An Expanding Cervical Synovial Cyst Causing Acute Cervical Radiculopathy

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.

Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review

“…From the literature reviewed, out of 499 cases, 258 (52.5%) had back pain, 303 (61.7%) and 116 (23.6%) had painful radiculopathy and neurogenic claudication, respectively, 183 (37.2%) had motor deficits, 187 (38%) had sensory loss and 175 (35.2%) demonstrated reflex disturbances. Radicular pain with acute onset may be associated with intracystic hemorrage and can be a result of both acute cyst distention or compression of a nervous element [32,36]. Symptoms may simulate a herniated nucleus pulposus, lumbar stenosis or facet joint syndrome, all of which are more common [2,13,28].…”

Cervical Juxtafacet Cyst With Myelopathy Due to Postoperative Instability -Case Report-

“…MR imaging can detect the presence of hemorrhage within the cyst, which may exacerbate neurological symptoms. 8,13) In addition, synovial cysts may also contain air, and air-filled juxtafacet cysts are difficult to detect and distinguish from facet arthropathy using MR imaging. 8) Surgical excision is the conventional treatment for cervical juxtafacet cysts with neurological deficits.…”

“…The diagnostic tools and treatment of choice are generally agreed for cervical juxtafacet cyst causing neurological symptoms, but the etiology of cervical juxtafacet cysts remains unclear. 4,13,16,17) We treated a patient who presented with progression of a cervical juxtafacet cyst of the right C5-6 accompanied by myelopathy 20 months after undergoing anterior foraminotomy at the same level and anterior cervical discectomy fusion with a cage at the adjacent level.…”

Diagnosis and management of juxtafacet cysts

“…Their presence and potential role as a generator of symptoms must be considered. 1,2,4,5,[9][10][11][12][13][14][15][16][17][20][21][22]25 Synovial Cysts Synovial cysts are small cystic growths that occur adjacent to and attached to synovial tissue-lined joints, such as the spinal facet joints. These lesions are attached to their adjacent joints with a narrow connecting pedicle, which connects their cystic centers to the cavities of their parent joints.…”