Skip to main content
SpringerLink
Log in

Subaxial cervical juxtafacet cysts: single institution surgical experience and literature review

  • Clinical Article - Spine
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 2
Fig. 1
Fig. 3

Similar content being viewed by others

Abbreviations

ALD:

Adjacent-level disease

CSF:

Cerebrospinal fluid

CT:

Computed tomography

JFC:

Juxtafacet cyst

MRI:

Magnetic resonance imaging

References

  1. Akhaddar A, Qamouss O, Belhachmi A, Elasri A, Okacha N, Elmostarchid B, Boucetta M (2008) Cervico-thoracic juxtafacet cyst causing spinal foraminal widening. Joint Bone Spine 75:747–749

    Article  PubMed  Google Scholar 

  2. Boviatsis EJ, Stavrinou LC, Kouyialis AT, Gavra MM, Stavrinou PC, Themistokleous M, Selviaridis P, Sakas DE (2008) Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. Eur Spine J 17:831–837

    Article  PubMed  Google Scholar 

  3. Cartwright MJ, Nehls DG, Carrion CA, Spetzler RF (1985) Synovial cyst of a cervical facet joint: case report. Neurosurgery 16:850–852

    Article  PubMed  CAS  Google Scholar 

  4. Cecchi PC, Peltz MT, Rizzo P, Musumeci A, Pinna G, Schwarz A (2008) Conservative treatment of an atlantoaxial degenerative articular cyst: case report. Spine J 8:687–690

    Article  PubMed  Google Scholar 

  5. Cheng WY, Shen CC, Wen MC (2006) Ganglion cyst of the cervical spine presenting with Brown-Sequard syndrome. J Clin Neurosci 13:1041–1045

    Article  PubMed  Google Scholar 

  6. Cheng YY, Chen CC, Yang MS, Hung HC, Lee SK (2004) Intraspinal extradural ganglion cyst of the cervical spine. J Formos Med Assoc 103:230–233

    PubMed  Google Scholar 

  7. Cho BY, Zhang HY, Kim HS (2004) Synovial cyst in the cervical region causing severe myelopathy. Yonsei Med J 45:539–542

    PubMed  Google Scholar 

  8. Christophis P, Asamoto S, Kuchelmeister K, Schachenmayr W (2007) “Juxtafacet cysts”, a misleading name for cystic formations of mobile spine (CYFMOS). Eur Spine J 16:1499–1505

    Article  PubMed  Google Scholar 

  9. Colen CB, Rengachary S (2006) Spontaneous resolution of a cervical synovial cyst. Case illustration. J Neurosurg Spine 4:186

    Article  PubMed  Google Scholar 

  10. Costa F, Menghetti C, Cardia A, Fornari M, Ortolina A (2010) Cervical synovial cyst: case report and review of literature. Eur Spine J 19(Suppl 2):S100–S102

    Article  PubMed  Google Scholar 

  11. Cudlip S, Johnston F, Marsh H (1999) Subaxial cervical synovial cyst presenting with myelopathy. Report of three cases. J Neurosurg 90:141–144

    Article  PubMed  CAS  Google Scholar 

  12. Eck JC, Triantafyllou SJ (2005) Hemorrhagic lumbar synovial facet cyst secondary to anticoagulation therapy. Spine J 5:451–453

    Article  PubMed  Google Scholar 

  13. Epstein NE, Hollingsworth R (1993) Synovial cyst of the cervical spine. J Spinal Disord 6:182–185

    PubMed  CAS  Google Scholar 

  14. Fonoff ET, Dias MP, Tarico MA (2004) Myelopathic presentation of cervical juxtafacet cyst: a case report. Spine (Phila Pa 1976) 29:E538–E541

    Article  Google Scholar 

  15. Found E, Bewyer D (2011) Cervical synovial cyst: case report. Iowa Orthop J 31:215–218

    PubMed  Google Scholar 

  16. Freidberg SR, Fellows T, Thomas CB, Mancall AC (1994) Experience with symptomatic spinal epidural cysts. Neurosurgery 34:989–993

    Article  PubMed  CAS  Google Scholar 

  17. Gazzeri R, Galarza M, Gorgoglione L, Bisceglia M, D’Angelo V (2005) Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report. Eur Spine J 14:807–809

    Article  PubMed  Google Scholar 

  18. Hatem O, Bedou G, Negre C, Bertrand JL, Camo J (2001) Intraspinal cervical degenerative cyst. Report of three cases. J Neurosurg 95:139–142

    PubMed  CAS  Google Scholar 

  19. Henaux PL, Hamlat A, Riffaud L, Guegan Y, Morandi X (2011) Spontaneous regression of a symptomatic atlanto-occipital joint cyst. Case report. Neurochirurgie 57:129–132

    Article  PubMed  Google Scholar 

  20. Jabre A, Shahbabian S, Keller JT (1987) Synovial cyst of the cervical spine. Neurosurgery 20:316–318

    Article  PubMed  CAS  Google Scholar 

  21. Jost SC, Hsien TP, Wright NM (2003) Symptomatic intraosseous synovial cyst in the cervical spine: a case report. Spine (Phila Pa 1976) 28:E344–E346

    Article  Google Scholar 

  22. Kao CC, Winkler SS, Turner JH (1974) Synovial cyst of spinal facet. Case report. J Neurosurg 41:372–376

    Article  PubMed  CAS  Google Scholar 

  23. Katsiva V, Mantaki A, Kailidoy E, Rizos K, Seretis A (2003) Unusual presentation of a cervical ganglion cyst. A case report. Radiol Med 106:123–125

    PubMed  CAS  Google Scholar 

  24. Kostanian VJ, Mathews MS (2007) CT guided aspiration of a cervical synovial cyst. case report and technical note. Interv Neuroradiol 13:295–298

