypoperfusion in a patient with upper thoracic synovial cyst. This is rare pathology with an even more unique presentation. The authors recommend careful perioperative hemodynamic monitoring to help avoid acute worsening in this patient population.
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Affiliation(s)
- Bradley T Schmidt
- Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Andrea L Strayer
- Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - James A Stadler
- Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
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Lambrechts MJ, Goldstein CL. Rapid Neurologic Deterioration due to an Enlarging Thoracic Spine Synovial Cyst: A Case Report. JBJS Case Connect 2020; 10:e0627. [PMID: 32649121 DOI: 10.2106/jbjs.cc.19.00627] [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 We present the case of a 69-year-old man arriving to our clinic after a previous outside hospital recommendation of L1-S1 fusion due to degenerative scoliosis. A thoracic spine synovial cyst was identified through magnetic resonance imaging. The patient had rapid progression of his neurologic deficit due to cyst enlargement. We elected to perform cyst decompression and instrumented fusion of the involved thoracic segment. The patient rapidly regained full neurologic function. After the one-year follow-up, he remained asymptomatic with no progression of thoracolumbar degeneration. CONCLUSIONS Thoracic spine synovial facet cysts are uncommonly encountered. Decompression alone or decompression and fusion are both viable treatment options depending on the surgeon's assessment of spine stability after decompression. This diagnosis should be considered in patients presenting with unilateral lower extremity upper motor neuron findings.
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Affiliation(s)
- Mark J Lambrechts
- 1Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri 2Department of Orthopaedic Spine Surgery, University of Colorado at Colorado Springs, Colorado Springs, Colorado
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Kida K, Tani T. A Crescent-Shaped Juxtafacet Cyst as a Rare Cause of High Thoracic Myelopathy with Partial Brown-Séquard's Syndrome. Spine Surg Relat Res 2020; 4:184-186. [PMID: 32405567 PMCID: PMC7217681 DOI: 10.22603/ssrr.2019-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Kazunobu Kida
- Department of Orthopaedic surgery, Kubokawa Hospital, Kochi, Japan
| | - Toshikazu Tani
- Department of Orthopaedic surgery, Kubokawa Hospital, Kochi, Japan
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Tompkins A, Chandran A, Lind C, Simonin A. Sudden Onset of Paraparesis Caused by a Hemorrhagic Thoracic Synovial Cyst. World Neurosurg 2019; 132:326-328. [PMID: 31449995 DOI: 10.1016/j.wneu.2019.08.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhage is a rare presentation of spinal synovial cysts, which are usually located in the lumbar spine. They may cause an epidural hematoma and compression of the cauda equina. Infrequently, they may be located in the thoracic spine. CASE DESCRIPTION We present a case of sudden onset paraparesis caused by hemorrhage in a synovial cyst at a midthoracic level. Clinical, radiologic, and histologic findings are described. CONCLUSIONS This report describes a unique case of hemorrhagic synovial cyst at the mid-thoracic spine. These lesions are rarely located in the cervico-thoracic spine but should be included in the differential diagnosis of myelopathy.
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Affiliation(s)
- Andrew Tompkins
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Australia
| | - Arjun Chandran
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Australia
| | - Christopher Lind
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - Alexandre Simonin
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Australia.
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A rare clinical case of surgical treatment of a periarticular cyst of the facet joint of the lumbar spine. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10297-103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Periarticular cysts of the facet joint, due to their rare occurrence, often slip away from the attention of clinicians. However their formation and progression may cause compression of vascular-neural structures with subsequent manifestations of severe neurological disorders.
Description of the clinical case. We present a rare clinical case of surgical treatment of a periarticular cyst of the facet joint. A comprehensive examination of the patient S. revealed: Dorsopathy with degenerative spinal canal stenosis at LV-SI level; spondyloarthrosis; periarticular facet cyst at LV-SI level on the left; radiculopathy LV on the left, in the acute stage; pronounced pain and musculo-tonic syndrome. Complaints of the patient: constant pain in the lumbar spine, extending to the left lower extremity and aggravating when walking at a distance of 50-100 meters; feeling numb when walking on the plantar surface of the left foot. When examining the local status, a forced posture with a bowed head and torso forward was noted; smooth lumbar lordosis and antalgic right-sided scoliosis; tension of paravertebral muscles. Neurological examination revealed LVradiculopathy on the left with moderate paresis of the extensor muscles of the left foot and ipsilateral Lasègue's positive test. MRI examination revealed spinal canal stenosis, facet joint cyst at the level of LV-SI with dimensions of 14×8×8.5 mm. An operative intervention was performed: reconstructive decompressive-stabilizing spinal surgery with a single block removing the articular facet with a periarticular cyst at the left LV-SI level with subsequent posterior transpedicular fixation of the vertebral motor segment. Two months after the operation, complete medical and social rehabilitation of the patient was achieved. No complaints.
