Department of Spine Surgery, Nanavati Super Specialty Hospital, Mumbai, Maharashtra, India.
Spine (Phila Pa 1976). 2020 Aug 15;45(16):E1047-E1051. doi: 10.1097/BRS.0000000000003499.
Case report.
To describe a modified posterior approach for decompression and excision of a multiloculated atlanto-axial cyst.
Atlanto-axial cyst with myelopathy is rare. A direct decompression through anterior approach or an indirect decompression through posterior approach has been proposed. We report a rare multiloculated large C1-C2 cyst extending down to C3 body with myelopathy that created a dilemma in choice of approach. A modified posterior approach was adopted for decompression.
A 72-year-old lady, known case of Rheumatoid arthritis, presented with cervical myelopathy which was rapidly progressive since 2 months being her to wheel chair bound. She had clumsiness of gait and bilateral grip weakness. Both upper and lower extremities had nonfunctional power (medical research council scale grade 2). Deep tendon reflexes were exaggerated. Sensation was reduced in trunk and both extremities. Magnetic resonance imaging and computed tomography scan showed a large multiloculated cyst compressing spinal cord. Here author used modified posterior approach from the right side to access the cyst. The C2 ganglion excision, vertebral artery isolation, and resection of the pars allowed an approach similar to transforaminal decompression in the lumbar spine. A large antero-lateral epidural part of the cyst was excised. The retro-dental cyst was decompressed by puncturing cyst. Biopsy confirmed a synovial cyst.
The patient showed rapid neurological recovery after surgery. Postoperative magnetic resonance imaging at 3 months showed complete resolution of cyst. At 2-year follow-up, there was a complete neurological recovery with residual spasticity.
A customized posterior approach allowed near total excision of a rare multiloculated large C1-2 cyst extending to the C3 body. This allowed visualisation anterior to the spinal cord without undue retraction that saved an additional anterior decompression.
病例报告。
描述一种改良的后路入路，用于减压和切除多房性寰枢椎囊肿。
伴有脊髓病的寰枢椎囊肿很少见。已经提出了通过前路直接减压或通过后路间接减压的方法。我们报告了一例罕见的多房性大型 C1-C2 囊肿，向下延伸至 C3 体，伴有脊髓病，这在选择入路方面造成了困境。采用改良后路入路进行减压。
一名 72 岁女性，类风湿关节炎患者，表现为进行性颈髓病，自 2 个月前开始迅速进展，导致她无法行走，只能坐轮椅。她步态笨拙，双侧握力减弱。上下肢均无功能（医学研究委员会分级 2 级）。深腱反射亢进。躯干和四肢感觉减退。磁共振成像和计算机断层扫描显示一个大的多房性囊肿压迫脊髓。作者在这里从右侧采用改良后路入路进入囊肿。切除 C2 神经节、椎动脉隔离和椎板切除，使入路类似于腰椎经椎间孔减压。切除了囊肿的前外侧硬膜外部分。通过穿刺囊肿对齿状突后囊肿进行减压。活检证实为滑膜囊肿。
患者术后神经功能迅速恢复。术后 3 个月磁共振成像显示囊肿完全消退。2 年随访时，完全恢复神经功能，仅遗留痉挛。
一种定制的后路入路允许对罕见的多房性大型 C1-2 囊肿进行近乎完全切除，该囊肿延伸至 C3 体。这使得在不进行过度牵拉的情况下可以在脊髓前方进行可视化，从而避免了额外的前路减压。
5 级。
