Synovial Cyst at the C1-C2 Junction in a Patient with Atlantoaxial Subluxation

Abstract

Synovial cysts of the cervical spine causing myelopathy are rare. The pathogenesis of these cysts is often attributed to degenerative changes of the facet joints or microtrauma. The authors report a synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation without a congenital anomaly or inflammatory conditions. A 72-year-old man presented with a progressive right-sided myelopathy attributed to a C1-C2 synovial cyst accompanied by atlantoaxial subluxation and C3-C6 spondylosis. Magnetic resonance imaging of the cervical spine showed a large cystic mass compressing the spinal cord located at the C1-C2 junction. A C1 hemilaminectomy, complete evacuation of the cyst contents, and posterior atlantoaxial fusion were performed, and a double-door laminoplasty was also done at C3-C6. The patient showed significant improvement of paresthesia and motor weakness of the right upper and lower extremities immediately after the operation. Synovial cysts should be considered in the differential diagnosis of an extradural mass of the upper cervical spine. Posterior fusion combined with direct excision of the cyst may be the optimum treatment of a synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation.

Retro-odontoid synovial cyst resected via an anterolateral approach without fusion

“…Retro-odontoid synovial cysts are rare; to date, there have been 13 histologically confirmed reports of these lesions [1][2][3][4][5][6][7][8][9][10][11][12][13] (Table 1). The mean age of the affected patients was 71.9 ± 8.9 years (range 51-85 years), and the population included 12 men and 13 women.…”

“…The natural course of a retroodontoid synovial cyst remains unknown, although clinical deterioration has been reported over periods of weeks to months [1][2][3][4][5][6][7][8][9][10][11][12][13]. Treatments for retro-odontoid synovial cysts include transoral resection with posterior fusion, posterior resection with or without posterior fusion, posterior fusion only, and aspiration; however, the ideal treatment method remains unknown [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Surgical Approach for Synovial Cyst of the Atlantoaxial Joint

“…To the authors knowledge only 24 cases [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] have been reported. Synovial cysts usually arise from the facet joint laterally or dorsolaterally in the lumbar spinal canal and are rarely symptomatic.…”

The role of spinal fusion in the treatment of cervical synovial cysts: a series of 17 cases and meta-analysis

“…[1][2][3][4]6,[8][9][10][11][12]15,17,[19][20][21][22][25][26][27][28][29][30][31]33,34,36,38,39,42,43,[45][46][47][48][49][50][51][52][53][54][56][57][58][60][61][62][63][64][66][67][68][69] We also included our own 17 cases from the present study in the analysis, bringing the total number of articles to 54 and the total number of patients to 101. Ther...…”