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Sharma A, Naseem A, Agrawal H, Marathe N, Nares-Lopez FE, Gaddikeri MB. Unilateral facet cyst at the atlantoaxial joint leading to cervical myelopathy: A case report and review of literature. Surg Neurol Int 2022; 13:557. [PMID: 36600735 PMCID: PMC9805656 DOI: 10.25259/sni_900_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Spinal synovial cysts are rare in the cervical spine where they may cause myeloradiculopathy. Contrast MR studies help differentiate these from other lesions. The optimal treatment is often surgical removal. Case Description A 47-year-old male presented with axial neck pain, numbness, and left-hand paresthesia. When the MR study showed dorsolateral cord compression due to a left-sided C1-C2 facet cyst, he underwent a unilateral decompression/fusion. Adequate cyst removal/excision was documented on a postoperative MR performed 2 weeks and 3 months postoperatively. Conclusion A 47-year-old male presented with myelopathy attributed to an MR-documented dorsolateral C1/ C2 facet cyst. Following excision/decompression of the cyst and posterior fusion, the patient's symptoms/signs resolved.
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Affiliation(s)
- Ayush Sharma
- Department of Orthopaedics and Spine Surgery, Bharat Ratna Dr. Babasaheb Ambedkar Memorial Hospital, Byculla, Mumbai
| | - Atif Naseem
- Department of Orthopaedics and Spine Surgery, Bharat Ratna Dr. Babasaheb Ambedkar Memorial Hospital, Byculla, Mumbai,,Corresponding author: Atif Naseem, Department of Orthopaedics and Spine Surgery, Bharat Ratna Dr. Babasaheb Ambedkar Memorial Hospital, Byculla, Mumbai, Maharashtra, India.
| | - Harsh Agrawal
- Department of Orthopaedics and Spine Surgery, Bharat Ratna Dr. Babasaheb Ambedkar Memorial Hospital, Byculla, Mumbai
| | - Nandan Marathe
- Spine Services, Chaitanya Spine Clinic, Cardinal Gracias Memorial Hospital, Vasai, Mumbai, Maharashtra, India
| | | | - Manojkumar B. Gaddikeri
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra, Mumbai, Maharashtra, India
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2
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Buck LS, Farmer S, Stringer SP. Dysphagia and Pharyngeal Cyst. JAMA Otolaryngol Head Neck Surg 2020; 146:958-959. [PMID: 32790870 DOI: 10.1001/jamaoto.2020.1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lauren S Buck
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson
| | - Sarah Farmer
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson
| | - Scott P Stringer
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson
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3
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Patel BK, Bapat MR, Upadhyay AS. A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy. Spine (Phila Pa 1976) 2020; 45:E1047-E1051. [PMID: 32701738 DOI: 10.1097/brs.0000000000003499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a modified posterior approach for decompression and excision of a multiloculated atlanto-axial cyst. SUMMARY OF BACKGROUND DATA Atlanto-axial cyst with myelopathy is rare. A direct decompression through anterior approach or an indirect decompression through posterior approach has been proposed. We report a rare multiloculated large C1-C2 cyst extending down to C3 body with myelopathy that created a dilemma in choice of approach. A modified posterior approach was adopted for decompression. METHODS A 72-year-old lady, known case of Rheumatoid arthritis, presented with cervical myelopathy which was rapidly progressive since 2 months being her to wheel chair bound. She had clumsiness of gait and bilateral grip weakness. Both upper and lower extremities had nonfunctional power (medical research council scale grade 2). Deep tendon reflexes were exaggerated. Sensation was reduced in trunk and both extremities. Magnetic resonance imaging and computed tomography scan showed a large multiloculated cyst compressing spinal cord. Here author used modified posterior approach from the right side to access the cyst. The C2 ganglion excision, vertebral artery isolation, and resection of the pars allowed an approach similar to transforaminal decompression in the lumbar spine. A large antero-lateral epidural part of the cyst was excised. The retro-dental cyst was decompressed by puncturing cyst. Biopsy confirmed a synovial cyst. RESULT The patient showed rapid neurological recovery after surgery. Postoperative magnetic resonance imaging at 3 months showed complete resolution of cyst. At 2-year follow-up, there was a complete neurological recovery with residual spasticity. CONCLUSION A customized posterior approach allowed near total excision of a rare multiloculated large C1-2 cyst extending to the C3 body. This allowed visualisation anterior to the spinal cord without undue retraction that saved an additional anterior decompression. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Bharat K Patel
- Department of Spine Surgery, Nanavati Super Specialty Hospital, Mumbai, Maharashtra, India
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4
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Mak D, Vidoni A, James S, Choksey M, Beale D, Botchu R. Magnetic Resonance Imaging Features of Cervical Spine Intraspinal Extradural Synovial Cysts. Can Assoc Radiol J 2019; 70:403-407. [PMID: 30922789 DOI: 10.1016/j.carj.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/08/2018] [Accepted: 12/15/2018] [Indexed: 11/15/2022] Open
Abstract
Spinal synovial cysts are relatively uncommon and are most frequently found in the lumbar spine and rarely in the cervical spine. Intraspinal extradural cervical synovial cysts can occur and potentially cause cord/nerve root compression with symptoms of myelopathy/radiculopathy; however, most are asymptomatic and incidental findings. We conducted a literature review and present, to our knowledge, the largest imaging case series and describe the magnetic resonance imaging features of cervical synovial cysts.
