An 84-year-old man, presents a 2-month history of cervico-brachyalgia to the right arm and progressive hypostenia of the right arm. No traumas were referred. Neurological examination at admission showed a hypotrophy of the interosseous muscles of the right hand and hypostenia of the right biceps and triceps muscle. No signs of myelopathy or sensory deficits were found.
Pre-operative Magnetic Resonance (MR) imaging and Computed Tomography (CT) scans of the cervical spine showed an extradural lesion with a right lateral extension between C7 and T1, without any spinal cord compression: an increased T2 signal intensity and a low to moderate T1 signal intensity were detected. No evidence of contrast enhancement was detected in the MRI, while CT scans images revealed a round peripheral enhancement of the cyst wall (Fig. ).
Fig. 1 a, b (Sagital–assial) pre-operative T2 weight MRI: right extradural lesion between C7 and T1; c, d pre-operative CT scan after contrast injection: enhancement of the cyst wall; e, f post-operative T2-weight MRI control: complete removal of the (more ...)
The patient underwent a posterior approach with a complete right hemi-laminectomy of C7 and partial laminectomy of C6 and T1. The cyst lesion was completed removed. The histological exam showed a cystic formation with thin fibrous walls covered by synovial lining with diagnosis of synovial cyst (Fig. ).
Photomicrography showing thin fibrous wall covered by pavimented cells, compatible with SC
After surgery, the patient showed a rapid pain regression and good improvement of distal hypostenia after physiotherapy.