A rare case of cervical facet joint and synovial cyst at C5/C6

Management of symptomatic cervical facet cyst with cervical interlaminar epidural block: A case report

BACKGROUND

Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region. These cysts are usually located in the 7^th cervical and 1^st thoracic vertebral (C7/T1) area, and surgical excision is performed in most cases. However, facet cysts are associated with degenerative conditions, and elderly patients are often ineligible for surgical procedures. Cervical interlaminar epidural block has been used in patients with cervical radiating symptoms and achieved good results. Therefore, cervical interlaminar epidural block may be the first-choice treatment for symptomatic cervical facet cysts.

CASE SUMMARY

A 70-year-old man complained of a tingling sensation in the left hand, focused on the 4^th and 5^th fingers, for 1 year, and posterior neck pain for over 5 mo. The patient’s numeric rating scale (NRS) score was 5/10. The patient was diagnosed with symptomatic cervical facet cyst at the left C7/T1 facet joint. Fluoroscopy-guided cervical interlaminar epidural block at the C7/T1 level with 20 mg triamcinolone and 5 mL of 0.5% lidocaine was administered. The patient's symptoms improved immediately after the block, with an NRS score of 3 points. After 3 mo, his left posterior neck pain and tingling along the left 8^th cervical dermatome were relieved, with an NRS score of 2.

CONCLUSION

A cervical interlaminar epidural block is a good alternative for managing symptomatic cervical facet cysts.

Magnetic Resonance Imaging Features of Cervical Spine Intraspinal Extradural Synovial Cysts

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.