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Affiliation(s)
- Davina Mak
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alessandro Vidoni
- Cardiff and Vale Orthopedic Centre, University Hospital Llandough, Cardiff, United Kingdom
| | - Steven James
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | | | - David Beale
- Heath Lodge Clinic, Birmingham, United Kingdom
| | - Rajesh Botchu
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.
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5
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Breckwoldt T, Oktenoglu T, Sasani M, Suzer T, Ozer AF. A rare cause of root-compression: Subaxial cervical synovial cyst in association with congenital fusion. Int J Surg Case Rep 2015; 16:90-2. [PMID: 26433927 PMCID: PMC4643443 DOI: 10.1016/j.ijscr.2015.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/18/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Synovial cyst in the cervical spine is a very rare pathology that develops from the facet joint. When a synovial cyst emerges into the surrounding space, it can compress the nervous tissue and cause neurological symptoms. In the cervical area there is additionally the risk of spinal cord compression comparing to the more common presentation of synovial cysts in the lumbar spine. PRESENTATION OF CASE Here, a cervical synovial cysts from the left facet joint grew into the spinal canal and compressed the C8 nerve root which led to root compressing symptoms. Interestingly we found this synovial cyst with congenital fusion. We identified only nine similar cases in the literature. The cyst was removed surgically and the patient discharged without complications. DISCUSSION Numerous theories have been established to explain the pathogenesis of synovial cyst. Biomechanical alterations of the spine play a significant role in the development of synovial cyst. However, the etiology is still unclear. CONCLUSION Surgical treatment should be considered in cervical synovial cysts with neurologic deficit or with cord compression or when the conservative treatment is ineffective.
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Affiliation(s)
- Tabea Breckwoldt
- University of Fribourg, Faculty of Sciences, Fribourg, Switzerland
| | - Tunc Oktenoglu
- American Hospital, Neurosurgery Department, Istanbul, Turkey.
| | - Mehdi Sasani
- American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Tuncer Suzer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
| | - Ali Fahir Ozer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
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6
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Overvliet G, van Scherpenzeel-de Vries MA, Wattjes MP, Vermeulen RJ. Cervical Synovial Cyst in a 16-Year-Old Girl. Pediatr Neurol 2015; 53:173-4. [PMID: 25937385 DOI: 10.1016/j.pediatrneurol.2015.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Geke Overvliet
- Department of Child Neurology, VU Medical Centre, Amsterdam, the Netherlands; Department of Neurology, VU Medical Centre, Amsterdam, the Netherlands.
| | - Machtel A van Scherpenzeel-de Vries
- Department of Child Neurology, VU Medical Centre, Amsterdam, the Netherlands; Department of Pediatrics, VU Medical Centre, Amsterdam, the Netherlands
| | - Mike P Wattjes
- Department of Radiology, Nuclear Medicine & PET Research, VU Medical Centre, Amsterdam, the Netherlands
| | - Robert J Vermeulen
- Department of Child Neurology, VU Medical Centre, Amsterdam, the Netherlands
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7
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Kim SW, Ju CI, Kim HS, Kim YS. Brown-séquard syndrome caused by a cervical synovial cyst. J Korean Neurosurg Soc 2014; 55:215-7. [PMID: 25024827 PMCID: PMC4094748 DOI: 10.3340/jkns.2014.55.4.215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 12/05/2013] [Accepted: 04/15/2014] [Indexed: 11/27/2022] Open
Abstract
Synovial cysts are recognized as an uncommon cause of radicular and myelopathic symptoms. They are most frequently found in the lumbar region. The cervical spine or cervicothoracic junction is a rare location for a degenerative intraspinal synovial cyst as compared with the lumbar spine. At given cervical spinal levels, synovial cysts probably share clinical features with disc herniation and stenosis. However, the pathogenesis of synovial cysts remains still controversial. Here, we report a rare case of a synovial cyst in the lower cervical spine presented as Brown-Séquard syndrome and include a brief review of the literature. To the best of our knowledge, no previous report has been issued in the English literature on a synovial cyst presenting with Brown-Séquard syndrome. Neurologic function recovered completely after complete removal of the cyst and expansive laminoplasty.