Conclusion. In case of compression of a periarticular cyst of vascular-neural structures with severe neurological disorders, surgical treatment with the cyst removal is recommended.
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Giovannini SJM, Pinto H, Marino P, Cervio A. Bilateral synovial cyst of the thoracic spine causing paraparesis. Neurochirurgie 2019; 65:89-92. [PMID: 30922840 DOI: 10.1016/j.neuchi.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/24/2019] [Accepted: 03/09/2019] [Indexed: 11/19/2022]
Abstract
Spinal synovial cysts are degenerative extradural lesions mostly found in the lumbar region, and more rarely at cervical or thoracic levels and in a bilateral presentation. We report a patient with a history of progressive paraparesis associated with bilateral cervicothoracic synovial cysts, causing spinal canal narrowing and cord compression, ultimately resulting in myelopathy. A review of the literature summarizes previous reports on this topic. Surgical excision of the extradural mass, decompression of the spinal canal and instrumented fusion were performed, improving lower limb deficit and gait. Post-surgical MRI showed evidence of complete cyst resection, and good arthrodesis consolidation with adequate sagittal balance. Surgical excision is indicated in case of medical treatment failure or increasing symptom severity. Given the strong pathophysiological link between synovial cysts and spinal instability, concomitant instrumented fusion may help improve outcome.
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Affiliation(s)
- S J M Giovannini
- Department of Neurosurgery, FLENI, Montañeses 2325, CP1428 Buenos Aires, Argentina.
| | - H Pinto
- Department of Neurosurgery, FLENI, Montañeses 2325, CP1428 Buenos Aires, Argentina
| | - P Marino
- Department of Neurosurgery, FLENI, Montañeses 2325, CP1428 Buenos Aires, Argentina
| | - A Cervio
- Department of Neurosurgery, FLENI, Montañeses 2325, CP1428 Buenos Aires, Argentina
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Campbell R, Phan K, Mobbs R. Classification of Lumbar Facet Joint Cysts Using the NeuroSpine Surgery Research Group (NSURG) Grading Score and Correlation with Recurrence and Clinical Outcomes. World Neurosurg 2018; 119:e502-e512. [DOI: 10.1016/j.wneu.2018.07.190] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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PERIARTICULAR CYSTS OF FACET JOINTS: ETIOPATHOGENESIS, DIAGNOSIS, METHODS OF SURGICAL TREATMENT. A CLINICAL EXAMPLE. ACTA BIOMEDICA SCIENTIFICA 2018. [DOI: 10.29413/abs.2018-3.4.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Periarticular cysts (PC) of facet joints is a rare pathology in neurosurgical practice. The concept of PC is applicable for all cysts that are located either pararticularly in the region of facet joints, or start from them.Material and methods. A systematic search was performed in medical databases: Medline, RINC, EMedicine, UMKB, Pubmed on the relevant topic in Russian and English. The search query includes words: arcuate joint, periarticular cyst, clinic, diagnosis, surgical treatment. One of the significant factors of PC development is the instability of the vertebralmotor segment of both degenerative and post-traumatic character.Results. The result of the literature review was the writing of a clinical lecture, the current state of the issue of etiopathogenesis, diagnosis and management of patients with periarticular cysts of facet joints was studied. The article gives a clinical example of surgical treatment of a patient with a periarticular cyst at the level of LIV-LV on the right.Conclusion. Periarticular cysts of facet joints are one of the factors of compression of cauda equina roots, with surgical treatment being a radical and effective way of treatment. A detailed study of this pathology is a promising direction in spinal neurosurgery. Further research is required on comparative analysis of clinical and instrumental efficacy of various methods of surgical treatment of periarticular cysts of facet joints.
