- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Department of Pathology, Tan Tock Seng Hospital (TTSH), Singapore
Charandeep Singh Gandhoke
Department of Neurosurgery, National Neuroscience Institute, Singapore
DOI:10.25259/SNI-153-2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Charandeep Singh Gandhoke, Siu Kei David Mak, Nishal Kishinchand Primalani, Eng Tah Goh, Hwei Yee Lee, Colum Patrick Nolan. Cervical C7 ganglion cyst causing compressive myelopathy: A rare case report. 24-Apr-2019;10:61
How to cite this URL: Charandeep Singh Gandhoke, Siu Kei David Mak, Nishal Kishinchand Primalani, Eng Tah Goh, Hwei Yee Lee, Colum Patrick Nolan. Cervical C7 ganglion cyst causing compressive myelopathy: A rare case report. 24-Apr-2019;10:61. Available from: http://surgicalneurologyint.com/surgicalint-articles/9293/
Background:Juxtafacet cysts, synovial and ganglion cysts, emanate from the facet joints. Patients with these cysts are typically asymptomatic but may rarely present with radiculopathy and/or myelopathy.
Case Description:A 72-year-old female presented with a 1-month history of progressive lower extremity weakness (left more than right), numbness, and urinary incontinence. Notably, she also had a C7 sensory level to pin appreciation of 1-month duration. The magnetic resonance imaging showed an extradural C7 cystic lesion whose capsule enhanced with gadolinium, causing severe cord compression. The patient underwent a left C7 hemilaminectomy for complete excision of the cyst; postoperatively in 2-weeks duration, she regained full neurological function. The final histopathology was consistent with a ganglion cyst.
Conclusion:Cervical juxtafacet cysts rarely cause compressive myelopathy. They may be readily diagnosed and resected with excellent postoperative outcomes.
Keywords: Cervical, Compressive, Ganglion cyst, Juxtafacet cyst, Myelopathy
Juxtafacet cysts (ganglion and synovial) emanate from the facet joints. They are mostly asymptomatic but can occasionally contribute to radiculopathy and/or myelopathy.
A 72-year-old female presented with a 1-month history of a C7 sensory level to pin appreciation accompanied by progressive lower extremity weakness (left more than right), numbness, and urinary incontinence. The T1-weighted magnetic resonance (MR) study showed an iso/hypointense extradural lesion on the left side of the spinal canal at the C7 level contributing to marked cord compression. It was hyperintense on the T2-weighted MR study, and the cyst wall enhanced with the administration of gadolinium [
Left C7 hemilaminectomy/operative findings
The patient underwent a left C7 hemilaminectomy for complete excision of the cyst. At surgery, the juxtafacet cyst wall was fibrous and densely adherent to the dura; the cyst itself contained gelatinous material. Notably, there was no obvious communication with the left C7-T1 facet joint cavity [
On histopathological examination, portions of the fibrous cyst wall showed no discernible internal lining. However, mucoid and basophilic calcified material was seen in the lumen of the cyst. This, accompanied by myxoid degeneration within the cyst wall, was consistent with a diagnosis of a ganglion cyst [
(a) Hematoxylin and eosin ×40 magnification: a low power view showing a part of the fibrous cyst wall without a discernible internal lining. Mucoid and basophilic calcified material is seen. (b) Alcian blue – Periodic Acid Schiff (PAS) ×40 magnification: highlights the mucoid material in the lumen of the cyst. (c) Alcian blue – PAS ×100 magnification: another area showing myxoid degeneration in the cyst wall, consistent with a ganglion cyst.
Location and frequency of juxtafacet cysts
Juxtafacet cysts are intraspinal, extradural, and benign cysts located near/contiguous with the facet joints. They are most common in the lumbar spine (95%) followed by the cervical spine (3.5%) and thoracic regions (1.5%).
Etiopathogenesis of juxtafacet cysts
These lesions are attributed to facet joint degeneration, for example, erosion through the wall of the facet joint capsule due to microinstability and repetitive microtrauma.[
Comparison between synovial versus ganglion cysts
Both synovial and ganglion cysts have an external layer covered by connective tissue. However, synovial cysts communicate with the facet joint, and the internal lining is made up of pseudostratified columnar cells, accompanied by a clear serous content.[
Location and diagnosis of juxtafacet cysts
Cervical juxtafacet cysts are most commonly located at the cervicothoracic junction (e.g., C7-T1: a transitional level).[
Treatment of cervical juxtafacet cysts
Most symptomatic juxtafacet cysts should be surgically excised. Extensive laminectomy may be required if there is attendant multilevel stenosis/spondylosis. Fusion may only be warranted in the few cases where frank documented instability is present and/or when lesions are located at the cervicothoracic junction.[
Cervical juxtafacet cysts rarely cause compressive myelopathy. They may be readily diagnosed and resected with excellent postoperative outcomes.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
1. Bydon M, Lin JA, de la Garza-Ramos R, Sciubba DM, Wolinsky JP, Witham TF. The role of spinal fusion in the treatment of cervical synovial cysts:A series of 17 cases and meta-analysis. J Neurosurg Spine. 2014. 21: 919-28
2. Epstein NE, Hollingsworth R. Synovial cyst of the cervical spine. J Spinal Disord. 1993. 6: 182-5
3. Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. Case report. J Neurosurg. 1974. 41: 372-6
4. Lunardi P, Acqui M, Ricci G, Agrillo A, Ferrante L. Cervical synovial cysts:Case report and review of the literature. Eur Spine J. 1999. 8: 232-7
5. Lyons MK, Birch BD, Krauss WE, Patel NP, Nottmeier EW, Bo K. Subaxial cervical synovial cysts:Report of 35 histologically confirmed surgically treated cases and review of the literature. Spine (Phila Pa 1976). 2011. 36: E1285-9
6. Rahimizadeh A, Soufiani H, Hassani V, Agari N, Amirzadeh M, Ava R. Cervical subaxial synovial cyst with progressive myelopathy:Report of a case and review of the literature. World Spinal Column J. 2016. 7: 189-94
7. Sasamori T, Hida K, Anzai K, Yano S, Kato Y, Tanaka S. A case of cervical juxtafacet cyst with extensive rim enhancement on Gd-DTPA MRI. Clin Imaging. 2014. 38: 199-201
8. Shima Y, Rothman SL, Yasura K, Takahashi S. Degenerative intraspinal cyst of the cervical spine:Case report and literature review. Spine (Phila Pa 1976). 2002. 27: E18-22
9. Song JK, Musleh W, Christie SD, Fessler RG. Cervical juxtafacet cysts:Case report and literature review. Spine J. 2006. 6: 279-81