Thoracic juxtafacet cyst (JFC): a cause of spinal myelopathy

Abstract

Spinal cord compression due to synovial facet cyst in thoracolumbar spine is rare. Several etiologies of juxtafacet cysts (JFCs) in this location have been discussed, particularly overload of the arthritic facet joints.Due to the narrow caliber of the thoracic spine, JFC in this location can present with radicular pain or progressive myelopathy. We report an interesting case of a 67 year-old woman who presented with the signs and symptoms of thoracic myelopathy. A left-sided T11/12 JFC was identified on MRI and CT scans correlating with her myelopathy. She experienced a substantial improvement in her myelopathic symptoms after surgical excision of the JFC. The presentation, etiology, and therapeutic aspects of JFC are discussed in detail.

Lumbar Facet Cyst as a Rare Cause of L5 Radiculopathy: A Case Report

“…Spinal facetal cysts are usually asymptomatic and found incidentally on MRI; however, they may present with back pain, radicular pain, neurogenic claudication, and rarely with caude equina syndrome and myelopathy [3,4,12,13]. In our case, the patient presented with right-sided L5 radicular pain typical of lumbar disc disease.…”

“…The fluoroscopic or CT-guided direct lumbar facet synovial cyst aspiration technique is a usually safe and minimally invasive procedure. It has good short-term results in terms of pain relief; however, a review of studies utilizing these techniques reveals a high long-term failure rate, which is around 50-100% [9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The high-failure rate contributed to failure of complete decompression of these cysts, since they contain thick gelatinous nonabsorbable materials and also it leaves the cyst capsule behind which may still compress the neurological structures leading to lack of complete symptom relief [22].…”

Upper Thoracic Spine Synovial Cyst Resulting in Paraplegia Following Transient Hypotension

“…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].…”

“…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 - 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.…”

“…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.…”