From the Research
Introduction to Cervical Spine Synovial Cysts
Cervical spine synovial (ganglion) cysts are rare conditions that can cause significant neurological deficits due to compression of the spinal cord or nerve roots. Evaluating these cysts requires a comprehensive approach, including diagnostic imaging and consideration of surgical treatment options.
Diagnostic Guidelines
Imaging Characteristics
The diagnosis of cervical synovial cysts relies heavily on magnetic resonance imaging (MRI) features, as described by 1. MRI can reveal a well-circumscribed, extra-axial, homogeneous mass located posterolaterally to the spinal cord. The contents of the cyst are typically 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.
Location and Symptoms
Cervical synovial cysts can occur at any level of the cervical spine but are most commonly found at the C1-2 and C7-T1 joints, as noted by 2. Symptoms can include myelopathy, radiculopathy, and cord compression, leading to significant neurological deficits.
Treatment Options
Surgical Intervention
Surgical treatment is often necessary to relieve compression and prevent further neurological deterioration. As described by 3 and 4, surgical removal of the cyst can lead to significant improvement in symptoms. The approach may involve laminectomy, with or without fusion, depending on the location and size of the cyst.
Considerations for Surgery
The decision to operate should be based on the presence of neurological symptoms and the risk of further deterioration. As highlighted by 4, even asymptomatic cysts can pose a risk of bleeding and subsequent neurological damage, making surgical intervention a consideration in all cases.
Differential Diagnoses and Caveats
Intradural Cysts
Intradural synovial cysts, such as the one described by 5, can occur and require careful consideration during diagnosis and treatment. These cysts can compress the spinal cord and cause significant neurological deficits.
Asymptomatic Cysts
Asymptomatic cysts can still pose a risk of bleeding and subsequent neurological damage, as noted by 4. Therefore, surgical intervention should be considered even in the absence of symptoms.
Conclusion
Evaluating cervical spine synovial cysts requires a comprehensive approach, including diagnostic imaging and consideration of surgical treatment options. Surgical intervention can effectively improve neurological symptoms associated with these cysts, and the decision to operate should be based on the presence of neurological symptoms and the risk of further deterioration.