scholarly journals Synovial Cyst of the Atlantoaxial Joint Removed through a Posterior Intradural Approach

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Atsuhiko Toyoshima ◽  
Kiminori Sakurai ◽  
Nobuhiro Sasaki ◽  
Miyuki Fukuda ◽  
Shigeo Ueda ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Rapid Progression ◽  
Atlantoaxial Joint ◽  
Tumor Lesion ◽  
One Year ◽  
The Right

Introduction. Synovial cysts rarely develop in the atlantoaxial joint. We report a case of posterior C1-2 laminectomy for a synovial cyst of the atlantoaxial joint which passed through the dorsal dura and put pressure on the cervical spinal cord. Case Presentation. A 62-year-old man with rapid progression of pain and weakness in the left upper extremity presented to our hospital. A cervical spine X-ray showed left C5-6 and C6-7 stenoses. A cervical magnetic resonance imaging showed an intradural extramedullary cystic lesion on the right side of the ventral cervical spinal cord at the C1-2 level and severe compression of the cervical spinal cord. Because a cyst was partially enhancing, a tumor lesion was not identifiable. Due to severe spinal cord compression, we performed intradural cyst removal via a posterior intradural approach with C1-2 laminectomy and left-sided C5-6 and C6-7 foraminotomies. One year after surgery, the cyst did not recur, and atlantoaxial instability did not appear. Discussion. A compressive lesion on the cervical spinal cord was not identified preoperatively as a synovial cyst. However, intraoperative and pathological findings suggested that the compressive lesion can be a synovial cyst which passed through the dorsal dura. The surgical treatment strategy for a synovial cyst of the atlantoaxial joint is controversial due to factors, such as the presence of atlantoaxial instability, level of cyst causing compression of the cervical spinal cord, severity of myelopathy, and cyst location. In the present study, the cervical spinal cord was highly compressed and the cyst was located on the right side of the cervical spinal cord; we chose cyst removal through a posterior intradural approach with C1-2 laminectomy.

Lateral Suboccipital Craniotomy With C1-C2 Hemilaminectomies and C1-C3 Fusion for the Treatment of a C1-C2 Synovial Cyst Causing Spinal Cord Compression: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Davide Marco Croci ◽  
Vance L Fredrickson ◽  
Todd C Hollon ◽  
Andrew T Dailey ◽  
William T Couldwell
Keyword(s):  
Spinal Cord ◽  
Posterior Spinal Fusion ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Os Odontoideum ◽  
Suboccipital Craniotomy ◽  
Patient Consent ◽  
Upper And Lower Extremities ◽  
The Right ◽  
Cyst Fenestration

Abstract Atlantoaxial synovial cysts are a rare cause of cervical myelopathy. Here we describe a case of a 26-yr-old woman who presented with progressively decreasing right arm and leg strength and associated gait imbalance. On examination, she had diffuse weakness in the right upper and lower extremities, a positive right-sided Hoffman sign, and clonus in the right lower extremity. Computed tomography demonstrated an os odontoideum and a retro-odontoid cyst. Magnetic resonance imaging demonstrated a T1 hypointense, T2 hyperintense, slightly rim-enhancing retro-odontoid cyst causing a marked narrowing of the spinal canal, with resultant flattening and leftward deviation of the spinal cord. The patient consented to undergo cyst fenestration via a right suboccipital craniotomy and right C1-C2 hemilaminectomies, along with a C1-C3 instrumented posterior spinal fusion. This approach was chosen because it allows for cyst fenestration and instrumentation of the hypermobile cervical spine within the same incision. After the dura was opened and the arachnoid was dissected, the cyst was visualized compressing the spinal cord. The cyst was fenestrated just inferior to the C1 nerve rootlets, resulting in immediate egress of a gelatinous content; thereafter, all accessible cyst wall portions were removed. Fusion was performed with lateral mass screws at C1 and C3 and pars screws at C2. Pathological analysis described the cyst content as reactive fibrovascular tissue with cholesterol deposition. There were no complications associated with the procedure, and the patient's right-sided weakness had nearly resolved by postoperative day 1. Patient consent was granted for publication.

Remarkable reduction or disappearance of retroodontoid pseudotumors after occipitocervical fusion

2006 ◽  
Vol 5 (2) ◽  
pp. 156-160 ◽  
Author(s):  
Ikuko Yamaguchi ◽  
Sei Shibuya ◽  
Nobuo Arima ◽  
Shiro Oka ◽  
Yoshiaki Kanda ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Symptomatic Improvement ◽  
Cord Compression ◽  
Magnetic Resonance Images ◽  
Mass Lesion ◽  
Atlantoaxial Instability ◽  
Occipitocervical Fusion ◽  
Upper Cervical ◽  
Posterior Laminectomy

