Cecchi Paolo Cipriano, Peltz Maria Teresa, Rizzo Paolo, Musumeci Angelo, Pinna Giampietro, Schwarz Andreas
Unitá Operativa di Neurochirurgia, Ospedale Generale Regionale, Via Bohler 5, 39100 Bolzano, Italy.
Spine J. 2008 Jul-Aug;8(4):687-90. doi: 10.1016/j.spinee.2007.01.006. Epub 2007 Mar 20.
Atlantoaxial degenerative articular cysts are rare lesions that can cause extradural compression of the cervicomedullary junction. When symptomatic, they usually require surgical treatment. We report an unusual case of spontaneous regression of an atlantoaxial degenerative articular cyst after conservative treatment with an external cervical brace along with a systemic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids. We also discuss the potential pathogenetic mechanisms involved.
To describe a case of significant volume reduction of an atlantoaxial articular degenerative cyst in a patient treated with a Philadelphia collar and anti-inflammatory drugs.
Case report with analysis of the literature.
A 80-year-old patient was admitted to our institution with a history of progressive tetraparesis, ataxic gait, and cervical pain. A cervical spine magnetic resonance imaging (MRI) scan showed an extradural mass lesion behind the dens of C2 causing significant compression of the cervicomedullary junction, suggesting the diagnosis of atlantoaxial degenerative articular cyst. The patient refused surgery in favour of a conservative treatment with a Philadelphia collar and a short-term course of NSAIDs and corticosteroids.
After 6 weeks, the patient's neurological condition improved, and a 6-month follow-up cervical spine MRI scan revealed an almost complete regression of the atlantoaxial cystic lesion. At a 1-year follow-up, his clinical condition was further improved.
Atlantoaxial articular degenerative cysts are rare lesions that should be included in the differential diagnosis of those extradural lesions that can cause a ventral or ventrolateral compression of the cervicomedullary junction. They most commonly occur in elderly female patients affected by diffuse arthrosic degeneration of the cervical spine, with or without clear radiological signs of atlantoaxial instability, and have a typical appearance on MRI imaging. Surgery, with direct excision of the cyst and/or a C1-C2 fusion, is the first treatment of choice. Nevertheless, our report points out the possibility of a significant spontaneous regression of these lesions following a simple conservative strategy based on the use of an external cervical brace together with a systemic anti-inflammatory therapy.
寰枢椎退行性关节囊肿是罕见病变，可导致颈髓交界处硬膜外受压。出现症状时，通常需要手术治疗。我们报告了1例罕见病例，1例寰枢椎退行性关节囊肿在使用颈托进行保守治疗并联合使用非甾体抗炎药（NSAIDs）和类固醇进行全身治疗后出现自发消退。我们还讨论了其中潜在的发病机制。
描述1例使用费城颈托和抗炎药物治疗的患者，其寰枢椎关节退行性囊肿体积显著缩小的病例。
病例报告及文献分析。
1例80岁患者因进行性四肢轻瘫、共济失调步态和颈部疼痛病史入住我院。颈椎磁共振成像（MRI）扫描显示C2齿状突后方硬膜外肿块病变，导致颈髓交界处明显受压，提示寰枢椎退行性关节囊肿诊断。患者拒绝手术，选择使用费城颈托及短期NSAIDs和皮质类固醇进行保守治疗。
6周后，患者神经状况改善，6个月随访颈椎MRI扫描显示寰枢椎囊性病变几乎完全消退。1年随访时，其临床状况进一步改善。
寰枢椎关节退行性囊肿是罕见病变，应列入可导致颈髓交界处腹侧或腹外侧受压的硬膜外病变的鉴别诊断中。它们最常发生于患有颈椎弥漫性关节退变的老年女性患者，有或无寰枢椎不稳定的明确影像学征象，且在MRI成像上有典型表现。手术，即直接切除囊肿和/或C1-C2融合，是首选治疗方法。然而，我们的报告指出，基于使用颈托和全身抗炎治疗的简单保守策略，这些病变有可能显著自发消退。