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Affiliation(s)
- Seok Won Kim
- Department of Neurosurgery, School of Medicine, Chosun University, Gwangju, Korea
| | - Chang Il Ju
- Department of Neurosurgery, School of Medicine, Chosun University, Gwangju, Korea
| | - Hyeun Sung Kim
- Department of Neurosurgery, Heorisarang Hospital, Daejeon, Korea
| | - Yun Sung Kim
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Korea
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8
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Gutierrez-Quintana R, Hammond G, Wessmann A. Ventral occipito-atlanto-axial fluid-filled lesion causing dynamic spinal cord compression in a cat. J Feline Med Surg 2014; 16:532-5. [PMID: 24101745 PMCID: PMC11112179 DOI: 10.1177/1098612x13507073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cystic lesions affecting the vertebral canal or spinal cord have rarely been reported in cats. A 3-year-old female neutered domestic longhair cat presented for evaluation of a 2-year-history of episodes of ataxia and paresis affecting all limbs. Neurological examination was consistent with a lesion in the C1-C5 spinal cord segments. Magnetic resonance imaging (MRI) showed a fluid-filled lesion at the occipito-atlanto-axial region causing dynamic spinal cord compression on flexion of the neck. The imaging characteristics were compatible with a juxta-articular cyst. To our knowledge, this is the first report of a fluid-filled lesion causing dynamic cervical spinal cord compression in a cat and highlights the importance of performing flexion-extension MRI views in diagnosing cases with dynamic spinal cord compression.
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Affiliation(s)
- Rodrigo Gutierrez-Quintana
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Gawain Hammond
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Annette Wessmann
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK Pride Veterinary Centre, Derby, UK
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9
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Bisson EF, Sauri-Barraza JC, Niazi T, Schmidt MH. Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature. Neurosurg Focus 2013; 35:E3. [DOI: 10.3171/2013.3.focus1385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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10
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Pikis S, Cohen JE, Barzilay Y, Hasharoni A, Kaplan L, Itshayek E. Symptomatic facet cysts of the subaxial cervical spine. J Clin Neurosci 2013; 20:928-32. [PMID: 23683742 DOI: 10.1016/j.jocn.2012.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/24/2012] [Indexed: 11/29/2022]
Abstract
Subaxial cervical facet cysts are uncommon. We report two patients with intraspinal, extradural, subaxial cervical spinal facet cysts, and review the literature to describe the epidemiology, clinical presentation, imaging findings, and treatment options for these lesions. Intraspinal, extradural, cervical spinal cysts should be considered as part of the differential diagnosis in patients presenting with clinical signs of cervical radiculopathy or myelopathy.
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Affiliation(s)
- Stylianos Pikis
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel
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11
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Bydon M, Papadimitriou K, Witham T, Wolinsky JP, Sciubba D, Gokaslan Z, Bydon A. Treatment of Spinal Synovial Cysts. World Neurosurg 2013; 79:375-80. [DOI: 10.1016/j.wneu.2012.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/26/2012] [Accepted: 08/17/2012] [Indexed: 01/24/2023]
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12
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Uschold T, Panchmatia J, Fusco DJ, Abla AA, Porter RW, Theodore N. Subaxial cervical juxtafacet cysts: single institution surgical experience and literature review. Acta Neurochir (Wien) 2013; 155:299-308. [PMID: 23160630 DOI: 10.1007/s00701-012-1549-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/25/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Juxtafacet cysts (JFCs) of the subaxial cervical spine are rare causes of neurological deficits. Their imaging characteristics, relationship to segmental instability, and potential for inducing acute symptomatic deterioration have only been described in a few case reports and small case series. The objective of the current study was to review the surgical experience at our center and across the literature to better define these variables. METHODS A single-institution, multisurgeon series of 12 consecutive patients (mean age 63.4 years, range 52-83 years) harboring 14 JFCs treated across 9 years was retrospectively reviewed. Clinical history, neurological status, preoperative imaging, operative findings, pathology, and postoperative outcomes were obtained from medical records. The mean follow up was 9.2 ± 7.8 months. A literature review identified 35 studies with 89 previously reported cases of surgically treated subaxial cervical JFCs. RESULTS Consistent with previously reported cases, most JFCs in our series involved the C7/T1 level. Nine patients reported axial neck pain, 12 patients had radicular symptoms, four patients had myelopathy, and one patient experienced rapid neurological decline attributable to cystic hemorrhage. Cyst expansion without hemorrhage caused subacute deterioration in one patient. All patients experienced sensory and/or motor improvement following surgical decompression. Preoperative axial neck pain improved in eight of nine patients (89 %). Seven out of 12 patients (58 %) underwent fusion either at the time of decompression (six patients) or at a delayed timepoint within the follow-up period (one patient). Prior history of cervical instrumentation, hypermobility on dynamic imaging, and other risk factors for segmental instability were more common in our series than in previous reports. CONCLUSIONS Our findings lead us to advocate for early decompression rather than prolonged conservative treatment, for pre- and postoperative dynamic imaging, and for fusion in selected cases as an initial surgical consideration.
