Regression of an atlantoaxial degenerative articular cyst associated with subluxation during conservative treatment

Case report and review of the literature

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✓ The presence of an atlantoaxial degenerative articular cyst is rare; when present this lesion extends posteriorly to the dens, causing cervicomedullary compressive myelopathy. The authors describe a symptomatic case of this lesion associated with atlantoaxial subluxation in a 76-year-old man. The patient’s neurological symptoms resolved and corresponded to a reduction in the size of the cyst. After 8 months of continued conservative treatment, in which the patient wore a Philadelphia collar, the cyst spontaneously regressed. Subsequently, a C1–2 posterior fusion was performed to treat the atlantoaxial subluxation.

Abbreviation used in this manuscript:MR = magnetic resonance.

Article Information

Address reprint requests to: Takao Sagiuchi, M.D., Department of Neurosurgery, The Kitasato Institute Medical Center Hospital, 6-100, Arai, Kitamoto, Saitama 364-8501, Japan. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Dynamic flexion cervical radiograph revealing atlantoaxial subluxation.

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    Cervical MR images showing a well-circumscribed extradural cyst extending posteriorly to the dens. The lesion appears slightly hypointense on T1-weighted images (A, sagittal image; B, axial image) and hyperintense on T2-weighted images (C, sagittal image; D, axial image).

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    Sagittal (A) and axial (B) T2-weighted MR images obtained 8 months after commencement of conservative treatment with a Philadelphia collar, demonstrating almost complete regression of the cyst.

  • View in gallery

    Postoperative cervical radiograph showing C1–2 posterior fusion.



Akiyama HTamaki NKondoh TNagashima T: Cranio-cervical junction synovial cyst associated with atlantoaxial dislocation—case report. Neurol Med Chir 39:5395431999


Birch BDKhandji AGMcCormick PC: Atlantoaxial degenerative articular cysts. J Neurosurg 85:8108161996


Choe WWalot ISchlesinger CChambi ILin F: Synovial cyst of dens causing spinal cord compression. Case report. Paraplegia 31:8038071993


Eustacchio STrummer MUnger FFlaschka G: Intraspinal synovial cyst at the craniocervical junction. Zentralbl Neurochir 64:86892003


Fransen PPizzolato GPOtten PReverdin ALagier Rde Tribolet N: Synovial cyst and degeneration of the transverse ligament: an unusual cause of high cervical myelopathy. Case report. J Neurosurg 86:102710301997


Goffin JWilms GPlets CBruneel BCasselman J: Synovial cyst at the C1-C2 junction. Neurosurgery 30:9149161992


Isono MIshii KKamida TFujiki MGoda MKobayashi H: Retro-odontoid soft tissue mass associated with atlantoaxial subluxation in an elderly patient: a case report. Surg Neurol 55:2232272001


Ito THayashi MOgino T: Retrodental synovial cyst which disappeared after posterior C1-C2 fusion: a case report. J Orthop Surg (Hong Kong) 8:83872000


Kao CCUihlein ABickel WHSoule EH: Lumbar intraspinal extradural ganglion cyst. J Neurosurg 29:1681721968


Kao CCWinkler SSTurner JH: Synovial cyst of spinal facet. Case report. J Neurosurg 41:3723761974


Kaufmann AMHalliday WCWest MFewer DRoss I: Periodontoid synovial cysts causing cervico-medullary compression. Can J Neurol Sci 23:2272301996


Miller JDAl-Mefty OMiddleton TH III: Synovial cyst at the craniovertebral junction. Surg Neurol 31:2392421989


Onofrio BMMih AD: Synovial cysts of the spine. Neurosurgery 22:6426471988


Pendleton BCarl BPollay M: Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery 13:3223261983


Sze GBrant-Zawadzki MNWilson CRNorman DNewton TH: Pseudotumor of the craniovertebral junction associated with chronic subluxation: MR imaging studies. Radiology 161:3913941986


Zorzon MSkrap MDiodato SNasuelli DLucci B: Cysts of the atlantoaxial joint: excellent long-term outcome after posterolateral surgical decompression. Report of two cases. J Neurosurg 95:(1 Suppl)1111142001




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