The role of spinal fusion in the treatment of cervical synovial cysts: a series of 17 cases and meta-analysis

Clinical article

View More View Less
  • 1 Spinal Column Biomechanics and Surgical Outcomes Laboratory and
  • 2 Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

This study was undertaken to compare surgical outcomes between patients with atlantoaxial versus subaxial cervical synovial cysts (CSCs) and to compare outcomes between patients who underwent decompression alone versus decompression and fusion for the treatment of CSCs.

Methods

The authors present a series of 17 cases involving patients treated at their institution and report the surgical outcomes. Due to the rarity of CSCs, a meta-analysis was conducted, and results of the literature search were combined with the case series to enhance the power of the study.

Results

Seventeen patients underwent surgical treatment for CSCs at our institution: 3 patients (17.6%) had atlantoaxial cysts and 14 (82.3%) had subaxial cysts. Of the 17 patients, 16 underwent a decompression and fusion; most patients experienced symptom resolution at last follow-up, and there were no cyst recurrences. A total of 54 articles (including the current series) and 101 patients were included in the meta-analysis. The mean age at presentation was 64 ± 13.9 years, and the most common symptoms were motor and sensory deficits. Forty-one patients (40.6%) presented with atlantoaxial cysts, and 60 (59.4%) with subaxial cysts. There were no significant differences between groups in terms of presenting symptoms, Nurick scores, surgical treatment, or surgical outcomes. Fifty-two patients (51.4%) underwent surgical decompression without fusion, while 49 patients (48.6%) underwent fusion. The preoperative Nurick scores were significantly lower in the fused group (p = 0.001), with an average score of 1.32 compared with 2.75 in the nonfused group. After a mean follow-up of 16.5 months, a difference of means analysis between final and preoperative Nurick scores revealed that patients who received a decompression alone improved on average 1.66 points (95% CI 1.03–2.29) compared with 0.8 points (95% CI 0.23–1.39) in the fused group (p = 0.004). However, there was no statistically significant difference in symptom resolution between the groups, and the rate of cyst recurrence was found to be 0%.

Conclusions

In this study, patients with CSCs had similar outcomes regardless of cyst location and regardless of whether they underwent decompression only or fusion. In the authors' institutional experience, 16 of 17 patients underwent fusion due to underlying spinal instability. While there were no reports of cyst recurrence in their series or in the literature in patients who only received decompression, this is likely due to the limited follow-up time available for the study population. Longer follow-up and prospective and biomechanical studies are needed to corroborate these findings.

Abbreviation used in this paper:CSC = cervical synovial cyst.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Dr. M. Bydon and J. A. Lin contributed equally to this work.

Address correspondence to: Ali Bydon, M.D., The Johns Hopkins Hospital, 600 North Wolfe St., Meyer 5-109, Baltimore, MD 21287. email: abydon1@jhmi.edu.

Please include this information when citing this paper: published online September 26, 2014; DOI: 10.3171/2014.8.SPINE13897.

  • 1

    Aizawa T, , Ozawa H, , Kusakabe T, , Nakamura T, , Chanplakorn P, & Itoi E: C1/2 facet cyst revealed by facet joint arthrography. J Orthop Sci 15:603607, 2010

    • Search Google Scholar
    • Export Citation
  • 2

    Akhaddar A, , Qamouss O, , Belhachmi A, , Elasri A, , Okacha N, & Elmostarchid B, : Cervico-thoracic juxtafacet cyst causing spinal foraminal widening. Joint Bone Spine 75:747749, 2008

    • Search Google Scholar
    • Export Citation
  • 3

    Birch BD, , Khandji AG, & McCormick PC: Atlantoaxial degenerative articular cysts. J Neurosurg 85:810816, 1996

  • 4

    Bisson EF, , Sauri-Barraza JC, , Niazi T, & Schmidt MH: Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature. Neurosurg Focus 35:1 E3, 2013