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Thoracic Synovial Cyst at the Th2-3 Level Causing Myelopathy. Case Rep Neurol Med 2017; 2017:6257294. [PMID: 29082053 PMCID: PMC5610893 DOI: 10.1155/2017/6257294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/06/2017] [Indexed: 11/17/2022] Open
Abstract
Intraspinal synovial cyst is a rare cause of myelopathy. These cysts present most often in the lumbar and cervical parts of the spine but are more infrequent in the thoracic spine. We present a case of a 73-year-old man with an intraspinal, extradural synovial cyst at the Th2-3 level causing paraesthesia and weakness in the legs. A laminectomy and excision of the cyst were performed and the patient recovered fully. In the thoracic spine, synovial cysts are almost exclusively found in the lower part. Laminectomy, with excision, is the treatment of choice, although steroid injections have been described.
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Janjua MB, Smith ML, Shenoy K, Kim YH, Razi AE. Thoracic juxtafacet cyst (JFC): a cause of spinal myelopathy. JOURNAL OF SPINE SURGERY 2017; 3:294-299. [PMID: 28744516 DOI: 10.21037/jss.2017.06.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Spinal cord compression due to synovial facet cyst in thoracolumbar spine is rare. Several etiologies of juxtafacet cysts (JFCs) in this location have been discussed, particularly overload of the arthritic facet joints. Due to the narrow caliber of the thoracic spine, JFC in this location can present with radicular pain or progressive myelopathy. We report an interesting case of a 67 year-old woman who presented with the signs and symptoms of thoracic myelopathy. A left-sided T11/12 JFC was identified on MRI and CT scans correlating with her myelopathy. She experienced a substantial improvement in her myelopathic symptoms after surgical excision of the JFC. The presentation, etiology, and therapeutic aspects of JFC are discussed in detail.
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Affiliation(s)
- M Burhan Janjua
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
| | - Michael L Smith
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
| | - Kartik Shenoy
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
| | - Yong H Kim
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
| | - Afshin E Razi
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
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Saiwai H, Okada S, Miyazaki K, Nakano R, Iwamoto Y, Tsuchiya K. Clinical features and surgical management of rare cases of thoracic intraspinal cysts: Report of 3 cases. J Orthop Sci 2017; 22:578-582. [PMID: 26740453 DOI: 10.1016/j.jos.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/16/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Hirokazu Saiwai
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Japan.
| | - Seiji Okada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kosei Miyazaki
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Japan
| | - Ryuji Nakano
- Department of Pathology, Japan Community Health Care Organization, Kyushu Hospital, Japan
| | - Yukihide Iwamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kuniyoshi Tsuchiya
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Japan
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Intradural synovial cyst of the atlantoaxial joint: a case report. Acta Neurochir (Wien) 2016; 158:1583-6. [PMID: 27230912 DOI: 10.1007/s00701-016-2829-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/28/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Intradural synovial cysts of the cervical spine represent a rare disease entity, causing stenosis of the spinal canal and thereby leading to progressive myelopathy. In particular, at the cranio-cervical junction early intervention is necessary to prevent permanent neurological dysfunction. We present the case of a 74-year-old man who presented with moderate cervicogenic headache, gait disturbance and progressive left-sided weakness. Magnetic resonance imaging (MRI) of the cervical spine confirmed a left-sided cystic mass located anteriorly at the craniovertebral junction compressing the surrounding structures. METHOD Surgical decompression was performed by means of a minimal left-sided laminectomy of C1. Postoperatively, the patients symptoms slowly improved, albeit a persistent ataxic gait. RESULTS Intraoperatively, a large intradural cyst was removed via a minimal suboccipital craniectomy combined with laminectomy of C1. Histopathological evaluation revealed a synovial cyst without any features of neoplasia. Despite not using craniocervical instrumentation, no clinical or radiological signs of atlantoaxial instability were observed up to 2 years after surgery. CONCLUSIONS Cystic lesions located at the atlanto-axial joint are a rare cause of cervical myelopathy. Preoperative imaging of the cervical spine should include not only MRI and computerised tomography (CT) but also dynamic imaging. Dorsal decompression without instrumentation prevents progressive neurological decline and may allow cord function to recover. If there is additional preoperative instability, instrumentation and fusion may be necessary.
