From the Research
Introduction to Synovial Cysts of the Cervical Spine
Synovial cysts of the cervical spine are rare entities that can cause significant neurological symptoms due to compression of the spinal cord or nerve roots. The diagnostic approach for these cysts involves a combination of clinical evaluation and imaging studies.
Clinical Presentation
Patients with synovial cysts of the cervical spine may present with symptoms such as myelopathy, radiculopathy, or spinal cord compression syndrome, which can include pain, tingling, dysesthesia, and weakness in the upper or lower extremities [ 1, 2, 3 ].
Imaging Studies
Imaging studies play a crucial role in the diagnosis of synovial cysts of the cervical spine. The following imaging modalities can be used:
- CT Scan: Can show a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst [ 1, 4 ].
- MRI: Can show the contents of the cyst as iso/hypointense on T1- and hyperintense on T2-weighted images, with a hypointense rim on T2-weighted images that enhances after intravenous administration of gadolinium [ 1, 2, 5 ].
Diagnostic Approach
The diagnostic approach for a synovial cyst of the cervical spine involves:
- Clinical evaluation to identify symptoms and signs of spinal cord or nerve root compression
- Imaging studies, including CT scan and MRI, to confirm the presence of a synovial cyst and evaluate its location and size
- Consideration of other differential diagnoses, such as herniated discs, osteophytes, or other spinal tumors
Treatment Options
Treatment options for synovial cysts of the cervical spine include:
- Surgical removal: Can provide significant amelioration of symptoms [ 1, 3 ]
- CT-guided aspiration: Can provide long-lasting symptomatic relief in some patients 2
- Epidural steroid injection: Can be used in combination with CT-guided aspiration to provide symptomatic relief
Caveats and Considerations
- Synovial cysts of the cervical spine are rare and can be associated with os odontoideum 5
- Intracystic hemorrhage can occur, leading to acute presentation with spinal cord compression syndrome 3
- Surgery should be considered for any cervical synovial cyst due to the risk of bleeding and resulting irreversible neurological damage 3