Cervical juxtafacet cysts: case report and literature review

doi:10.1016/j.spinee.2005.09.006

The Spine Journal

Volume 6, Issue 3, May–June 2006, Pages 279-281

https://doi.org/10.1016/j.spinee.2005.09.006 Get rights and content

Abstract

Background

Juxtafacet cysts of the cervical and thoracic spine are rare and often present with myelopathy. Juxtafacet cysts are well recognized entities found commonly in the lumbar spine but are unusual in the cervical and thoracic spine. We present a case of a patient with gait disturbance and early myelopathy who was found to have a juxtafacet cyst at the cervico-thoracic junction. We further review the literature.

Purpose

To describe a case of a cervico-thoracic juxtafacet cyst and review the literature.

Study design

Case report and subject review.

Methods

One patient presenting with early myelopathy and pain underwent surgery for resection of the lesion. Pathologic analysis revealed a juxtafacet cyst.

Results

The patient recovered uneventfully with relief of his pain. Pubmed review revealed less than 30 similar cases in the literature.

Conclusion

Juxtafacet cysts of the cervical spine are rare entities. These lesions comprise both synovial cysts and ganglion cysts. The benign lesions present with myelopathy and should be considered in patients with cystic lesions in the cervical spinal canal.

Introduction

Spinal extradural cysts are common findings in the lumbar spine. The term juxtafacet cyst encompasses entities such as synovial cysts and ganglion cysts. In most cases, determining the exact diagnosis does not make any difference with regard to treatment. These cysts have the effect of narrowing the spinal canal and impinging on nerve roots causing radiculopathy. Surgical removal is the treatment of choice.

Rarely, these cysts can be found to arise in the cervical and thoracic spine. Correspondingly, they cause symptoms also by mass effect resulting in radiculopathy and myelopathy. A handful of cases are found throughout the literature, and nine cases have been reported occurring at the cervico-thoracic junction. We present a typical case and review the literature.

Section snippets

Case report

A 74-year-old African-American male presented with complaints of subjective gait difficulty. He complained of unsteadiness when walking but otherwise denied weakness, numbness, radiculopathy, or bowel and bladder disturbances. His past medical history was significant only for mild coronary artery disease and degenerative arthritis of his hip for which he was scheduled for a total hip replacement in the near future. There was no history of trauma or prior spinal surgery.

On physical examination,

Discussion

Juxtafacet cysts were first described by von Gruker in 1880 [1]. Kao et al. proposed the term juxtafacet cyst to encompass synovial cysts (those cysts with a synovial lining) and ganglion cysts (cysts without a synovial lining) that arise near the spinal facet joint [2].

Usually, these cysts are located dorsolateral in the spinal canal, but one case has been described in an intraosseous location [3]. Typically they are unilateral but have been described as occurring bilaterally [4]. Most

Conclusion

Juxtafacet cysts of the cervical spine are rare entities. These lesions comprise both synovial cysts and ganglion cysts. They are benign lesions, typically present with myelopathy, and should be considered in patients with cystic lesions in the cervical spinal canal. Surgical removal yields relief of symptoms in most cases.

References (12)

P.F. Doherty et al.
Bilateral synovial cysts of the thoracic spine: a case report
Surg Neurol
(1993)
R.F. Heary et al.
Preoperative diagnosis of an extradural cyst arising from a spinal facet joint: case report
Neurosurgery
(1992)
C.C. Kao et al.
Lumbar intraspinal extradural ganglion cyst
J Neurosurg
(1968)
S.C. Jost et al.
Symptomatic intraosseous synovial cyst in the cervical spine: a case report
Spine
(2003)
R. Wilkins
Intraspinal cysts
E. Nijensohn et al.
Calcified synovial cyst of the cervical spine: CT and MR evaluation
J Comput Assist Tomogr
(1990)

There are more references available in the full text version of this article.

Cited by (25)

