CT Guided Aspiration of a Cervical Synovial Cyst

Synovial cysts are cystic dilations of synovial sheaths with or without anatomical continuity within a joint space that occasionally involve the lumbar spine. Image-guided aspiration has been used successfully in the management of lumbar synovial cysts. Synovial cysts of the cervical spine are rare, tend to present with myelopathic symptoms, and are classically treated using operative intervention. We report a novel approach for cervical synovial cyst aspiration under CT guidance. A 66-year-old woman presented to the clinic complaining of severe pain, tingling, and dysesthesia in her right upper extremity in the C5, C6 and C7 nerve root distribution. MR imaging of her cervical spine showed a synovial cyst within the right C6-C7 neural foramen with significant compression and obliteration of the C7 nerve root. The patient underwent CT-guided aspiration of the cyst using a double needle technique, where one needle was used to open up the epidural space while another aspirated the cyst. This was followed by epidural injection of local anesthetic and steroids. Immediately after injection, the patient experienced complete relief of her right forearm pain, tingling, and dysesthesias. The patient tolerated the procedure well and there were no postprocedure complications. At four year follow-up the patient is free of any symptoms. Image-guided aspiration of cervical synovial cysts is feasible using CT fluoroscopy. Aspiration of these cysts combined with epidural steroid injection can provide long-lasting symptomatic relief in some patients.

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Minimally invasive CT guided treatment of intraspinal synovial cyst

Radiology and Oncology ◽

10.2478/raon-2013-0024 ◽

2014 ◽

Vol 48 (1) ◽

pp. 35-39 ◽

Cited By ~ 8

Author(s):

Sergeja Kozar ◽

Miran Jeromel

Keyword(s):

Synovial Cyst ◽

Radicular Pain ◽

Neurological Deficits ◽

Low Back ◽

Facet Joints ◽

Resonance Imaging ◽

Ct Guided ◽

Synovial Cysts ◽

Magnetic Resonance Imaging Mri

Abstract Background. Intraspinal synovial cysts of vertebral facet joints are uncommon cause of radicular pain as well as neurological deficits. They can be managed both conservatively and surgically. Case report. A 77-year old polymorbid patient presented with bilateral low back pain which worsened during the course of time and did not respond to the conservative treatment. A diagnosis of intraspinal synovial cyst was made using the magnetic resonance imaging (MRI). Percutaneous computed tomography (CT) guided injection with installation of local anesthetic together with corticosteroid and rupture of the cyst was successfully used. A month after the procedure his pain improved, the usage of analgesics diminished and his over-all quality of life improved. Conclusions. Percutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

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Evaluation of Cervical Spine Surgery by Postoperative Myelography

Neurosurgery ◽

10.1227/00006123-198304000-00008 ◽

1983 ◽

Vol 12 (4) ◽

pp. 416-421 ◽

Cited By ~ 8

Author(s):

Charles A. Fager

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Nerve Root ◽

Spontaneous Remission ◽

Cord Compression ◽

Cervical Disc ◽

Nerve Root Compression ◽

Cervical Fusion ◽

Cervical Spine Surgery ◽

Cervical Spine Fusion

Abstract After spontaneous remission of nerve root compression, a myelographic defect may persist. Similarly, myelopathy may remain nonprogressive for long periods despite appreciable myelographic deformity. Although operation may arrest or improve the symptoms of cervical disc lesions and spondylosis, the ultimate confirmation that entrapped neural elements have been relieved permanently can only be provided by postoperative myelography. Preoperative and postoperative myelography documents the significant improvement that can be achieved by using posterolateral and posterior approaches to the cervical spine in patients with nerve root or spinal cord compression. The results in this group of patients were achieved with none of the disadvantages or complications of cervical spine fusion or of the interbody removal of cervical disc tissue, also leading to cervical fusion.

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Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.5.peds15194 ◽

2016 ◽

Vol 17 (1) ◽

pp. 13-18 ◽

Cited By ~ 4

Author(s):

Jason K. Chu ◽

Brandon A. Miller ◽

Michael P. Bazylewicz ◽

John F. Holbrook ◽

Joshua J. Chern

Keyword(s):

Fibrin Glue ◽

Chest Tube ◽

Epidural Injection ◽

Dural Defect ◽

Percutaneous Injection ◽

Ct Guided ◽

First Line Therapy ◽

Tube Output ◽

Chest Tube Output ◽

Dural Defects

Subarachnoid-pleural fistulas (SPFs) are rare clinical entities that occur after severe thoracic trauma or iatrogenic injury during anterolateral approaches to the spine. Treatment of these fistulas often entails open repair of the dural defect. The authors present the case of an SPF in a 2-year-old female after a penetrating injury to the chest. The diagnosis of an SPF was suspected given the high chest tube output and was confirmed with a positive β2-transferrin test of the chest tube fluid, as well as visualization of dural defects on MRI. The dural defects were successfully repaired with CT-guided percutaneous epidural injection of fibrin glue alone. This case represents the youngest pediatric patient with a traumatic SPF to be treated percutaneously. This technique can be safely used in pediatric patients, offers several advantages over open surgical repair, and could be considered as an alternative first-line therapy for the obliteration of SPFs.

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