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Tai PA, Li TC. Lumbar Intradural Ganglion Cyst. World Neurosurg 2016; 88:691.e1-691.e4. [DOI: 10.1016/j.wneu.2015.11.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 12/01/2022]
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Abstract
STUDY DESIGN This was a retrospective study. PURPOSE To study the surgical outcome of synovial cysts of the lumbar spine through posterior laminectomy in combination with transpedicular screw fixation. OVERVIEW OF LITERATURE Synovial cysts of the lumbar spine contribute significantly to narrowing of the spinal canal and lateral thecal sac and nerve root compression. Cysts form as a result of arthrotic disruption of the facet joint, leading to degenerative spondylolisthesis in up to 40% of patients. METHODS Retrospective data from 6 patients, treated during the period of March 2007 to February 2011, were analyzed. All preoperative and postoperative manifestations, extension/flexion radiographs, magnetic resonance imaging, and computed tomography records were reviewed. All underwent surgery for synovial cysts with excision and decompression combined with posterior fixation. The result of surgery was evaluated with Macnab's classification. An excellent or good outcome was considered as satisfactory. Japanese Orthopedic Association Scale was used for evaluation of back pain. RESULTS All patients included in this study had excellent outcomes as regarding to improvement of all preoperative manifestations and returning to normal daily activities. Only 2 cases developed postoperative transient cerebro-spinal fluid leak and were treated conservatively and improved during the follow up period. CONCLUSIONS Although this study included a small number of cases and we could not have statistically significant results, the good outcome of decompression of synovial cysts combined with posterior fixation and fusion encouraged us to recommend this approach for patients with juxtafacet synovial cysts.
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Sukkarieh HG, Hitchon PW, Awe O, Noeller J. Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases. J Neurosurg Spine 2015; 23:444-50. [DOI: 10.3171/2015.1.spine14996] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach.
METHODS
All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times.
RESULTS
There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m2. Sixty-nine percent (9 of 13) of the cysts were at L4–5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series.
CONCLUSIONS
The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.
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Dahuja A, Dahuja G, Kaur R. Rare Thoracolumbar Facet Synovial Cyst Presenting as Paraparesis. KOREAN JOURNAL OF SPINE 2015; 12:193-5. [PMID: 26512282 PMCID: PMC4623182 DOI: 10.14245/kjs.2015.12.3.193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/08/2015] [Accepted: 08/08/2015] [Indexed: 11/19/2022]
Abstract
Spinal cord compressing syndrome due to synovial cyst (SC) of the thoracolumbar spine is a rare clinical condition. In this report we aim to heighten awareness of the thoracolumbar facet synovial cyst as a possible cause of thoracic myelopathy. The SC was removed thoroughly by laminectomy. The patient had an excellent recovery. The etiological and therapeutic aspects are discussed.
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Affiliation(s)
- Anshul Dahuja
- Department of Orthopedics, GGS Medical College Faridkot, Faridkot, India
| | - Gitanshu Dahuja
- Department of Orthopedics, GGS Medical College Faridkot, Faridkot, India
| | - Rashmeet Kaur
- Department of Radiodiagnosis, GGS Medical College Faridkot, Faridkot, India
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Bydon M, Lin JA, de la Garza-Ramos R, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A. The role of spinal fusion in the treatment of cervical synovial cysts: a series of 17 cases and meta-analysis. J Neurosurg Spine 2014; 21:919-28. [DOI: 10.3171/2014.8.spine13897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Object
This study was undertaken to compare surgical outcomes between patients with atlantoaxial versus subaxial cervical synovial cysts (CSCs) and to compare outcomes between patients who underwent decompression alone versus decompression and fusion for the treatment of CSCs.
Methods
The authors present a series of 17 cases involving patients treated at their institution and report the surgical outcomes. Due to the rarity of CSCs, a meta-analysis was conducted, and results of the literature search were combined with the case series to enhance the power of the study.
Results
Seventeen patients underwent surgical treatment for CSCs at our institution: 3 patients (17.6%) had atlantoaxial cysts and 14 (82.3%) had subaxial cysts. Of the 17 patients, 16 underwent a decompression and fusion; most patients experienced symptom resolution at last follow-up, and there were no cyst recurrences. A total of 54 articles (including the current series) and 101 patients were included in the meta-analysis. The mean age at presentation was 64 ± 13.9 years, and the most common symptoms were motor and sensory deficits. Forty-one patients (40.6%) presented with atlantoaxial cysts, and 60 (59.4%) with subaxial cysts. There were no significant differences between groups in terms of presenting symptoms, Nurick scores, surgical treatment, or surgical outcomes. Fifty-two patients (51.4%) underwent surgical decompression without fusion, while 49 patients (48.6%) underwent fusion. The preoperative Nurick scores were significantly lower in the fused group (p = 0.001), with an average score of 1.32 compared with 2.75 in the nonfused group. After a mean follow-up of 16.5 months, a difference of means analysis between final and preoperative Nurick scores revealed that patients who received a decompression alone improved on average 1.66 points (95% CI 1.03–2.29) compared with 0.8 points (95% CI 0.23–1.39) in the fused group (p = 0.004). However, there was no statistically significant difference in symptom resolution between the groups, and the rate of cyst recurrence was found to be 0%.
