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

Case report and review of the literature

Restricted access

✓ 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.

Headings

Figures

  • View in gallery

    Dynamic flexion cervical radiograph revealing atlantoaxial subluxation.

  • View in gallery

    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).

  • View in gallery

    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.

References

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 81 81 32
Full Text Views 61 61 10
PDF Downloads 94 94 9
EPUB Downloads 0 0 0

PubMed

Google Scholar