    • Search Google Scholar
    • Export Citation
  • 5

    Boviatsis EJ, , Stavrinou LC, , Kouyialis AT, , Gavra MM, , Stavrinou PC, & Themistokleous M, : Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. Eur Spine J 17:831837, 2008

    • Search Google Scholar
    • Export Citation
  • 6

    Brotis AG, , Kapsalaki EZ, , Papadopoulos EK, & Fountas KN: A cervical ligamentum flavum cyst in an 82-year-old woman presenting with spinal cord compression: a case report and review of the literature. J Med Case Reports 6:92, 2012

    • Search Google Scholar
    • Export Citation
  • 7

    Bydon A, , Xu R, , Parker SL, , McGirt MJ, , Bydon M, & Gokaslan ZL, : Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. Spine J 10:820826, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Cai CY, , Palmer CA, & Paramore CG: Exuberant transverse ligament degeneration causing high cervical myelopathy. J Spinal Disord 14:8488, 2001

    • Search Google Scholar
    • Export Citation
  • 9

    Cartwright MJ, , Nehls DG, , Carrion CA, & Spetzler RF: Synovial cyst of a cervical facet joint: case report. Neurosurgery 16:850852, 1985

  • 10

    Chang H, , Park JB, & Kim KW: Synovial cyst of the transverse ligament of the atlas in a patient with os odontoideum and atlantoaxial instability. Spine (Phila Pa 1976) 25:741744, 2000

    • Search Google Scholar
    • Export Citation
  • 11

    Cheng WY, , Shen CC, & Wen MC: Ganglion cyst of the cervical spine presenting with Brown-Sequard syndrome. J Clin Neurosci 13:10411045, 2006

    • Search Google Scholar
    • Export Citation
  • 12

    Cheng YY, , Chen CC, , Yang MS, , Hung HC, & Lee SK: Intraspinal extradural ganglion cyst of the cervical spine. J Formos Med Assoc 103:230233, 2004

    • Search Google Scholar
    • Export Citation
  • 13

    Christophis P, , Asamoto S, , Kuchelmeister K, & Schachenmayr W: “Juxtafacet cysts”, a misleading name for cystic formations of mobile spine (CYFMOS). Eur Spine J 16:14991505, 2007

    • Search Google Scholar
    • Export Citation
  • 14

    Cohen-Gadol AA, , White JB, , Lynch JJ, , Miller GM, & Krauss WE: Synovial cysts of the thoracic spine. J Neurosurg Spine 1:5257, 2004

  • 15

    Cudlip S, , Johnston F, & Marsh H: Subaxial cervical synovial cyst presenting with myelopathy. Report of three cases. J Neurosurg 90 :1 Suppl 141144, 1999

    • Search Google Scholar
    • Export Citation
  • 16

    Eguchi K, , Migita K, , Nakashima M, , Ida H, , Terada K, & Sakai M, : Fibroblast growth factors released by wounded endothelial cells stimulate proliferation of synovial cells. J Rheumatol 19:19251932, 1992

    • Search Google Scholar
    • Export Citation
  • 17

    Elhammady MS, , Farhat H, , Aziz-Sultan MA, & Morcos JJ: Isolated unilateral hypoglossal nerve palsy secondary to an atlantooccipital joint juxtafacet synovial cyst. Case report and review of the literature. J Neurosurg Spine 10:234239, 2009

    • Search Google Scholar
    • Export Citation
  • 18

    Enyo Y, , Yamada H, , Kim JH, , Yoshida M, & Hutton WC: Microendoscopic lateral decompression for lumbar foraminal stenosis: a biomechanical study. J Spinal Disord Tech 27:257262, 2014

    • Search Google Scholar
    • Export Citation
  • 19

    Eustacchio S, , Trummer M, , Unger F, & Flaschka G: Intraspinal synovial cyst at the craniocervical junction. Zentralbl Neurochir 64:8689, 2003