Conclusions
In this study, patients with CSCs had similar outcomes regardless of cyst location and regardless of whether they underwent decompression only or fusion. In the authors' institutional experience, 16 of 17 patients underwent fusion due to underlying spinal instability. While there were no reports of cyst recurrence in their series or in the literature in patients who only received decompression, this is likely due to the limited follow-up time available for the study population. Longer follow-up and prospective and biomechanical studies are needed to corroborate these findings.
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Affiliation(s)
- Mohamad Bydon
- 1Spinal Column Biomechanics and Surgical Outcomes Laboratory and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Joseph A. Lin
- 1Spinal Column Biomechanics and Surgical Outcomes Laboratory and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Rafael de la Garza-Ramos
- 1Spinal Column Biomechanics and Surgical Outcomes Laboratory and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel M. Sciubba
- 1Spinal Column Biomechanics and Surgical Outcomes Laboratory and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jean Paul Wolinsky
- 1Spinal Column Biomechanics and Surgical Outcomes Laboratory and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Timothy F. Witham
- 1Spinal Column Biomechanics and Surgical Outcomes Laboratory and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ziya L. Gokaslan
- 1Spinal Column Biomechanics and Surgical Outcomes Laboratory and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ali Bydon
- 1Spinal Column Biomechanics and Surgical Outcomes Laboratory and
- 2Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Zhenbo Z, Huanting L, Jin W, Haifeng G, Yuan F, Ming L. Hemilaminoplasty for the treatment of lumbar intraspinal synovial cysts (LISCs) and literature review. 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 2014; 25:3393-3402. [DOI: 10.1007/s00586-014-3570-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 01/17/2023]
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Longhofer LK, Moskowitz A. Thoracic Extradural Intraspinal Synovial Cyst Causing Progressive Myelopathy: A Case Report. JBJS Case Connect 2014; 4:e24. [PMID: 29252583 DOI: 10.2106/jbjs.cc.m.00157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lisa K Longhofer
- Department of Orthopaedic Surgery, University of Kansas School of Medicine-Wichita, 929 North St. Francis, Wichita, KS 67214.
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Bisson EF, Sauri-Barraza JC, Niazi T, Schmidt MH. Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature. Neurosurg Focus 2013; 35:E3. [DOI: 10.3171/2013.3.focus1385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Synovial cysts are uncommon pathological entities in patients with cervical degenerative spinal disease, and there are only a few reports in the literature. Treatment typically involves decompression; however, biomechanical data indicate that laminectomies in the cervical spine also result in cervical instability, specifically within the cervicothoracic junction, supporting the use of fusion as well. The authors describe the use of fusion with decompression in the treatment of 3 patients with cervicothoracic synovial cysts that presented in an acute fashion with associated myelopathy and neurological decline, and they review the diagnostic elements, histopathology, and treatment of these cysts. All 3 of the patients did well with decompression via a posterior approach with a single-level instrumented fusion from C-7 to T-1. Each patient regained complete neurological function and had no residual neurological deficits. These results are promising, although the sample size of 3 cases is too small to make any conclusive evaluations. Future studies incorporating Class I and Class II data are imperative to make firm conclusions regarding general management of this rare entity.
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Kazanci B, Tehli O, Türkoglu E, Guclu B. Bilateral thoracic ganglion cyst : a rare case report. J Korean Neurosurg Soc 2013; 53:309-11. [PMID: 23908708 PMCID: PMC3730036 DOI: 10.3340/jkns.2013.53.5.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 02/12/2013] [Accepted: 04/08/2013] [Indexed: 11/27/2022] Open
Abstract
Ganglion cysts usually arise from the tissues around the facet joints. It is usually associated with degenerative cahanges in facet joints. Bilateral thoracic ganglion cysts are very rare and there is no previous case that located in bilateral intervertebral foramen compressing the L1 nerve root associated with severe radiculopathy. We report a 53 years old woman who presented with bilateral groin pain and severe numbness. Magnetic resonance imaging revealed bilateral cystic mass in the intervertebral foramen between 12th thoracal and 1st lumbar vertebrae. The cystic lesions were removed after bilateral exposure of Th12-L1 foramens. The result of hystopathology confirmed the diagnosis as ganglion cyst. The ganglion cyst may compromise lumbar dorsal ganglion when it located in the intervertebral foramen. The surgeon should keep this rare entity in their mind for differential diagnosis.
