Abstract
Intraspinal extradural synovial cysts are a rare occurrence at the spinal cord level and thus a rare cause of myelopathy. Synovial cysts usually present in the more mobile lumbar and cervical parts of the spine; however, they may also arise in the thoracic spine. We present a case of a 59-year-old male with a left upper thoracic synovial cyst at T2-3 causing disabling, progressive myelopathy, and an incomplete spinal cord injury syndrome with inability to ambulate. An urgent decompressive laminectomy with bilateral facetectomies, cyst excision, and posterior fusion was performed. Subsequently, the patient recovered full function. Synovial cysts should be considered in the differential diagnosis of progressive thoracic myelopathy. This is only the sixth reported case of a synovial cyst of this kind occurring between the levels of T1 and T7. Urgent surgical decompression is the recommended treatment.
Highlights
Intraspinal extradural synovial cysts are a rare cause of myelopathy, and when they occur, they most commonly present in the lumbar and cervical spine
We present a case of a 59-year-old male with a left-sided intraspinal, extradural synovial cyst at the T2-T3 levels on the left resulting in an inability to ambulate and paresthesia in bilateral lower extremities
There have been 6 reported cases of extradural synovial cysts appearing in the cervicothoracic junction and 20 cases occurring between T10 and T12 [7, 8]
Summary
Intraspinal extradural synovial cysts are a rare cause of myelopathy, and when they occur, they most commonly present in the lumbar and cervical spine. Such cysts can appear in the thoracic spine, such cases are rare. A laminectomy and excision of the cyst with fusion from T2-T4 was performed resulting in complete resolution of symptoms. There are only 5 reported cases of synovial cysts in the upper thoracic spine. Laminectomy, with cyst excision, is the treatment of choice, steroid injections and percutaneous drainage have been described in the literature
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