    PubMed  CAS  Google Scholar 

  25. Kotilainen E, Marttila RJ (1997) Paraparesis caused by a bilateral cervical synovial cyst. Acta Neurol Scand 96:59–61

    Article  PubMed  CAS  Google Scholar 

  26. Krauss WE, Atkinson JL, Miller GM (1998) Juxtafacet cysts of the cervical spine. Neurosurgery 43:1363–1368

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  28. Lyons MK, Birch BD, Krauss WE, Patel NP, Nottmeier EW, Boucher OK (2011) Subaxial cervical synovial cysts: report of 35 histologically confirmed surgically treated cases and review of the literature. Spine (Phila Pa 1976) 36:E1285–E1289

    Article  Google Scholar 

  29. McGuigan C, Stevens J, Gabriel CM (2005) A synovial cyst in the cervical spine causing acute spinal cord compression. Neurology 65:1293

    Article  PubMed  Google Scholar 

  30. Miwa M, Doita M, Takayama H, Muratsu H, Harada T, Kurosaka M (2004) An expanding cervical synovial cyst causing acute cervical radiculopathy. J Spinal Disord Tech 17:331–333

    Article  PubMed  Google Scholar 

  31. Moon HJ, Kim JH, Kim JH, Kwon TH, Chung HS, Park YK (2010) Cervical juxtafacet cyst with myelopathy due to postoperative instability. Case report. Neurol Med Chir (Tokyo) 50:1129–1131

    Article  Google Scholar 

  32. Nijensohn E, Russell EJ, Milan M, Brown T (1990) Calcified synovial cyst of the cervical spine: CT and MR evaluation. J Comput Assist Tomogr 14:473–476

    Article  PubMed  CAS  Google Scholar 

  33. Patel SC, Sanders WP (1988) Synovial cyst of the cervical spine: case report and review of the literature. AJNR Am J Neuroradiol 9:602–603

    PubMed  CAS  Google Scholar 

  34. Sagiuchi T, Shimizu S, Tanaka R, Tachibana S, Fujii K (2006) Regression of an atlantoaxial degenerative articular cyst associated with subluxation during conservative treatment. Case report and review of the literature. J Neurosurg Spine 5:161–164

    Article  PubMed  Google Scholar 

  35. Shima Y, Rothman SL, Yasura K, Takahashi S (2002) Degenerative intraspinal cyst of the cervical spine: case report and literature review. Spine (Phila Pa 1976) 27:E18–E22

    Article  Google Scholar 

  36. Sivakumar W, Elder JB, Bilsky MH (2011) Cervical juxtafacet cyst after anterior cervical discectomy and fusion. Neurosurg Focus 31:E19

    Article  PubMed  Google Scholar 

  37. Song JK, Musleh W, Christie SD, Fessler RG (2006) Cervical juxtafacet cysts: case report and literature review. Spine J 6:279–281

    Article  PubMed  CAS  Google Scholar 

  38. Spinner RJ, Hebert-Blouin MN, Maus TP, Atkinson JL, Desy NM, Amrami KK (2010) Evidence that atypical juxtafacet cysts are joint derived. J Neurosurg Spine 12:96–102

    Article  PubMed  Google Scholar 

  39. Stoodley MA, Jones NR, Scott G (2000) Cervical and thoracic juxtafacet cysts causing neurologic deficits. Spine (Phila Pa 1976) 25:970–973

    Article  CAS  Google Scholar 

  40. Takano Y, Homma T, Okumura H, Takahashi HE (1992) Ganglion cyst occurring in the ligamentum flavum of the cervical spine. A case report. Spine (Phila Pa 1976) 17:1531–1533

    Article  CAS  Google Scholar 

  41. Tofuku K, Koga H, Komiya S (2012) Facet arthrography of a cervical synovial cyst. J Neurointerv Surg 4:e17

    Article  PubMed  Google Scholar 

  42. Vastagh I, Palasti A, Nagy H, Veres R, Balint K, Karlinger K, Varallyay G (2008) Cervical juxtafacet cyst combined with spinal dysraphism. Clin Imaging 32:387–389

    Article  PubMed  Google Scholar 

  43. Wang YY, McKelvie P, Trost N, Murphy MA (2004) Trauma as a precipitant of haemorrhage in synovial cysts. J Clin Neurosci 11:436–439

    Article  PubMed  CAS  Google Scholar 

  44. Yamamoto A, Nishiura I, Handa H, Kondo A (2001) Ganglion cyst in the ligamentum flavum of the cervical spine causing myelopathy: report of two cases. Surg Neurol 56:390–395

    Article  PubMed  CAS  Google Scholar 

  45. Yarde WL, Arnold PM, Kepes JJ, O’Boynick PL, Wilkinson SB, Batnitzky S (1995) Synovial cysts of the lumbar spine: diagnosis, surgical management, and pathogenesis. Report of eight cases. Surg Neurol 43:459–464

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Timothy Uschold, David J. Fusco, Adib A. Abla, Randall W. Porter & Nicholas Theodore

  2. Department of Spinal Surgery, Mount Vernon Hospital, London, UK

    Jaykar Panchmatia

  3. c/o Neuroscience Publications; Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA

    Nicholas Theodore

Authors
  1. Timothy Uschold
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaykar Panchmatia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David J. Fusco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adib A. Abla
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Randall W. Porter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicholas Theodore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicholas Theodore.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uschold, T., Panchmatia, J., Fusco, D.J. et al. Subaxial cervical juxtafacet cysts: single institution surgical experience and literature review. Acta Neurochir 155, 299–308 (2013). https://doi.org/10.1007/s00701-012-1549-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-012-1549-0

Keywords

Search

Navigation