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: sagiuchi-t@kitasato.or.jp.

© AANS, except where prohibited by US copyright law.

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    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.

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    Postoperative cervical radiograph showing C1–2 posterior fusion.

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