Sudden Onset of Paraparesis Caused by a Hemorrhagic Thoracic Synovial Cyst

Upper Thoracic Spine Synovial Cyst Resulting in Paraplegia Following Transient Hypotension

“…Of the reports on thoracic synovial cysts, most are in the more mobile thoracolumbar junction [2][3][4][5][6][7][8]12]. Our case adds to the limited literature available on upper thoracic and cervicothoracic junction synovial cysts [9][10][11][12][13][14][15]. In one previously reported case, the cyst was also at T1-2, though the onset of symptoms in that case was subacute [15].…”

“…Importantly, this case also suggests that some patients may be at risk for sudden neurological decline despite the chronic nature of the underlying pathology. Symptoms related to spinal synovial cysts are typically gradual, though there are rare hyperacute presentations described in the literature, with one case of intracystic hemorrhage and one case of pain and weakness after direct blunt trauma [14,17]. Our patient had acute onset of lower extremity weakness and worsened myelopathy associated with hypotension, a result of inadvertently robust diuresis for preoperative cardiac optimization.…”

“…The synovial cyst in our case report originated from the left T1-2 facet joint and was medially projecting into the spinal canal rather than out the foramen. Upon review of the limited case reports available for these thoracic synovial cysts, many of them appear to be medially projecting into the canal as well [2,5,6,9,10,[13][14][15]17]. We hypothesize that the coronally oriented nature of the thoracic spine facets may predispose synovial cyst formation in that trajectory rather than the more sagittally oriented facets of the lumbar spine, which may predispose cyst formation towards the lateral recess and foramen.…”

“…In this report, we describe a patient with a large, compressive thoracic synovial cyst with sudden neurological deterioration associated with acute hypotension. Thoracic synovial cysts are rare, with a review of literature yielding only a few case reports [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Of the reports on thoracic synovial cysts, most are in the more mobile thoracolumbar junction [2][3][4][5][6][7][8]12].…”

“…Synovial cyst formation is common, particularly in mobile segments of the lumbar spine [1]. However, development of these cysts in the rigid thoracic spine is much more rare, with relatively few cases of this pathology reported [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Typically, synovial cysts arise at the facet joint and cause either lateral recess stenosis or exiting nerve root compression and subsequently cause subacute or chronic radiculopathy.…”