- Department of Neurosurgery, St. John Providence Health System, Southfield, Michigan, USA
- Department of Neurosurgery, Michigan Head and Spine Institute, Southfield, Michigan, USA
Ratnesh Nandan Mehra
Department of Neurosurgery, Michigan Head and Spine Institute, Southfield, Michigan, USA
DOI:10.4103/2152-7806.163961Copyright: © 2015 Mehra RN. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Mehra RN, Grigorov M, Pieper D. Synovial chondromatosis presenting as an epidural mass. Surg Neurol Int 31-Aug-2015;6:
How to cite this URL: Mehra RN, Grigorov M, Pieper D. Synovial chondromatosis presenting as an epidural mass. Surg Neurol Int 31-Aug-2015;6:. Available from: http://surgicalneurologyint.com/surgicalint_articles/synovial-chondromatosis-presenting-as-an-epidural-mass/
Background:Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules in the synovium of the facet joint. It most commonly affects large joints such as hip or shoulder. Commonly seen features are bony erosion and calcifications. Synovial chondromatosis is rare in the spine and there are few previous reports of extension into the spinal canal.
Case Description:A 58-year-old man presented with a 2 year history of progressive numbness in the right upper extremity without objective weakness. A several month course of conservative management, including physical therapy, failed to alleviate symptoms. Magnetic resonance imaging of the cervical spine demonstrated the erosion of the right facet C5–C6 joint with listhesis and foraminal enlargement secondary to a lesion. Treatment was offered to the patient in the form of surgical resection. The lesion was removed in piecemeal fashion using curettes and Cavitron ultrasonic surgical aspirator. Histological examination demonstrated atypical well-differentiated cartilaginous proliferation.
Conclusion:This patient had an uncomplicated postoperative course and experienced complete resolution of right upper extremity sensory symptoms. Synovial chondromatosis may compromise cervical spinal cord and nerve roots if it extends into the spinal canal. Although it remains rare, it should be included in the differential diagnosis for upper extremity radiculopathy and myelopathy. Surgical resection is a viable treatment option for symptomatic patients with this pathology. In some cases, adequate resection may necessitate stabilization with instrumentation.
Keywords: Chondromatosis, epidural, foraminal, radiculopathy, synovial chondromatosis
Synovial chondromatosis is a rare disorder characterized by the formation of multiple cartilaginous nodules in the synovium of a joint space.[
A 58-year-old male presented with a 2 year history of progressive pain and numbness in the right upper extremity. The patient underwent conservative management, which included physical therapy, but had worsening of his symptoms over several months. On physical examination, he had unilateral decreased sensation along the C5–C6 dermatome with no focal motor deficit. There was no gait abnormality and the patient exhibited no myelopathic signs. Magnetic resonance imaging (MRI) of the cervical spine was performed which demonstrated a lesion with effects of significant erosion on the C5–C6 facet joint, listhesis with suspected instability, displacement of the spinal cord to the left, epidural extension, and foraminal enlargement [Figures
Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules in the synovium and most commonly affects large joints, such as hip and shoulder,[
Synovial chondromatosis of the cervical spine remains rare, especially with epidural extension. The differential diagnosis for a patient with radiculopathy of uncertain origin should contain synovial chondromatosis despite the paucity of previously reported cases. For these symptomatic patients, surgical therapy should include resection of the synovial joint with stabilization if necessary. This patient experienced complete resolution of upper extremity sensory symptoms postoperatively. Treatment is not necessary for asymptomatic patients. However, close observation for development of radiculopathy or myelopathy should be performed.
The authors sincerely appreciate Beverly Walters MD for her contributions in organizing and editing the manuscript.
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