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Affiliation(s)
- Timothy Uschold
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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13
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Machino M, Yukawa Y, Ito K, Kato F. Cervical degenerative intraspinal cyst: a case report and literature review involving 132 cases. BMJ Case Rep 2012. [PMID: 23195823 DOI: 10.1136/bcr-2012-007126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intraspinal and extradural cysts in the cervical spine are rare disorders that may cause myelopathy or radiculopathy. A synovial cyst or ganglion derived from the facet joint and that from a ligamentum flavum have been reported. We report a surgical case of degenerative intraspinal cyst, causing cervical myelopathy. MRI of a case revealed cystic lesion at C4-5. Spinal cord was compressed by cyst and symptoms of myelopathy were also observed. The patient with cervical spinal canal stenosis underwent laminoplasty and excision of the cyst. The patient recovered well immediately after the surgery. Literature review showed that 133 patients have been reported, including the present case. Previous reports indicated that most cysts occurred in old patients and at the atlanto-axial or C7-T1 junction, and laminectomy or laminoplasty with excision of the cyst gave good results in most cases.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan.
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14
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Walcott BP, Coumans JV. Postlaminectomy synovial cyst formation: A possible consequence of ligamentum flavum excision. J Clin Neurosci 2012; 19:252-4. [DOI: 10.1016/j.jocn.2011.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 01/15/2023]
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15
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Sivakumar W, Elder JB, Bilsky MH. Cervical juxtafacet cyst after anterior cervical discectomy and fusion. Neurosurg Focus 2011; 31:E19. [DOI: 10.3171/2011.8.focus11119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anterior cervical discectomy and fusion (ACDF) is a common neurosurgical procedure, and the benefits, long-term outcomes, and complications are well described in the literature. The development of a juxtafacet joint cyst resulting in radiculopathy is a rare outcome after ACDF and merits further description. The authors describe a patient in whom a juxtafacet joint cyst developed after ACDF procedures, resulting in surgical intervention. When a juxtafacet joint cyst develops after ACDF, symptoms can include radiculopathy, neck pain, and neurological symptoms such as paresthesias and motor weakness. The presence of a juxtafacet joint cyst implies instability in that region of the spine. Patients with this pathological entity may require decompression of neural elements and fusion across the segment involved with the cyst.
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Affiliation(s)
- Walavan Sivakumar
- 1Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - J. Bradley Elder
- 2Department of Neurosurgery, The Ohio State University Medical Center, Columbus, Ohio; and
| | - Mark H. Bilsky
- 3Department of Neurosurgery, Memorial Sloan–Kettering Cancer Center, New York, New York
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Found E, Bewyer D. Cervical synovial cyst: case report. THE IOWA ORTHOPAEDIC JOURNAL 2011; 31:215-218. [PMID: 22096444 PMCID: PMC3215138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 47-year-old female school teacher with a six-week history of left-sided scapular and arm pain is presented. We report her evaluation and treatment Although lumbar degenerative synovial cysts have been reported over 200 times in the literature,6 cervical synovial cysts are much more rare. This case reports a cervicothoracic junction degenerative synovial cyst presenting as radiculopathy.
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Affiliation(s)
- Ernest Found
- Department of Orthopaedics and Rehabilitation, UI Spine Center, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52240-1009, USA
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