Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review

Abstract

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.

Figure 1:

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.

Figure 2:

Intraoperative image (a) showing en bloc resection of the calcified cyst. Axial bone window CT image (b) and its three-dimensional CT reconstruction (c) show postoperative results and the completely excision of the bone mass, without altering C1-C2 facet joints and cervical stability.

Figure 3:

The microscopical examination showed a fibrocalcific capsule containing a moderately fibrous and sclerotic liquid matrix, and the absence of synovial cell lining of the cystic wall (hematoxylin-eosin stain).