- Department of Neurosurgery, S. Elia Hospital, Caltanissetta, Italy
- Department of Neurosurgery, Neurosurgical Clinic, AOUP “Paolo Giaccone,” Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
- Department of Pathology, S. Elia Hospital, Caltanissetta, Italy.
Lara Brunasso, Department of Neurosurgery, Neurosurgical Clinic, AOUP “Paolo Giaccone,” Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy.
DOI:10.25259/SNI_574_2021Copyright: © 2021 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: Luca Ruggeri1, Lara Brunasso2, Giovanni Urrico3, Raffaele Alessandrello1, Giovanni Cinquemani1, Rita Lipani1, Jaime Mandelli1, Francesco Nobile3, Domenico Gerardo Iacopino2, Rosario Maugeri2. Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review. 27-Jul-2021;12:369
How to cite this URL: Luca Ruggeri1, Lara Brunasso2, Giovanni Urrico3, Raffaele Alessandrello1, Giovanni Cinquemani1, Rita Lipani1, Jaime Mandelli1, Francesco Nobile3, Domenico Gerardo Iacopino2, Rosario Maugeri2. Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review. 27-Jul-2021;12:369. Available from: https://surgicalneurologyint.com/surgicalint-articles/11004/
Background: Calcified juxtafacet cysts in the cervical spine are extremely rate. Such symptomatic cysts commonly cause neck pain, radiculopathy, or even myelopathy. MR and CT studies typically document cord/ root compression. On occasion, some of these cysts will spontaneously regress, while many others may warrant surgical removal.
Case Description: A 70-year-old male presented with a 2-year history of a progressive tetraparesis. The preoperative MR/CT studies showed a C1-C2 left extradural mass occupying more than half of the spinal canal. On MR, it was homogeneously hypointense on both T1- and T2-weighted images, while the CT showed a calcified cyst. Intraoperative and histopathological findings documented a calcified cervical juxtafacet cyst (i.e. ganglion subtype) that was fully excised without sequelae.
Conclusion: C1-C2 juxtafacet cervical cyst should be considered when a patient presents with myelopathy due to a calcified MR/CT documented paraspinal lesion contributing to significant cervical cord/root compression.
Keywords: Calcified cyst, Cervical degenerative disease, Ganglion cyst, Juxtafacet cyst, Spinal cyst
Cervical juxtafacet cysts are unilateral/dorsolateral intraspinal extradural lesions originating from the facet capsule of a cervical synovial joint[
A 70-year-old male presented with a 2-year history of a progressive tetraparesis that markedly worsened 2 weeks before presentation. On examination, he was severely myelopathic (i.e. with diffuse hyperreflexia, and bilateral Babinski and Hoffman’s signs).
MR and CT studies
MR and CT studies documented a large left-sided C1-C2 juxtafacet cyst that resulted in unilateral/dorsolateral extradural cord compression. It was homogeneously hypointense on both T2- and T1-weighted images; additionally, there was significant T2 hyperintensity in the medulla [
T2-weighted coronal (a), sagittal (b), and axial (c) MRI images show an extradural mass homogeneously hypointense at the C1-C2 level on the left with the characteristic total signal loss. The mass causes severe compression and dislocation of the dural sac with prominent area of T2 hyperintensity involving enterally the medulla at the same level. Axial bone window CT image (d) shows a completely bone density mass occupying more than half spinal canal, with no apparent connections with adjacent bony articular structures. In (e), a three-dimensional CT reconstruction.
The patient underwent a C1 and C2 left hemilaminectomy. At surgery, the C1-C2 cyst appeared as a yellow, round, well-defined and bone-like finding, easily separated from adjacent neural/dural and/or vascular structures [
The histopathology was consistent with a juxtafacet cervical ganglion cyst comprised a fibrocalcific capsule containing a moderately fibrous and sclerotic liquid matrix. No atypical cells were observed, and no synovial lining was found [
Here, we reviewed multiple studies involving cervical juxtafacet cysts. Criteria for literature review search strategy included “spinal cyst” or “ganglion cyst” or “facet cyst” or “juxtafacet cyst” or “cervical” or “calcified” in appropriate combination, in the main databases (PubMed, Google Scholar, MEDLINE, and Scopus). We identified 169 patients with these lesions; patients averaged 65.2 years of age and included 96 men, 66 women and unknown 5 cases. Cysts were located predominantly at the following levels: odontoid process in 17 cases (10.06%), C1-C2 facet joint in 25 (14.8%), and C7-T1 facet joint in 57 cases (33.73%). Most of the patients typically underwent laminectomy/hemilaminectomy for the excision of these cysts; 3 had laminoplasty. Posterior cervical fusion was also performed in 22 cases (i.e. two were occipitocervical fusions). Fifteen cases were approached utilizing a transoral route (i.e. most of were C1-C2 facet joint cysts). The histopathological examination, when accessible, documented 103 synovial cyst, 27 ganglion cyst, and 37 were not specified. No completely calcified cysts were found [
Juxtafacet cysts are likely due to “degenerative joint disease” and facet joint degeneration.[
Two histopathological types of degenerative spinal cyst are describe The synovial cyst is considered as an extrusion of the synovial membrane through a capsular defect from a degenerated facet joint; here, there is direct communication with the synovial cavity of the facet joint. The ganglion cyst shows no synovial lining but has a fibrous connective tissue wall with no direct communication with the facet joint.[
Imaging of juxtafacet cysts
MRI is the modality of choice to differentiate juxtafacet cysts from other extradural or even intradural compressive lesions.[
Calcification of juxtafacet cyst
Calcification in the cyst walls is commonly reported and characterized by low signal intensity (hypodensity) on T1-weighted and T2-weighted images.[
Surgery for juxtafacet cysts
Only a subset of juxtafacet cysts is symptomatic.[
Juxtafacet cysts should be considered among the differential diagnostic consideration for symptomatic intraspinalextradural or paraspinal space-occupying lesions of the cervical spine, even when completely calcified radiological findings are documented.
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