From the Research
Introduction to Synovial Cysts of the Odontoid Process
Synovial cysts of the odontoid process are rare lesions that can cause spinal cord compression, leading to symptoms such as myelopathy or radiculopathy 1, 2. These cysts are thought to arise from degenerative changes in the atlantoaxial joints or from microtrauma 3.
Clinical Presentation
Patients with synovial cysts of the odontoid process may present with progressive symptoms due to spinal cord compression, including neurological deficits 1, 4, 5. The diagnosis can be challenging, and the cysts may be initially mistaken for other lesions such as meningiomas or pannus formation 1.
Diagnostic Imaging
Magnetic resonance imaging (MRI) is a crucial diagnostic tool for identifying synovial cysts of the odontoid process 1, 3, 4. The cysts typically appear as low-signal intensity lesions on T1-weighted images and high-signal intensity lesions on T2-weighted images, with marginal enhancement with gadolinium-DTPA on T1-weighted images 3.
Treatment Options
Treatment of synovial cysts of the odontoid process often involves surgical intervention, with the goal of relieving spinal cord compression and stabilizing the atlantoaxial joint 2, 3, 4, 5. The surgical approach may vary, with options including:
- Posterior surgical resection of the cyst with fusion of adjacent cervical vertebrae 2
- Transarticular fusion of C1/C2 2
- Posterior atlantoaxial fusion alone 3
- Anterolateral approach without fusion 4
- Transoral approach with odontoid resection and posterior fixation 5
Key Considerations
When treating synovial cysts of the odontoid process, it is essential to consider the following:
- The need for stabilization of the atlantoaxial joint to prevent further instability and neurological deterioration 2, 3, 5
- The potential for spontaneous regression of the cyst after stabilization of the joint 3
- The importance of careful patient selection and surgical planning to minimize the risk of complications and optimize outcomes 4
Conclusion
Synovial cysts of the odontoid process are rare and challenging lesions that require careful diagnosis and treatment. A thorough understanding of the clinical presentation, diagnostic imaging, and treatment options is essential for healthcare providers to provide optimal care for patients with these lesions 1, 2, 3, 4, 5.