A Rare Case of C8 Radiculopathy Due to Cervical Spine Synovial Cyst

Abstract

Cervical spine synovial cysts are rare degenerative spinal abnormalities when compared to more frequently noticed degenerative cyst in the lumbar spine. Many times, cervical 
synovial cysts can be asymptomatic. However, as in the cervical spine, synovial cysts can cause 
nerve root compression and in the cervical spine can cause spinal cord compression, especially, 
when acute hemorrhage and/or a marked increase in the size of the cyst occurs, and thus, they 
can result in radiculopathy and/or myelopathy. The authors report a unique case of a 69-yearsold female who presented with a right C7-T1 synovial cyst causing right C8 radiculopathy and 
early myelopathy. This case is felt to be unique, because the diagnosis of the right C8 radiculopathy was confirmed on Electromyography (EMG) testing. The patient was also found not to 
have any signs of carpal tunnel syndrome. In addition, the diagnosis was further supported by 
a myelogram Computed Tomography (CT) scan done after the Magnetic Resonance Imaging 
(MRI). The MRI showed multiple levels of degenerative spondylosis, namely at C4-5, C5-6, 
and C6-7 with the question of stenosis at C7-T1, wrose on the right. The myelogram CT scan 
showed a much more clear-cut synovial cyst causing right sided C8 neural impingement and 
foraminal encroachment. Flexion/extension x-rays and the myelogram showed that the patient 
had a very minimal subluxation and a synovial cyst in the cervicothoracic junction is treated 
with spinal fusion. The authors showed, in the case, that even with slight subluxation, it is safe 
to treat a patient with a more minimally invasive C7-T1 laminotomy, foraminotomy and postoperative Flexion/extension x-rays and showed no sign of cervical instability after she was 
treated for her synovial cyst. She had nearly complete resolution of symptoms post operatively 
and did not develop instability in the follow-up period.