✓ Retroodontoid or periodontoid pseudotumor unassociated with rheumatoid arthritis or hemodialysis is clinically rare. The authors report three cases of retroodontoid pseudotumor that they treated surgically. All patients exhibited myelopathy of the upper cervical spinal cord. Plain radiography depicted atlantoaxial instability in two of the three patients. Spinal cord compression caused by a mass lesion in all patients was clearly demonstrated on magnetic resonance images. In two patients, the mass lesion was not limited to the retroodontoid region and expanded continuously to the cranial base. Posterior laminectomy of the atlas and occipitocervical fusion were performed. After surgery, the pseudotumor disappeared in two cases and was clearly reduced in one case, and neurological symptoms also improved. Retroodontoid pseudotumor is a lesion for which symptomatic improvement can be expected with posterior decompression and fusion, even without direct tumor excision.

scholarly journals Hemorrhagic synovial cyst: An unexpected cause of acute cervical spinal cord compression. Case report

2020 ◽  
Vol 77 ◽  
pp. 527-530
Author(s):  
Khaled Radhouane ◽  
Hadhemi Dridi ◽  
Nada Mansouri ◽  
Mohamed Dehmani Yedeas ◽  
Ahmed Harbaoui ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Spinal Cord Compression ◽  
Cervical Spinal Cord ◽  
Synovial Cyst ◽  
Cord Compression

scholarly journals Os Odontoideum: an unusual association of compressive synovial cyst. Case report and review of the literature

2015 ◽  
Vol 42 (S1) ◽  
pp. S50-S50
Author(s):  
AA Ahmed ◽  
T Watson ◽  
A Elgheriani ◽  
E Kachur ◽  
A Cenic
Keyword(s):  
Spinal Cord ◽  
Synovial Cyst ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Complete Regression ◽  
Cyst Excision ◽  
Persistent Symptoms ◽  
Atlantoaxial Stabilization ◽  
Synovial Cysts

Background: Os odontoideum is a rare cervical abnormality that harbours a potential risk for atlantoaxial instability. In rare circumstances, synovial cysts may develop and compromise the spinal cord. Therefore, cyst excision has been suggested as part of the surgical management. However, in recent reports, it has been shown that atlantoaxial stabilization alone is sufficient for synovial cyst regression. Methodology: 48-year-old woman presented with symptoms and signs of cervical myelopathy secondary to os odontoideum with atlantoaxial instability. A large synovial cyst was diagnosed with significant spinal cord compression. In addition, her spinal and cranial imaging was suggestive of multiple sclerosis which was confirmed clinically thereafter with one episode of MS flare up and positive cerebrospinal fluid analysis. Results: After she had recovered from her MS flare up, posterior atlantoaxial instrumentation and fusion was performed without synovial cyst resection. Postoperatively, her clinical condition improved substantially and complete regression of the synovial cyst was noted on cervical MRI. Interestingly, she has not had any MS recurrent episodes after the surgery. Conclusion: Degenerative changes in os odontoideum are consequences of atlantoaxial instability. Compressive synovial cysts may develop with associated cord compression. We recommend posterior atlantoaxial stabilization alone in such conditions while preserving cyst fenestration or excision for persistent symptoms related to unresolved synovial cysts.

Odontoid cervical gout causing atlantoaxial instability: case report

2019 ◽  
Vol 30 (4) ◽  
pp. 541-544
Author(s):  
Justin Slavin ◽  
Marcello DiStasio ◽  
Paul F. Dellaripa ◽  
Michael Groff
Keyword(s):  
Rheumatoid Arthritis ◽  
Spinal Cord ◽  
Case Report ◽  
Physical Examination ◽  
Odontoid Process ◽  
Signs And Symptoms ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Posterior Stabilization ◽  
Rotatory Subluxation

The authors present a case report of a patient discovered to have a rotatory subluxation of the C1–2 joint and a large retroodontoid pannus with an enhancing lesion in the odontoid process eventually proving to be caused by gout. This patient represented a diagnostic conundrum as she had known prior diagnoses of not only gout but also sarcoidosis and possible rheumatoid arthritis, and was in the demographic range where concern for an oncological process cannot fully be ruled out. Because she presented with signs and symptoms of atlantoaxial instability, she required posterior stabilization to reduce the rotatory subluxation and to stabilize the C1–2 instability. However, despite the presence of a large retroodontoid pannus, she had no evidence of spinal cord compression on physical examination or imaging and did not require an anterior procedure to decompress the pannus. To confirm the diagnosis but avoid additional procedures and morbidity, the authors proceeded with the fusion as well as a posterior biopsy to the retroodontoid pannus and confirmed a diagnosis of gout.

Osteochondroma causing cervical spinal cord compression

2017 ◽  
Vol 46 (8) ◽  
pp. 1125-1130 ◽  
Author(s):  
Ryunosuke Fukushi ◽  
Makoto Emori ◽  
Noriyuki Iesato ◽  
Masanobu Kano ◽  
Toshihiko Yamashita
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cervical Spinal Cord ◽  
Cord Compression
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