Transoral surgical approach for treatment of symptomatic atlantoaxial cervical synovial cysts.

Abstract

Synovial cysts are relatively common in the lumbar spine and very uncommon in the cervical spine. Several case reports and a few small series have been reported in the literature over the past four decades. There are two distinct cervical spine synovial cyst categories: atlantoaxial and the subaxial cervical spine. The surgical treatments are very different. We report eleven patients undergoing transoral resection and posterior fusion for histologically confirmed symptomatic atlantoaxial synovial cysts. This represents a retrospective review over 18 years. The authors analyzed the literature of patients who underwent surgical treatment for symptomatic atlantoaxial synovial cysts. There were four male and seven female patients with a mean age of 76 years (range 54-84 years). All patients presented with cervical myelopathy. Patients were neurologically assessed pre- and postoperatively and outcome reported using the Modified Rankin Outcome score. Mean follow-up period was 22 months (range 6-120 months). Ten of the eleven patients had improvement in their postoperative assessment and one patient remained unchanged. Myelopathy is the presenting symptom in the vast majority of these patients. Surgical resection and decompression of the neural structures can be an effective treatment for symptomatic atlantoaxial synovial cysts.