J Korean Soc Spine Surg.  2011 Mar;18(1):29-33. 10.4184/jkss.2011.18.1.29.

Cervical Facet Cyst Causing Progressive Paraplegia: A Case Report and Review of Literature

• Seo HY
• Chung JY
• Park GH
• Shin YJ

• KMID: 1448029
• DOI: http://doi.org/10.4184/jkss.2011.18.1.29

Abstract

STUDY DESIGN: A case report and literature review.
OBJECTIVES
To report a patient with a cervical facet cyst causing progressive paraplegia, and to review the clinical features, treatment and outcomes of a cervical facetal cyst. SUMMARY OF LITERATURE REVIEW: Extradural intraspinal synovial cysts of the cervical spine are quite rare. They typically occur in the cervical region at the C1-C2 junction or in the space adjacent to the facet joints in the lower cervical spine, and show similar clinical features to the intervertebral disc protrusion.
MATERIALS AND METHODS
This article reports a case of a male patient, 64 years old, who presented with a 2 day history of numbness below the nipple and progressive paraplegia. A physical examination at admission revealed a wheelchair ambulatory state due to a motor deficit (motor grade good) below both hip flexors. Magnetic resonance imaging of the cervical spine showed an extradural lesion with a left lateral extension between C7 and T1, causing spinal cord compression. The patient underwent a hemi-laminectomy of C7 and complete cyst excision through the posterior approach. His motor power improved to almost normal.
RESULTS
The patient showed good recovery of myelopathy, and he was able to walk with a cane 3 months after surgery. A 1 year follow-up did not reveal any recurrence or new neurological conditions.
CONCLUSION
Cervical facet cysts are rare lesions that are occasionally signaled by progressive paraplegia but can be treated successfully by a surgical excision.

Keyword

Facet cyst; Cervical spine; Progressive paraplegia

MeSH Terms

Canes
Follow-Up Studies
Hip
Humans
Hypesthesia
Intervertebral Disc
Magnetic Resonance Imaging
Male
Nipples
Paraplegia
Physical Examination
Recurrence
Spinal Cord Compression
Spinal Cord Diseases
Spine
Synovial Cyst
Wheelchairs
Zygapophyseal Joint

Figure

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  Fig. 1. Magnetic resonance imaging showing extradural cystic lesion at facet joint of C7-T1 compressing cervical spinal cord. (A) T-2 weighted sagittal and axial images showing high-intensity extradural lesion. (B) T-1 weighted sagittal and axial images showing intermediate-intensity extradural lesion.

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  Fig. 2. Photomicrograph of the cyst wall shows nonspecific fibrocollagenous tissue with amorphous secretary materials. Compatible with synovial cyst. [H & E stain, original magnification X200]

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  Fig. 3. T-2 weighted magnetic resonance imaging made 3 months after C7 hemilaminectomy and cyst excision, showing complete removal of the synovial cyst.

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