    • Search Google Scholar
    • Export Citation
  • 20

    Fonoff ET, , Dias MP, & Tarico MA: Myelopathic presentation of cervical juxtafacet cyst: a case report. Spine (Phila Pa 1976) 29:E538E541, 2004

    • Search Google Scholar
    • Export Citation
  • 21

    Found E, & Bewyer D: Cervical synovial cyst: case report. Iowa Orthop J 31:215218, 2011

  • 22

    Fransen P, , Pizzolato GP, , Otten P, , Reverdin A, , Lagier R, & de Tribolet N: Synovial cyst and degeneration of the transverse ligament: an unusual cause of high cervical myelopathy. Case report. J Neurosurg 86:10271030, 1997

    • Search Google Scholar
    • Export Citation
  • 23

    Freidberg SR, , Fellows T, , Thomas CB, & Mancall AC: Experience with symptomatic spinal epidural cysts. Neurosurgery 34:989993, 1994

  • 24

    Greenberg MS: Initial management of spinal cord injury. Handbook of Neurosurgery ed 7 New York, Thieme, 2010. 933943

  • 25

    Harries A, & Wasserberg J: Synovial cyst presenting as a C1/2 tumour. Br J Neurosurg 24:595596, 2010

  • 26

    Hatem O, , Bedou G, , Négre C, , Bertrand JL, & Camo J: Intraspinal cervical degenerative cyst. Report of three cases. J Neurosurg 95 :1 Suppl 139142, 2001

    • Search Google Scholar
    • Export Citation
  • 27

    Ito T, , Hayashi M, & Ogino T: Retrodental synovial cyst which disappeared after posterior C1-C2 fusion: a case report. J Orthop Surg (Hong Kong) 8:8387, 2000

    • Search Google Scholar
    • Export Citation
  • 28

    Jabre A, , Shahbabian S, & Keller JT: Synovial cyst of the cervical spine. Neurosurgery 20:316318, 1987

  • 29

    Kahiloğullari G, , Tuna H, & Attar A: Management of spinal synovial cysts. Turk Neurosurg 18:211214, 2008

  • 30

    Kao CC, , Winkler SS, & Turner JH: Synovial cyst of spinal facet. Case report. J Neurosurg 41:372376, 1974

  • 31

    Kaufmann AM, , Halliday WC, , West M, , Fewer D, & Ross I: Periodontoid synovial cyst causing cervico-medullary compression. Can J Neurol Sci 23:227230, 1996

    • Search Google Scholar
    • Export Citation
  • 32

    Khan AM, , Synnot K, , Cammisa FP, & Girardi FP: Lumbar synovial cysts of the spine: an evaluation of surgical outcome. J Spinal Disord Tech 18:127131, 2005

    • Search Google Scholar
    • Export Citation
  • 33

    Kirk HJ, & Pik JH: A novel operative technique to manage a symptomatic synovial cyst associated with an os odontoideum. J Clin Neurosci 16:822824, 2009

    • Search Google Scholar
    • Export Citation
  • 34

    Kotilainen E, & Marttila RJ: Paraparesis caused by a bilateral cervical synovial cyst. Acta Neurol Scand 96:5961, 1997

  • 35

    Ludwig SC, , Kramer DL, , Vaccaro AR, & Albert TJ: Transpedicle screw fixation of the cervical spine. Clin Orthop Relat Res 359 7788, 1999

  • 36

    Lunardi P, , Acqui M, , Ricci G, , Agrillo A, & Ferrante L: Cervical synovial cysts: case report and review of the literature. Eur Spine J 8:232237, 1999

    • Search Google Scholar
    • Export Citation
  • 37

    Lyons MK, & Birch B: Transoral surgical approach for treatment of symptomatic atlantoaxial cervical synovial cysts. Turk Neurosurg 21:483488, 2011

