A Rare Case of C8 Radiculopathy Due to Cervical Spine Synovial Cyst

Abstract

Cervical spine synovial cysts are rare degenerative spinal abnormalities when compared to more frequently noticed degenerative cyst in the lumbar spine. Many times, cervical synovial cysts can be asymptomatic. However, as in the cervical spine, synovial cysts can cause nerve root compression and in the cervical spine can cause spinal cord compression, especially, when acute hemorrhage and/or a marked increase in the size of the cyst occurs, and thus, they can result in radiculopathy and/or myelopathy. The authors report a unique case of a 69-yearsold female who presented with a right C7-T1 synovial cyst causing right C8 radiculopathy and early myelopathy. This case is felt to be unique, because the diagnosis of the right C8 radiculopathy was confirmed on Electromyography (EMG) testing. The patient was also found not to have any signs of carpal tunnel syndrome. In addition, the diagnosis was further supported by a myelogram Computed Tomography (CT) scan done after the Magnetic Resonance Imaging (MRI). The MRI showed multiple levels of degenerative spondylosis, namely at C4-5, C5-6, and C6-7 with the question of stenosis at C7-T1, wrose on the right. The myelogram CT scan showed a much more clear-cut synovial cyst causing right sided C8 neural impingement and foraminal encroachment. Flexion/extension x-rays and the myelogram showed that the patient had a very minimal subluxation and a synovial cyst in the cervicothoracic junction is treated with spinal fusion. The authors showed, in the case, that even with slight subluxation, it is safe to treat a patient with a more minimally invasive C7-T1 laminotomy, foraminotomy and postoperative Flexion/extension x-rays and showed no sign of cervical instability after she was treated for her synovial cyst. She had nearly complete resolution of symptoms post operatively and did not develop instability in the follow-up period.