scholarly journals Os Odontoideum: an unusual association of compressive synovial cyst. Case report and review of the literature

2015 ◽  
Vol 42 (S1) ◽  
pp. S50-S50
Author(s):  
AA Ahmed ◽  
T Watson ◽  
A Elgheriani ◽  
E Kachur ◽  
A Cenic
Keyword(s):  
Spinal Cord ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Complete Regression ◽  
Cyst Excision ◽  
Persistent Symptoms ◽  
Atlantoaxial Stabilization ◽  
Synovial Cysts

Background: Os odontoideum is a rare cervical abnormality that harbours a potential risk for atlantoaxial instability. In rare circumstances, synovial cysts may develop and compromise the spinal cord. Therefore, cyst excision has been suggested as part of the surgical management. However, in recent reports, it has been shown that atlantoaxial stabilization alone is sufficient for synovial cyst regression. Methodology: 48-year-old woman presented with symptoms and signs of cervical myelopathy secondary to os odontoideum with atlantoaxial instability. A large synovial cyst was diagnosed with significant spinal cord compression. In addition, her spinal and cranial imaging was suggestive of multiple sclerosis which was confirmed clinically thereafter with one episode of MS flare up and positive cerebrospinal fluid analysis. Results: After she had recovered from her MS flare up, posterior atlantoaxial instrumentation and fusion was performed without synovial cyst resection. Postoperatively, her clinical condition improved substantially and complete regression of the synovial cyst was noted on cervical MRI. Interestingly, she has not had any MS recurrent episodes after the surgery. Conclusion: Degenerative changes in os odontoideum are consequences of atlantoaxial instability. Compressive synovial cysts may develop with associated cord compression. We recommend posterior atlantoaxial stabilization alone in such conditions while preserving cyst fenestration or excision for persistent symptoms related to unresolved synovial cysts.

scholarly journals Synovial Cyst of the Atlantoaxial Joint Removed through a Posterior Intradural Approach

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Atsuhiko Toyoshima ◽  
Kiminori Sakurai ◽  
Nobuhiro Sasaki ◽  
Miyuki Fukuda ◽  
Shigeo Ueda ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Rapid Progression ◽  
Atlantoaxial Joint ◽  
Tumor Lesion ◽  
One Year ◽  
The Right

Introduction. Synovial cysts rarely develop in the atlantoaxial joint. We report a case of posterior C1-2 laminectomy for a synovial cyst of the atlantoaxial joint which passed through the dorsal dura and put pressure on the cervical spinal cord. Case Presentation. A 62-year-old man with rapid progression of pain and weakness in the left upper extremity presented to our hospital. A cervical spine X-ray showed left C5-6 and C6-7 stenoses. A cervical magnetic resonance imaging showed an intradural extramedullary cystic lesion on the right side of the ventral cervical spinal cord at the C1-2 level and severe compression of the cervical spinal cord. Because a cyst was partially enhancing, a tumor lesion was not identifiable. Due to severe spinal cord compression, we performed intradural cyst removal via a posterior intradural approach with C1-2 laminectomy and left-sided C5-6 and C6-7 foraminotomies. One year after surgery, the cyst did not recur, and atlantoaxial instability did not appear. Discussion. A compressive lesion on the cervical spinal cord was not identified preoperatively as a synovial cyst. However, intraoperative and pathological findings suggested that the compressive lesion can be a synovial cyst which passed through the dorsal dura. The surgical treatment strategy for a synovial cyst of the atlantoaxial joint is controversial due to factors, such as the presence of atlantoaxial instability, level of cyst causing compression of the cervical spinal cord, severity of myelopathy, and cyst location. In the present study, the cervical spinal cord was highly compressed and the cyst was located on the right side of the cervical spinal cord; we chose cyst removal through a posterior intradural approach with C1-2 laminectomy.

Lateral Suboccipital Craniotomy With C1-C2 Hemilaminectomies and C1-C3 Fusion for the Treatment of a C1-C2 Synovial Cyst Causing Spinal Cord Compression: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Davide Marco Croci ◽  
Vance L Fredrickson ◽  
Todd C Hollon ◽  
Andrew T Dailey ◽  
William T Couldwell
Keyword(s):  
Spinal Cord ◽  
Posterior Spinal Fusion ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Os Odontoideum ◽  
Suboccipital Craniotomy ◽  
Patient Consent ◽  
Upper And Lower Extremities ◽  
The Right ◽  
Cyst Fenestration