Lumbar spinal ganglion cyst: A systematic review with case illustration
2023, Journal of the Neurological Sciences
Ganglion cysts are benign soft tissue lesions found in joints, most commonly wrists. The incidence for juxtafacet cysts, the condition under which spinal ganglion cysts are categorized, is between 0.06% and 5.8%. Spinal ganglion cysts often arise in the most mobile segment of the lumbar spine, L4-L5. Patients commonly present with pain, radiculopathy, and weakness. Conservative management is used, but surgical resection is the most common treatment modality. We aim to review the literature and present a rare case of an L2-L3 situated spinal ganglion cyst, treated with maximal safe resection.
A systematic review of literature was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were queried using Boolean operators and search terms, “spinal ganglion cyst, lumbar ganglion cyst, and lumbar juxtafacet cyst”. Presentation, surgical management, and postoperative course of a 29-year-old male with an L2-L3 spinal ganglion cyst are also described.
The search yielded 824 articles; 23 met inclusion criteria. These papers consisted of 27 spinal ganglion cyst cases with disaggregated patient data. 63.0% of patients were male, and 53.4 years (range: 23–86) was the average age at presentation. Mean symptom duration was 1.9 years (range: 3 days-12 years). 70.4% of patients reported complete symptom resolution. 14.8% of cases noted neural foramen involvement.
Spinal ganglion cysts are benign lesions typically presenting with radiculopathy. Maximal safe resection is an effective treatment modality with low complication rates. Future studies are needed to understand if neural foramen involvement leads to increased symptom severity.
Magnetic Resonance Imaging Features of Cervical Spine Intraspinal Extradural Synovial Cysts
2019, Canadian Association of Radiologists Journal
Citation Excerpt :
These cysts can cause compression on nerve roots resulting in radiculopathy. Spinal synovial cysts usually arise at the facet capsule and are sited lateral or posterolateral in the spinal canal [11–13]. Other sites in the cervical spine are extremely rare; there has been one case report of an intraosseous synovial cyst in the cervical spine [14] and one report of an intradural synovial cyst at the atlantoaxial joint, which the authors suggested chronic pressure exerted on the dura by the cyst may have cause dural thinning leading to ingrowth over time [15].
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.
Les kystes synoviaux rachidiens sont relativement rares et se trouvent le plus souvent dans le rachis lombaire, mais rarement dans le rachis cervical. Bien que majoritairement asymptomatiques et à détection fortuite, des kystes synoviaux cervicaux intrarachidiens périduraux peuvent se former et potentiellement provoquer la compression de la moelle/racine nerveuse, entraînant des symptômes de myélopathie/radiculopathie. Suite à notre revue bibliographique, nous présentons, à notre connaissance, les plus grandes séries de cas d'imagerie et décrivons dans cet article les caractéristiques des kystes synoviaux cervicaux observés sous imagerie par résonance magnétique.
A rare cause of root-compression: Subaxial cervical synovial cyst in association with congenital fusion
2015, International Journal of Surgery Case Reports
Citation Excerpt :
Furthermore, the incidence of synovial cysts is increasing because of the eased availability of MR- and CT-imaging [1,3]. In case of significant/intense symptoms further treatment of cervical synovial cysts is usually surgical decompression and extinction of the cyst [1,6,14]. But it remains controversial whether a fusion augmentation is indicated [3,5,11].
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.
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.
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.
Surgical treatment should be considered in cervical synovial cysts with neurologic deficit or with cord compression or when the conservative treatment is ineffective.
Symptomatic facet cysts of the subaxial cervical spine
2013, Journal of Clinical Neuroscience
Citation Excerpt :
The mean age at presentation in the 67 patients was 68.2 years (range 33-86 years) and there was a male preponderance (44 male, 23 female, 1.91:1). There were 38 cysts located at the cervicothoracic junction (56.7%),2–17 three cysts located at C6-7 (4.5%),18,19 five at C5-6 (7.5%),1,20,21 10 at C4-5 (14.9%),1,10,22 nine at C3-4 (13.4%),1,7,10,23,24 and two cysts located at C2-3 (3%).1 The most common presentation was radiculopathy in 35 patients (52.2%), followed by myelopathy in 30 (44.8%), Two patients presented with myeloradiculopathy (3.0%) (Table 1).
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.
Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: Systematic review of reported postoperative outcomes
2010, Spine Journal
Citation Excerpt :
Despite the variation in reported outcome measures, each scale used persistent or recurrent symptomatology to stratify these outcome scores, making deduction of this endpoint possible for all reviewed articles. The literature search yielded 83 published studies that described outcomes in a total of 966 patients after surgical management of spinal synovial cysts [4,6,7,9–14,18–91]. Overall, mean (±standard deviation) age at the time of surgery was 64.7 (±12.3) years and 476 (49.3%) patients were male.
With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear.
To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence.
Systematic review of the literature.
All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion.
Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales.
We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts.
Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4–L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion.
Surgical decompression results in symptomatic resolution in the vast majority of patients; however, recurrent back pain occurs in a significant number of patients. Cyst recurrence occurs in less than 2% of patients but has never been reported after cyst excision with concomitant fusion. The lack of cyst recurrence after concomitant fusion supports the need to investigate the value of fusion of the involved motion segment in the treatment of symptomatic synovial cysts of the spine.
Thoracic juxtafacet cysts (JFC), a rare cause of myelopathy A supplementary reference confirming the instability hypothesis
2010, Revue du Rhumatisme (Edition Francaise)
Plusieurs hypothèses ont été avancées à l’origine du développement de kyste juxta-articulaire (KJA) du rachis, centrées sur l’instabilité avec surcharge des articulations articulaires postérieures (ou facettes articulaires). Au rachis dorsal, le KJA est une lésion très rare envahissant l’espace intracanalaire, qui peut entraîner une sténose du canal rachidien à l’origine d’une douleur, de signes de myélopathie et de déficits neurologiques. Nous décrivons l’observation d’une femme de 70 ans qui présentait une arthrodèse postérolatérale étendue de L2 à S1, puis un tassement vertébral L1 six semaines plus tard. Pendant la période de suivi, la patiente a développé une cyphose thoracolombaire. Quatorze mois après le processus d’arthrodèse, l’IRM et le scanner ont mis en évidence un KJA droit en T11/12, à l’origine des symptômes de myélopathie. Ce kyste n’avait pas été observé aux IRM antérieures. Après l’ablation chirurgicale du KJA, les symptômes de myélopathie ont nettement diminué et la patiente n’a plus présenté de douleur. Cette observation confirme bien l’hypothèse qu’une instabilité rachidienne peut conduire à une surcharge des articulations articulaires postérieures et entraîner un KJA.

View all citing articles on Scopus

FDA device/drug status: not applicable.

Nothing of value received from a commercial entity related to this manuscript.

View full text

Case ReportsCervical juxtafacet cysts: case report and literature review

Abstract

Background

Purpose

Study design

Methods

Results

Conclusion

Introduction

Section snippets

Case report

Discussion

Conclusion

Surg Neurol

Preoperative diagnosis of an extradural cyst arising from a spinal facet joint: case report

Neurosurgery

Lumbar intraspinal extradural ganglion cyst

J Neurosurg

Symptomatic intraosseous synovial cyst in the cervical spine: a case report

Spine

Intraspinal cysts

Calcified synovial cyst of the cervical spine: CT and MR evaluation

J Comput Assist Tomogr

Case Reports
Cervical juxtafacet cysts: case report and literature review