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Affiliation(s)
- Burak Kazanci
- Neurosurgery Clinic, Ministry of Health, Sevket Yilmaz Education and Research Hospital, Bursa, Turkey
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Walcott BP, Coumans JV. Postlaminectomy synovial cyst formation: A possible consequence of ligamentum flavum excision. J Clin Neurosci 2012; 19:252-4. [DOI: 10.1016/j.jocn.2011.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 01/15/2023]
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Daentzer D, Stüder D. Thoracic juxtafacet cyst (JFC) as a rare cause of myelopathy – An additional reference to support the instability theory. Joint Bone Spine 2010; 77:178-80. [DOI: 10.1016/j.jbspin.2009.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Accepted: 06/25/2009] [Indexed: 10/19/2022]
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Abstract
BACKGROUND Spinal extradural cysts are a rare cause of spinal cord or nerve root compression which tends to occur in the elderly but rarely reported in the under 20s. HISTORY A 14-year-old girl with a 9-month history of left radicular pain was found to have an intraspinal cystic lesion causing radicular compression. MRI showed a 1.1-cm extradural cystic lesion with a low signal on T1 and high signal on T2-weighted images lying in the spinal canal at the L4 vertebral body level. The patient underwent an L4 hemi-laminectomy and excision of a synovial cyst, and the radicular pain completely regressed. DISCUSSION We discuss the pathogenesis, radiological techniques, and management of synovial cyst in a pediatric patient. CONCLUSION Intraspinal ganglion cysts are extremely rare in children and only two other cases have been reported previously. They are benign lesions, frequently presenting radiculopathy, and should be considered in the differential diagnosis, in patients with low back pain and radiculopathy.
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Mizutamari M, Sei A, Fujimoto T, Taniwaki T, Mizuta H. L5 radiculopathy caused by a ganglion cyst of the posterior longitudinal ligament in a teenager. Spine J 2009; 9:e11-4. [PMID: 18640878 DOI: 10.1016/j.spinee.2008.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 03/18/2008] [Accepted: 05/19/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There is no previous report on the intraspinal ganglion cyst of the posterior longitudinal ligament in a teenager. PURPOSE To report a case of radiculopathy caused by a ganglion cyst of the posterior longitudinal ligament in a teenager. STUDY DESIGN Case report. METHODS A 17-year-old male with a 4-month history of left L5 radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging showed a cystic lesion located in the ventral side of the dura. The patient suffered from severe leg pain. As a result, a surgical operation was therefore performed. RESULTS The cyst containing jelly-like components and a hemorrhage was punctured and then extirpated. It originated from the posterior longitudinal ligament. A histological study revealed the cyst to be without any synovial layers. CONCLUSIONS This is the first report to describe a ganglion cyst originating from the posterior longitudinal ligament in a teenager. This possible etiology should be kept in mind for any other individuals displaying symptoms of spinal nerve root compression as well as disc herniation.
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Affiliation(s)
- Masaya Mizutamari
- Department of Orthopaedic and Neuro-Musculoskeletal Surgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.
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Gelabert-González M, Prieto-González A, Santin-Amo JM, Serramito-García R, García-Allut A. Lumbar synovial cyst in a adolescence: case report. Childs Nerv Syst 2009; 25:403-6. [PMID: 19082614 DOI: 10.1007/s00381-008-0766-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND Spinal extradural cysts are a rare cause of spinal cord or nerve root compression which tends to occur in the elderly but rarely reported in the under 20s. HISTORY A 14-year-old girl with a 9-month history of left radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging showed a 1.1-cm extradural cystic lesion with a low signal on T1-weighted images and high signal on T2-weighted images lying in the spinal canal at the L4 vertebral body level. The patient underwent an L4 hemilaminectomy and excision of a synovial cyst, and the radicular pain completely regressed. DISCUSSION We discuss the pathogenesis, radiological techniques and management of synovial cyst in a paediatric patient CONCLUSION Intraspinal ganglion cysts are extremely rare in children and only two other cases have been reported previously. They are benign lesions, frequently presenting radiculopathy, and should be considered in the differential diagnosis in patients with low back pain and radiculopathy.