Abstract Atlantoaxial synovial cysts are a rare cause of cervical myelopathy. Here we describe a case of a 26-yr-old woman who presented with progressively decreasing right arm and leg strength and associated gait imbalance. On examination, she had diffuse weakness in the right upper and lower extremities, a positive right-sided Hoffman sign, and clonus in the right lower extremity. Computed tomography demonstrated an os odontoideum and a retro-odontoid cyst. Magnetic resonance imaging demonstrated a T1 hypointense, T2 hyperintense, slightly rim-enhancing retro-odontoid cyst causing a marked narrowing of the spinal canal, with resultant flattening and leftward deviation of the spinal cord. The patient consented to undergo cyst fenestration via a right suboccipital craniotomy and right C1-C2 hemilaminectomies, along with a C1-C3 instrumented posterior spinal fusion. This approach was chosen because it allows for cyst fenestration and instrumentation of the hypermobile cervical spine within the same incision. After the dura was opened and the arachnoid was dissected, the cyst was visualized compressing the spinal cord. The cyst was fenestrated just inferior to the C1 nerve rootlets, resulting in immediate egress of a gelatinous content; thereafter, all accessible cyst wall portions were removed. Fusion was performed with lateral mass screws at C1 and C3 and pars screws at C2. Pathological analysis described the cyst content as reactive fibrovascular tissue with cholesterol deposition. There were no complications associated with the procedure, and the patient's right-sided weakness had nearly resolved by postoperative day 1. Patient consent was granted for publication.

scholarly journals Intradural synovial cyst of the upper cervical spine: A rare cause of symptomatic cord compression

2020 ◽  
Vol 11 ◽  
pp. 190
Author(s):  
Yahya H. Khormi ◽  
Ryan Chrenek ◽  
Sankar Tejas
Keyword(s):  
Synovial Cyst ◽  
Cord Compression ◽  
Neurophysiological Monitoring ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Histopathological Diagnosis ◽  
Lumbar Region ◽  
Cyst Excision ◽  
Upper Cervical ◽  
Synovial Cysts

Background: Synovial cysts are commonly observed soft-tissue masses of the spine, typically extradural and located in the lumbar region. We describe a very rare symptomatic case of a C1-C2 intradural synovial cyst. Case Description: A 78-year-old female presented with progressive left side weakness, paresthesia, and hyperreflexia. The magnetic resonance imaging revealed a well-circumscribed, subtly enhancing lesion medial to the C1-2 facet, causing cord compression and edema. Using neurophysiological monitoring, surgery included a modified laminectomy of C2 with the removal of the C1 posterior arch. When the dura was opened, a sizable intradural extramedullary lesion was encountered, the cyst was successfully drained and partially resected. The histopathological diagnosis was consistent with a synovial cyst. Postoperatively, the patient’s strength on the left side improved gradually until she was fully ambulatory. Postoperative imaging showed no recurrence at 8 months follow-up. Conclusion: Synovial cysts should be considered among the differential diagnose of C1-2 cysts. They can occur intradurally and compress the spinal cord resulting in a significant neurological deficit. Cyst excision may be accomplished utilizing a limited laminectomy for cyst identification and drainage, accompanied by partial resection of the cyst wall. Such intervention can lead to good clinical outcomes.

scholarly journals A Rare T2-T3 Synovial Facet Cyst Causing Progressive Myelopathy

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Mohamed F. Albana ◽  
Sean Z. Griffiths ◽  
Kris E. Radcliff
Keyword(s):  
Spinal Cord ◽  
Synovial Cyst ◽  
Thoracic Myelopathy ◽  
Cyst Excision ◽  
Progressive Myelopathy ◽  
Recommended Treatment ◽  
Cord Injury ◽  
Synovial Cysts ◽  
Spinal Cord Level ◽  
Upper Thoracic

Intraspinal extradural synovial cysts are a rare occurrence at the spinal cord level and thus a rare cause of myelopathy. Synovial cysts usually present in the more mobile lumbar and cervical parts of the spine; however, they may also arise in the thoracic spine. We present a case of a 59-year-old male with a left upper thoracic synovial cyst at T2-3 causing disabling, progressive myelopathy, and an incomplete spinal cord injury syndrome with inability to ambulate. An urgent decompressive laminectomy with bilateral facetectomies, cyst excision, and posterior fusion was performed. Subsequently, the patient recovered full function. Synovial cysts should be considered in the differential diagnosis of progressive thoracic myelopathy. This is only the sixth reported case of a synovial cyst of this kind occurring between the levels of T1 and T7. Urgent surgical decompression is the recommended treatment.