    • Search Google Scholar
    • Export Citation
  • 38

    Machino M, , Yukawa Y, , Ito K, & Kato F: Cervical degenerative intraspinal cyst: a case report and literature review involving 132 cases. BMJ Case Rep 2012 bcr2012007126, 2012

    • Search Google Scholar
    • Export Citation
  • 39

    Marbacher S, , Lukes A, , Vajtai I, & Ozdoba C: Surgical approach for synovial cyst of the atlantoaxial joint: a case report and review of the literature. Spine (Phila Pa 1976) 34:E528E533, 2009

    • Search Google Scholar
    • Export Citation
  • 40

    McCullen GM, & Garfin SR: Spine update: cervical spine internal fixation using screw and screw-plate constructs. Spine (Phila Pa 1976) 25:643652, 2000

    • Search Google Scholar
    • Export Citation
  • 41

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

  • 42

    Miller JD, , al-Mefty O, & Middleton TH III: Synovial cyst at the craniovertebral junction. Surg Neurol 31:239242, 1989

  • 43

    Miwa M, , Doita M, , Takayama H, , Muratsu H, , Harada T, & Kurosaka M: An expanding cervical synovial cyst causing acute cervical radiculopathy. J Spinal Disord Tech 17:331333, 2004

    • Search Google Scholar
    • Export Citation
  • 44

    Moher D, , Liberati A, , Tetzlaff J, & Altman DG: PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336341, 2010. (Erratum in Int J Surg 8: 658, 2010)

    • Search Google Scholar
    • Export Citation
  • 45

    Moon HJ, , Kim JH, , Kim JH, , Kwon TH, , Chung HS, & Park YK: Cervical juxtafacet cyst with myelopathy due to postoperative instability. Case report. Neurol Med Chir (Tokyo) 50:11291131, 2010

    • Search Google Scholar
    • Export Citation
  • 46

    Morio Y, , Yoshioka T, , Nagashima H, , Hagino H, & Teshima R: Intraspinal synovial cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability. Spine (Phila Pa 1976) 28:E492E495, 2003

    • Search Google Scholar
    • Export Citation
  • 47

    Mujic A, , Hunn A, , Liddell J, , Taylor B, , Havlat M, & Beasley T: Isolated unilateral hypoglossal nerve paralysis caused by an atlanto-occipital joint synovial cyst. J Clin Neurosci 10:492495, 2003

    • Search Google Scholar
    • Export Citation
  • 48

    Muzii VF, , Tanganelli P, , Signori G, & Zalaffi A: Ganglion cyst of the ligamentum flavum: a rare cause of cervical spinal cord compression. A case report. J Neurol Neurosurg Psychiatry 81:940941, 2010

    • Search Google Scholar
    • Export Citation
  • 49

    Nijensohn E, , Russell EJ, , Milan M, & Brown T: Calcified synovial cyst of the cervical spine: CT and MR evaluation. J Comput Assist Tomogr 14:473476, 1990

    • Search Google Scholar
    • Export Citation
  • 50

    Nojiri H, , Sakuma Y, & Uta S: Degenerative intraspinal cyst of the cervical spine. Orthop Rev (Pavia) 1:e17, 2009

  • 51

    Okamoto K, , Doita M, , Yoshikawa M, , Manabe M, , Sha N, & Yoshiya S: Synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation. J Spinal Disord Tech 17:535538, 2004

    • Search Google Scholar
    • Export Citation
  • 52

    Onofrio BM, & Mih AD: Synovial cysts of the spine. Neurosurgery 22:642647, 1988

  • 53

    Parks RM, , König MA, , Boszczyk B, & Shafafy M: Transarticular fusion for treatment of cystic lesion arising from an odontoid fracture. Eur Spine J 22:2125, 2013

    • Search Google Scholar
    • Export Citation
  • 54

    Quaghebeur G, & Jeffree M: Synovial cyst of the high cervical spine causing myelopathy. AJNR Am J Neuroradiol 13:981982, 1992