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Abstract
STUDY DESIGN Pre- and postoperative follow-up of a patient with progressive myelopathy caused by a thoracic synovial cyst developing within 6 months. OBJECTIVE To present the natural history of a developing thoracic synovial cyst and to highlight this unusual case. SUMMARY OF BACKGROUND DATA Thoracic synovial cysts are a rare finding and can produce myelopathy from spinal cord compression. The patient presented with progressing spasticity and sensory loss of both legs. Hereditary motor-sensory neuropathy was suspected and excluded by a molecular genetic examination. The cause of deterioration was finally found in an MRI of the thoracic spine revealing the rapid growth of a synovial cyst that had been detected in a previously performed MRI 6 months earlier. METHODS Clinical and MRI details are presented documenting the natural history and development of a thoracic synovial cyst causing myelopathy. RESULTS The thoracic synovial cyst was successfully decompressed. Stabilization and fusion were not performed. The myelopathy resolved after surgery and the patient stays well in the 6-months follow-up. CONCLUSION Although thoracic synovial cysts are a rare finding, they have to be considered as a source for progressive myelopathy. If an MRI of the spine does not reveal any pathologies, it should be repeated even after a short period of time if the patient's condition deteriorates, continuously to detect newly developed findings.
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Pratesi A, Ginestroni A, Padovani R, Mascalchi M. An unusual cause of cord compression: synovial cyst of the thoracic spine. BMJ Case Rep 2009; 2009:bcr2007127134. [PMID: 21687302 DOI: 10.1136/bcr.2007.127134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- A Pratesi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Almefty R, Arnautović KI, Webber BL. Multilevel bilateral calcified thoracic spinal synovial cysts. J Neurosurg Spine 2008; 8:473-7. [PMID: 18447695 DOI: 10.3171/spi/2008/8/5/473] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Synovial cysts of the thoracic spine are quite rare. Bilateral presentation is even less frequent, and to the authors' knowledge multilevel occurrence and consistent calcification have not been reported so far. The pathogenesis of these cysts is unknown and their histological features have not been studied. They may be overlooked as the cause of myelopathy. The authors report a series of 4 cases of bilateral, multilevel, consistently calcified thoracic synovial cysts. The details of clinical, radiological, and histological findings are presented, along with a review of the literature, and a hypothesis on the pathogenesis of these lesions is formulated based on results of the clinical and pathological studies performed in these patients.
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Affiliation(s)
- Rami Almefty
- Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee Health Science Center, Tennessee 38120, USA
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Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. 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 2008; 17:831-7. [PMID: 18389295 DOI: 10.1007/s00586-007-0563-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Revised: 10/07/2007] [Accepted: 11/25/2007] [Indexed: 12/12/2022]
Abstract
This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Although the relevant reports in the international literature are increasing, the controversy about conservative versus surgical treatment and the need for concomitant fusion still exists. Data from seven patients (age range 58-69 years, mean age 61 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concomitant local pathology, treatment and results of treatment were recorded. A follow-up of at least 6 months (range 6-48 months) was conducted and results were noted. All patients had back pain, while five also experienced unilateral radicular leg pain and one had bilateral leg pain. One patient had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. No fusion was performed. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. Review of the literature revealed a trend towards surgery, as this is correlated to a more favorable outcome compared with conservative treatment. Fusion should be performed on a case-by-case basis only. Surgery is a safe and effective treatment choice in this increasingly appearing ailment. A prospective, randomized trial should clarify issues under debate.
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Oliveira HA, Jesus ACFD, Prado RCP, Santos ACE, Sobral PMS, Oliveira AMP, Marcena SML, Silveira DRA. Synovial cyst of the thoracic spine: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:838-40. [DOI: 10.1590/s0004-282x2007000500021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 06/12/2007] [Indexed: 11/22/2022]
Abstract
Spinal cord compressing syndrome due to synovial cyst (SC) of the thoracic spine is a rare clinic condition. We report a case of SC located in the thoracic spine causing spastic paraparesis in a 14 year-old female patient. The SC was removed thoroughly by laminectomy. The patient had an excellent recovery. The etiological and therapeutic aspects are discussed.
