Myelopathic Presentation of Cervical Juxtafacet Cyst: A Case Report

Abstract

Case report. Discussion about the nature of the lesion, its various presentations, image characteristics, clinical features, surgical treatment, and patient outcome. Juxtafacet cysts are uncommon intraspinal lesions most frequently found in the lumbar region. They usually originate as monoradicular compression syndrome mimicking disc herniation. In the cervical spine, they are rare and also have similar clinical features to intervertebral disc protrusion. However, the image findings are highly discriminative and often lead to accurate diagnosis. The cyst occupies a posterolateral position within the spinal canal, displacing the nerve root anteriorly. This situation is better seen in magnetic resonance imaging, but computed tomography scan and plain myelography also point to a diagnosis. The posterolateral site in the spinal canal can be accessed directly by a single-level laminectomy or hemilaminectomy. These are epidural lesions, usually cystic, attached to the facet joint and protruding into the intervertebral foramen. Recurrence after surgery is extremely rare and has only been reported in the lumbar spine. In this article, we report the case of a male patient, 64 years of age, who presented with a progressive and severe myelopathy associated with multiple mononeuropathy, which delayed the diagnosis and treatment of the main neurologic condition, a cervical spinal compressive syndrome, proven to have originated as a juxtafacet cyst. The patient underwent complete surgical excision of the lesion. The patient had good recovery of the myelopathy, and 6 months after surgery, he was able to walk. A follow-up of 2.5 years has not revealed any recurrence or new neurologic conditions.