  • 55

    Sabo RA, , Tracy PT, & Weinger JM: A series of 60 juxtafacet cysts: clinical presentation, the role of spinal instability, and treatment. J Neurosurg 85:560565, 1996

    • Search Google Scholar
    • Export Citation
  • 56

    Shima Y, , Rothman SL, , Yasura K, & Takahashi S: Degenerative intraspinal cyst of the cervical spine: case report and literature review. Spine (Phila Pa 1976) 27:E18E22, 2002

    • Search Google Scholar
    • Export Citation
  • 57

    Sivakumar W, , Elder JB, & Bilsky MH: Cervical juxtafacet cyst after anterior cervical discectomy and fusion. Case report. Neurosurg Focus 31:4 E19, 2011

    • Search Google Scholar
    • Export Citation
  • 58

    Stoodley MA, , Jones NR, & Scott G: Cervical and thoracic juxtafacet cysts causing neurologic deficits. Spine (Phila Pa 1976) 25:970973, 2000

    • Search Google Scholar
    • Export Citation
  • 59

    Szekanecz Z, & Koch AE: Update on synovitis. Curr Rheumatol Rep 3:5363, 2001

  • 60

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

  • 61

    Uschold T, , Panchmatia J, , Fusco DJ, , Abla AA, , Porter RW, & Theodore N: Subaxial cervical juxtafacet cysts: single institution surgical experience and literature review. Acta Neurochir (Wien) 155:299308, 2013

    • Search Google Scholar
    • Export Citation
  • 62

    Van Gompel JJ, , Morris JM, , Kasperbauer JL, , Graner DE, & Krauss WE: Cystic deterioration of the C1-2 articulation: clinical implications and treatment outcomes. Clinical article. J Neurosurg Spine 14:437443, 2011

    • Search Google Scholar
    • Export Citation
  • 63

    Vastagh I, , Palásti A, , Nagy H, , Veres R, , Bálint K, & Karlinger K, : Cervical juxtafacet cyst combined with spinal dysraphism. Clin Imaging 32:387389, 2008

    • Search Google Scholar
    • Export Citation
  • 64

    Vergne P, , Bonnet C, , Zabraniecki L, , Bertin P, , Moreau JJ, & Treves R: Synovial cyst at the C1-C2 junction and spondyloarthropathy. J Rheumatol 23:14381440, 1996

    • Search Google Scholar
    • Export Citation
  • 65

    Voo LM, , Kumaresan S, , Yoganandan N, , Pintar FA, & Cusick JF: Finite element analysis of cervical facetectomy. Spine (Phila Pa 1976) 22:964969, 1997

    • Search Google Scholar
    • Export Citation
  • 66

    Weng C, , Wang LM, , Wang WD, & Tan HY: Bipartite atlas with os odontoideum and synovial cyst: case report and review literature. Spine (Phila Pa 1976) 35:E568E575, 2010

    • Search Google Scholar
    • Export Citation
  • 67

    Yahara Y, , Kawaguchi Y, , Seki S, , Abe Y, , Oya T, & Kimura T: Ligamentum flavum cyst of the cervical spine associated with rheumatoid arthritis. J Orthop Sci 14:215218, 2009

    • Search Google Scholar
    • Export Citation
  • 68

    Yamamoto A, , Nishiura I, , Handa H, & Kondo A: Ganglion cyst in the ligamentum flavum of the cervical spine causing myelopathy: report of two cases. Surg Neurol 56:390395, 2001

    • Search Google Scholar
    • Export Citation
  • 69

    Zorzon M, , Skrap M, , Diodato S, , Nasuelli D, & Lucci B: Cysts of the atlantoaxial joint: excellent long-term outcome after posterolateral surgical decompression. Report of two cases. J Neurosurg 95 :1 Suppl 111114, 2001

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 343 233 13
Full Text Views 462 17 0
PDF Downloads 183 16 0
EPUB Downloads 0 0 0