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Vasani SS, Demetriades AK, Joshi SM, Yeh J, Ellamushi H. Traumatic intraspinal extradural ganglion cyst in a teenager: Case report and review of the literature. Clin Neurol Neurosurg 2007; 109:88-91. [PMID: 16647199 DOI: 10.1016/j.clineuro.2006.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 03/10/2006] [Accepted: 03/15/2006] [Indexed: 11/19/2022]
Abstract
Spinal extradural cyst is a rare cause of spinal cord or nerve root compression. We present a case which is unique due to both the young age of the patient and its distinctly acute haemorrhagic presentation. In what is normally considered a degenerative disease in older patients this has implications for the possibility of a traumatic aetiology in children. The literature on the classification of extradural cysts is reviewed.
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Affiliation(s)
- Sarju S Vasani
- Department of Neurosurgery, Royal London Hospital, Whitechapel, London, UK
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Deinsberger R, Kinn E, Ungersböck K. Microsurgical treatment of juxta facet cysts of the lumbar spine. ACTA ACUST UNITED AC 2006; 19:155-60. [PMID: 16770210 DOI: 10.1097/01.bsd.0000188660.31212.83] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Juxta facet cysts are a common cause of low back and radicular pain. They are mostly associated with degenerative facet joints and spondylolisthesis. The study focuses on long-term outcomes after microsurgical treatment without fusion. METHOD From April 2002 to April 2004, 31 patients (23 female and 8 male) underwent microsurgical resection of lumbar juxta facet cysts. The patient age ranged from 31 to 83 years (mean 67.2 years). The most affected level was L4-L5 (19 patients), followed by L3-L4 (9 patients). Fourteen patients additionally had spondylolisthesis of the involved segment. All patients had signs of nerve root compression and had received conservative treatment preoperatively. We performed limited bone removal (sparing the facet joints) and cyst resection in 27 patients. In four patients, cyst resection and standard laminectomy were performed owing to spinal stenosis. RESULTS Conservative treatment was without any effect in all patients. At follow-up, 12-30 months after surgery, excellent to good outcome was achieved in 25 of 31 patients (80.7%), and 6 patients (19.3%) showed fair results. Persistent low back pain was more common in patients with spondylolisthesis than in the other group (6/14 vs 3/17); this may be due to instability. Spondylolisthesis did not progress or become mobile after surgery radiographically in any of our patients. CONCLUSIONS Conservative therapy does not adequately improve symptoms in patients with intraspinal juxta facet cysts and radicular signs. Juxta facet cysts can be treated effectively with a minimally invasive microsurgical approach. This may be of particular significance when the cysts are associated with spondylolisthesis, minimizing the risk of instability and the need for fusion. In a selected group of patients with persistent low back pain, fusion may become necessary to improve symptoms.
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Affiliation(s)
- Robert Deinsberger
- Department of Neurosurgery, Landesklinikum St. Pölten, Propst Führerstrasse 4, A-3100 St. Pölten, Austria.
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Abstract
GOAL The aim of this article is to describe rare and often unrecognized causes of spinal pain syndromes. METHOD Intervertebral disc degeneration frequently appears in early adulthood and can have a symptomatic or asymptomatic course. This article discusses incidence, pathophysiology, imaging, and pain symptomatology involved in the origin of back pain. RESULTS Anulus tears are often found in asymptomatic individuals but could be implicated in lumbar pain symptomatology in correlation with the provocative discography. Transient disorders can lead to pseudarthrosis of the iliac bone and to degeneration or to a reactive hypermobility with intervertebral disc degeneration in the level above. Modic type 1 erosive osteochondrosis is characterized by bone marrow edema near the hyaline cartilage end plate, which mostly elicits severe pain and results in serious limitations in everyday activities. The most important differential diagnosis is spondylodiscitis. Schmorl's nodes can exhibit considerable surrounding bone marrow edema that can be mistaken for metastases. A combination of MRI and CT should be employed for the diagnostic work-up of fatigue fracture of the interarticular portion, which is often overlooked due to its location. Synovial cysts of the facet joints can lead to radicular symptoms. Insufficiency fracture of the sacrum is frequently mistaken for metastasis due to intense scintigraphic enhancement and its signal behavior in MRI. CT provides instructive information. CONCLUSION Differential diagnosis should include less common causes such as anulus tears, transient disorders, activated Schmorl's nodes, synovial cysts of the facet joints, fatigue fractures of the interarticular portion of the spine and the sacrum and distinguish from metastases in particular.
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Affiliation(s)
- A Baur-Melnyk
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München.
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