J Korean Neurosurg Soc.  2014 Jul;56(1):55-57. 10.3340/jkns.2014.56.1.55.

Acute Myelopathy Caused by a Cervical Synovial Cyst

• Kim DS
• Yang JS
• Cho YJ
• Kang SH

• KMID: 2067078
• DOI: http://doi.org/10.3340/jkns.2014.56.1.55

Abstract

Synovial cysts of the cervical spine, although they occur infrequently, may cause acute radiculopathy or myelopathy. Here, we report a case of a cervical synovial cyst presenting as acute myelopathy after manual stretching. A 68-year-old man presented with gait disturbance, decreased touch senses, and increased sensitivity to pain below T12 level. These symptoms developed after manual stretching 3 days prior. Computed tomography scanning and magnetic resonance imaging revealed a 1-cm, small multilocular cystic lesion in the spinal canal with cord compression at the C7-T1 level. We performed a left partial laminectomy of C7 and T1 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 after surgery. We describe a case of acute myelopathy caused by a cervical synovial cyst that was treated by surgical excision. Although cervical synovial cysts are often associated with degenerative facet joints, clinicians should be aware of the possibility that these cysts can cause acute neurologic symptoms.

Keyword

Cervical spine; Synovial cyst; Myelopathy; Radiculopathy; Paralysis

MeSH Terms

Aged
Gait
Granulation Tissue
Humans
Laminectomy
Magnetic Resonance Imaging
Neurologic Manifestations
Paralysis
Radiculopathy
Spinal Canal
Spinal Cord Diseases*
Spine
Synovial Cyst*
Zygapophyseal Joint

Figure

• 

  Fig. 1 Preoperative cervical T2-weighted MRI revealed (A : sagittal, B : axial) a 1-cm sized, small extradural multilocular cystic lesion occupying the spinal canal with cord compression at the left C7-T1 level.

• 

  Fig. 2 A photomicrograph of the cyst revealed fibrous tissue fragments with amorphous material and granulation tissue (hematoxylin and eosin staining, ×20).

• 

  Fig. 3 Schematic illustration of the mechanisms that could lead cervical synovial cyst to neurologic deterioration. A : Asymptomatic cyst. B : Growing cyst with mass effect. C : Secondary changes of cyst. D : Static cyst with direct or repeated trauma to spinal cord.

Reference

1. Cartwright MJ, Nehls DG, Carrion CA, Spetzler RF. Synovial cyst of a cervical facet joint : case report. Neurosurgery. 1985; 16:850–852. PMID: 4010912.

2. Cho BY, Zhang HY, Kim HS. Synovial cyst in the cervical region causing severe myelopathy. Yonsei Med J. 2004; 45:539–542. PMID: 15227744.

3. Colen CB, Rengachary S. Spontaneous resolution of a cervical synovial cyst. Case illustration. J Neurosurg Spine. 2006; 4:186. PMID: 16506489.

4. Epstein NE. Lumbar synovial cysts : a review of diagnosis, surgical management, and outcome assessment. J Spinal Disord Tech. 2004; 17:321–325. PMID: 15280763.

5. Epstein NE, Hollingsworth R. Synovial cyst of the cervical spine. J Spinal Disord. 1993; 6:182–185. PMID: 8504232.

6. Hénaux PL, Hamlat A, Riffaud L, Guégan Y, Morandi X. Spontaneous regression of a symptomatic atlanto-occipital joint cyst. Case report. Neurochirurgie. 2011; 57:129–132. PMID: 21907363.

7. Hsu KY, Zucherman JF, Shea WJ, Jeffrey RA. Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment. Spine (Phila Pa 1976). 1995; 20:80–89. PMID: 7709284.

8. Jabre A, Shahbabian S, Keller JT. Synovial cyst of the cervical spine. Neurosurgery. 1987; 20:316–318. PMID: 3561742.

9. Lunardi P, Acqui M, Ricci G, Agrillo A, Ferrante L. Cervical synovial cysts : case report and review of the literature. Eur Spine J. 1999; 8:232–237. PMID: 10413351.

10. Seo HY, Chung JY, Park GH, Shin YJ. Cervical facet cyst causing progressive paraplegia : a case report and review of literature. J Korean Soc Spine Surg. 2011; 18:29–33.

11. Tofuku K, Koga H, Komiya S. Facet arthrography of a cervical synovial cyst. J Neurointerv Surg. 2012; 4:e17. PMID: 21990488.