Subaxial cervical synovial cyst presenting with myelopathy

1999 ◽  
Vol 90 (1) ◽  
pp. 141-144 ◽  
Author(s):  
Simon Cudlip ◽  
Francis Johnston ◽  
Henry Marsh
Keyword(s):  
Spinal Cord ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Facet Joints ◽  
Spinal Disease ◽  
Good Clinical Outcome ◽  
Content Type ◽  
Degenerative Spinal Disease ◽  
Synovial Cysts ◽  
Fine Print

✓ Synovial cysts occur infrequently in the spinal canal and are most often associated with degenerative facet joints. Despite the prevalence of degenerative spinal disease, symptomatic synovial cysts are extremely uncommon. There have been only two previously reported cases of subaxial degenerative synovial cysts of the cervical spine in patients who presented with a clinical picture of spinal cord compression. The authors report three additional patients treated for degenerative cervical synovial cysts who presented with myelopathy. In all three patients the cyst was successfully excised and a good clinical outcome achieved.

Odontoid cervical gout causing atlantoaxial instability: case report

2019 ◽  
Vol 30 (4) ◽  
pp. 541-544
Author(s):  
Justin Slavin ◽  
Marcello DiStasio ◽  
Paul F. Dellaripa ◽  
Michael Groff
Keyword(s):  
Rheumatoid Arthritis ◽  
Spinal Cord ◽  
Case Report ◽  
Physical Examination ◽  
Odontoid Process ◽  
Signs And Symptoms ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Posterior Stabilization ◽  
Rotatory Subluxation

The authors present a case report of a patient discovered to have a rotatory subluxation of the C1–2 joint and a large retroodontoid pannus with an enhancing lesion in the odontoid process eventually proving to be caused by gout. This patient represented a diagnostic conundrum as she had known prior diagnoses of not only gout but also sarcoidosis and possible rheumatoid arthritis, and was in the demographic range where concern for an oncological process cannot fully be ruled out. Because she presented with signs and symptoms of atlantoaxial instability, she required posterior stabilization to reduce the rotatory subluxation and to stabilize the C1–2 instability. However, despite the presence of a large retroodontoid pannus, she had no evidence of spinal cord compression on physical examination or imaging and did not require an anterior procedure to decompress the pannus. To confirm the diagnosis but avoid additional procedures and morbidity, the authors proceeded with the fusion as well as a posterior biopsy to the retroodontoid pannus and confirmed a diagnosis of gout.

scholarly journals Bilateral mirror-like image of cervical synovial cyst in adults

2019 ◽  
Vol 2 (2) ◽  
pp. 30-32
Author(s):  
Farid Yudoyono ◽  
Deasy Herminawaty ◽  
Hendra ◽  
Dewi Pratiwi ◽  
Nasofi Tri Ramdhani
Keyword(s):  
Amorphous Materials ◽  
Fibrous Tissue ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Cystic Mass ◽  
Neurological Deficits ◽  
Facet Joints ◽  
Increased Sensitivity ◽  
Synovial Cysts ◽  
Sensitivity To Pain

Cervical synovial cysts (SC), however uncommon, can cause radiculopathy and myelopathy. In this study, we report a case of a cervical synovial cyst presented as myelopathy. A 48-year-old man presented with gait disturbance decreased touch senses and increased sensitivity to pain below the C5 level. Magnetic resonance imaging revealed a 0.3-mm, bilateral mirror-like small cystic lesion in the spinal canal with cord compression at the C5-6 level. We performed a bilateral expansive laminoplasty of C5 using a posterior approach and completely removed the cystic mass. Histological examination of the resected mass revealed fibrous tissue fragments with amorphous materials and granulation tissue compatible with a synovial cyst. The patient’s symptoms resolved within 3 months after surgery. Although cervical SC is often associated with degenerative facet joints, clinicians must be aware that SC may lead to neurological deficits.

scholarly journals Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

2021 ◽  
Vol 49 ◽  
Author(s):  
Dênis Antonio Ferrarin ◽  
Dakir Nilton Polidoro Neto ◽  
Marcelo Luís Schwab ◽  
Angel Ripplinger ◽  
Mathias Reginatto Wrzesinski ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Synovial Cyst ◽  
Cerebrospinal Fluid Analysis ◽  
Cervical Neoplasm ◽  
Fluid Analysis ◽  
Dorsal Laminectomy ◽  
Synovial Cysts ◽  
Saint Bernard

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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