Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature

Abstract

<jats:p>Synovial cysts are uncommon pathological entities in patients with cervical degenerative spinal disease, and there are only a few reports in the literature. Treatment typically involves decompression; however, biomechanical data indicate that laminectomies in the cervical spine also result in cervical instability, specifically within the cervicothoracic junction, supporting the use of fusion as well. The authors describe the use of fusion with decompression in the treatment of 3 patients with cervicothoracic synovial cysts that presented in an acute fashion with associated myelopathy and neurological decline, and they review the diagnostic elements, histopathology, and treatment of these cysts. All 3 of the patients did well with decompression via a posterior approach with a single-level instrumented fusion from C-7 to T-1. Each patient regained complete neurological function and had no residual neurological deficits. These results are promising, although the sample size of 3 cases is too small to make any conclusive evaluations. Future studies incorporating Class I and Class II data are imperative to make firm conclusions regarding general management of this rare entity.</jats:p>

Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts

“…45,97 As shown in the present series, excision of the cyst and decompression of neural structures is effective; can be performed with low risk; and leads to immediate, dramatic pain relief and improvement of the symptoms in the majority of cases. 12,24,28,34,53,75,81,87,101 Various techniques for cyst resection have been described. In the present series, partial or complete hemilaminectomy followed by interlaminary fenestration were the most frequent approaches, in accordance with the literature.…”

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

“…The differentiation of these lesions relies on histopathological examination, 4 with synovial cysts ("true cysts") presenting a synovial lining, direct attachment to the joint, and clear or xanthochromic fluid. 30 Ganglion cysts, in contrast, have been called "pseudo-cysts" and are not directly connected to the joint; they have a fibrous connective tissue capsule instead of synovial tissue, and a gelatinous fluid.…”

“…3). 4 However, there is no consensus on the optimal technique. Although the most common procedure is decompression and excision, instrumented fusion is often added for cases with underlying instability or potential iatrogenic instability or to eliminate the risk of recurrence.…”

“…[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...…”

A Rare Case of C8 Radiculopathy Due to Cervical Spine Synovial Cyst

“…Cervical spine synovial cysts are rare. 1 Because they can be asymptomatic, the exact incidence is unknown. For example, they have been shown to become symptomatic with neurologic deficit only after an acute flexion-extension injury.…”