Bilateral Synovial Cysts as a Rare Cause of Myelopathy in a 38-year-old Woman

Abstract

Synovial cysts are rare, and they occur even more rarely bilaterally or in the cervical spine. A 38-year-old previously healthy female presented with acute onset of numbness and tingling down her arms and weakness in her legs, which progressed steadily over 2-3 weeks to include significant gait disturbance. She denied bowel or bladder symptoms, saddle anesthesia, night sweats, weight loss, fever, or chills. MRI spine revealed a C7-T1 extradural mass consistent with bilateral synovial cysts emanating from bilateral neuroforamina resulting in critical spinal cord compression with T2 signal change in the cord. There was questionable patch enhancement after gadolinium contrast. The patient underwent C7-T1 laminectomies and partial bilateral medial facetectomies with excision of the cysts. Intraoperative cultures unexpectedly grew Staphylococcus aureus, suggesting superinfection of cysts. The patient recovered neurologic function postoperatively and was discharged on a 6-week course of IV antibiotics. We report and discuss the clinical presentation, pathogenesis, and neuroradiological findings in an adult case of bilateral synovial cysts at the C-T-spine junction. Immediate resection at symptom onset is indicated due to the good clinical outcome following resection and the real risk of paralysis if cysts are not excised in a timely fashion.

Synovial cysts at the cervicothoracic junction: Illustrative series of three cases

“…[6] Bilateral cervical synovial cysts are even more rare, with only one other being reported in the literature. [7] However, cervical cysts at the C7-T1 level account for about a third of the cases of cervical spinal synovial cysts, making it the most common location. [3,[5][6][7]9] It is unknown why the C7-T1 level is particularly vulnerable to synovial cysts, despite degeneration and disc herniation being more common in higher levels of the cervical spine.…”

“…Synovial cysts are extradural soft-tissue masses that arise from extrusion of the synovium through a defect in the joint capsule. [5][6][7] ey most commonly occur from herniations out of the facet joints of the spine but can also arise from the ligamentun flavum or other spinal ligaments and discs. [3,9] Histologically, they are characterized by a pseudostratified columnar cell layer surrounding clear fluid.…”

“…ey may increase in size and become symptomatic as they grow and compress neural structures in the spinal canal. [3,[5][6][7]9] Surgical resection is the most common treatment and typically results in resolution of symptoms [Tables 1 and 2]. [3,[5][6][7]9] We present three cases of synovial cervical spinal cysts emerging from the C7-T1 facet joint treated with surgical resection, laminectomy, and fusion.…”

“…[3,[5][6][7]9] Surgical resection is the most common treatment and typically results in resolution of symptoms [Tables 1 and 2]. [3,[5][6][7]9] We present three cases of synovial cervical spinal cysts emerging from the C7-T1 facet joint treated with surgical resection, laminectomy, and fusion. Two are unilateral, while one was bilateral.…”

Acute development of spinal lumbar synovial facet cyst within 1 week after lumbar decompression: illustrative case

“…Cervical and thoracic spinal synovial facet cysts may even cause patients to present with cervical radiculomyelopathy 13 and isolated myelopathy. 14 Cysts in the lumbar spine cause symptomatic patients to present with radicular pain (most common) and neurological deficits, including neurogenic claudication in the setting of larger space-filling cysts. 5 , 6 A history of low back pain usually precedes radicular pain.…”