Subaxial cervical juxtafacet cysts: single institution surgical experience and literature review

Uschold, Timothy D.; Panchmatia, Jaykar R.; Fusco, David J.; Abla, Adib A.; Porter, Randall W.; Theodore, Nicholas

doi:10.1007/s00701-012-1549-0

Cited by 15 publications

(8 citation statements)

References 38 publications

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“…Osteoarthritic degeneration associated with joint mobility is believed to cause articular capsule rupture, synovial membrane protrusion, synovial fluid filling, and spinal cord extradural compression [8]. In human medicine, synovial cysts affecting the spine are rare, usually located in the lower back [12].…”

Section: Discussionmentioning

confidence: 99%

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Ferrarin

Neto

Schwab

et al. 2021

Acta Scientiae. Vet.

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Background: Extradural synovial cysts (ESC) originate from an extrusion of the synovium in unstable or degenerated joints. In the spine, this condition can cause neurological signs such as hyperesthesia, proprioceptive ataxia and paresis. Since extradural presentations of synovial cysts are unusual in dogs, the aim of this manuscript is to report a case of extradural synovial cyst of the cervical spine, as well as the clinical findings, diagnosis, surgical treatment and clinical evolution after therapy.Case: A 3-year-old spayed Saint Bernard weighing 60 kg was presented to a Veterinary Medical Teaching Hospital with a history of acute paraparesis that evolved to non-ambulatory tetraparesis five days after the appearance of the first clinical signs. Neurological examination revealed non-ambulatory tetraparesis, normal muscle tone and segmental spinal reflexes in the thoracic and pelvic limbs, as well as cervical pain associated with limited neck movement. According to the neurological examination, the likely lesion location was the C1-C5 spinal cord segment. The differential diagnosis list included intervertebral disc disease, caudal cervical spondylomyelopathy, neoplasm, infectious or noninfectious inflammatory disease, and cystic diseases. Complete blood (cell) count and serum biochemistry tests were within reference limits. The cerebrospinal fluid analysis revealed 35 mg/dL of protein (< 30 mg/dL) and 27 cells (up to 5 cells/mm3) with a predominance of lymphocytes. In plain radiography, bone proliferations of the C4 (caudal) C5 (cranial) articular processes were observed and, in myelography, extradural spinal cord compression was evident between C4-C5 on the right side. The animal underwent dorsal laminectomy for spinal cord decompression. An extradural synovial cyst and proliferated articular processes were removed. At 1,281 days after surgery, the dog was clinically normal and presented no neurological deficits.Discussion: The etiology of synovial cysts has not been well established. However, it is believed that osteoarthritic degeneration associated with joint mobility could cause a rupture in the articular capsule, leading to a synovial membrane protrusion, which would fill with synovial fluid and compress spinal structures. ESC in the cervical region have been reported, often associated with cervical neoplasm. The case we report had no evidence of bone or intervertebral disc compression in myelographic and radiographic exams, abnormalities that would appear in cervical neoplasm. The patient underwent dorsal laminectomy to confirm the presumptive diagnosis and decompress the spine. In the histopathological exam, the cystic material consisted of connective fibrous tissue with a synovial cell lining layer, compatible with synovial cysts. The fluid drained during surgery was also analyzed, showing similarities to synovial fluid drained from other conventional joints. Cerebrospinal fluid analysis revealed mononuclear pleocytosis, a common finding in ESC. The ESC should be included in the differential diagnosis of dogs with cervical myelopathy, especially in young animals and large breeds. A myelographic exam is an important but not definitive auxiliary tool for diagnosis and the therapeutic plan. Dorsal laminectomy is an effective technique for treating ESC.

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Section: Discussionmentioning

confidence: 99%

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Ferrarin

Neto

Schwab

et al. 2021

Acta Scientiae. Vet.

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“…[ 6 , 8 ] Posterior decompression surgery through laminectomy typically addresses the resultant cervical spinal stenosis, in some instances, also warranting fusion. [ 7 , 10 , 12 ] Laminoplasty is another alternative surgical approach. Due to occasional dense dural adhesions, some resections require leaving a small segment of the adherent capsule behind to avoid a cerebrospinal fluid leak (CSF).…”

Section: Discussionmentioning

confidence: 99%

Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review

Ruggeri¹,

Brunasso

Urrico³

et al. 2021

Surgical Neurology International

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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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“…They are mainly located at the atlantoaxial (27.88%) and cervicothoracic (36.97%) junctions. [ 1 2 3 4 5 6 7 8 9 11 12 14 15 16 ] JFCs’ etiology remains controversial, and their development is generally connected to facet joint degeneration, while other reports suggest congenital, inflammatory, or traumatic causes. Most are located at the L4-L5 level.…”

Section: Discussionmentioning

confidence: 99%

Recurrent atlantoaxial synovial cyst resection via a navigation-guided, endoscope-assisted posterior approach

et al. 2014

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Background:Atlantoaxial cysts are rare, and only 46 histologically confirmed cases have been reported.Case Description:A 75-year-old male presented 2 years ago with headache, neck pain, loss of balance, and episodic dysphagia, for which he had undergone posterior cervical drainage of a left-sided atlantoaxial cyst. Although his original symptoms resolved, they recurred 2 years later and were correlated with an enhanced MR that showed a recurrent left C1-C2 synovial cyst causing marked cervical cord compression. It was successfully resected through a navigation-guided, endoscope-assisted posterior approach. The patient's symptoms/signs resolved completely, and he has remained symptom-free for over 30 months postoperatively, with no evidence of recurrence on MR or craniocervical instability.Conclusions:A patient who successfully underwent resection of a recurrent synovial cervical cyst using a navigation-guided, endoscope-assisted posterior approach has been reported here.

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Subaxial cervical juxtafacet cysts: single institution surgical experience and literature review

Abstract: Our findings lead us to advocate for early decompression rather than prolonged conservative treatment, for pre- and postoperative dynamic imaging, and for fusion in selected cases as an initial surgical consideration.

Cited by 15 publications

References 38 publications

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review

Recurrent atlantoaxial synovial cyst resection via a navigation-guided, endoscope-assisted posterior approach

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