Loading…

A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy

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 rep...

Full description

Saved in:
Bibliographic Details
Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2020-08, Vol.45 (16), p.E1047-E1051
Main Authors: Patel, Bharat K., Bapat, Mihir R., Upadhyay, Arpit S.
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c3010-1825d6a927a123c1fc87431a3187a917f2b28ad2491d49296d8a5c0fca3cfbc3
container_end_page E1051
container_issue 16
container_start_page E1047
container_title Spine (Philadelphia, Pa. 1976)
container_volume 45
creator Patel, Bharat K.
Bapat, Mihir R.
Upadhyay, Arpit S.
description 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. 5.
doi_str_mv 10.1097/BRS.0000000000003499
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2427305562</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2427305562</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3010-1825d6a927a123c1fc87431a3187a917f2b28ad2491d49296d8a5c0fca3cfbc3</originalsourceid><addsrcrecordid>eNpdkV9PHCEUxUnTpq6238A0PPoylgszw_C4rlqbuKmxJn2c3GUgQ2VlBCa63760_mlTXgg355x78oOQQ2DHwJT8fHL9_Zj9c0St1BuygIZ3FUCj3pIFEy2veC3aPbKf0s8iagWo92RPcMlAim5B7JKuw-CsMwO9Cimb6EKky2mKAfVIbXmcGh22UzQpuXBHg6VI17PPzgc9e8zFuMwe73Ko8NGhp6tdyvSHyyNd74wPE-Zx94G8s-iT-fh8H5Cb87Ob1UV1-e3L19XystKCAaug483QouISgQsNVneyFoACOokKpOUb3uHAawVDrbhqhw4bzaxGoe1GiwNy9BRb6t_PJuV-65I2vtQzYU49r7kUrGlaXqT1k1THkFI0tp-i22Lc9cD634D7Arj_H3CxfXreMG-2Zng1vRD9m_sQfKGZbv38YGI_GvR5_JMnW1F-hXHGOmhYVSaciV8yRYXf</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2427305562</pqid></control><display><type>article</type><title>A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy</title><source>HEAL-Link subscriptions: Lippincott Williams &amp; Wilkins</source><creator>Patel, Bharat K. ; Bapat, Mihir R. ; Upadhyay, Arpit S.</creator><creatorcontrib>Patel, Bharat K. ; Bapat, Mihir R. ; Upadhyay, Arpit S.</creatorcontrib><description>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. 5.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0000000000003499</identifier><identifier>PMID: 32701738</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Aged ; Arthritis, Rheumatoid - complications ; Cervical Vertebrae - surgery ; Decompression, Surgical - methods ; Female ; Humans ; Magnetic Resonance Imaging ; Postoperative Period ; Spinal Cord Diseases - surgery ; Synovial Cyst - diagnostic imaging ; Synovial Cyst - surgery ; Tomography, X-Ray Computed</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2020-08, Vol.45 (16), p.E1047-E1051</ispartof><rights>Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3010-1825d6a927a123c1fc87431a3187a917f2b28ad2491d49296d8a5c0fca3cfbc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32701738$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Bharat K.</creatorcontrib><creatorcontrib>Bapat, Mihir R.</creatorcontrib><creatorcontrib>Upadhyay, Arpit S.</creatorcontrib><title>A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>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. 5.</description><subject>Aged</subject><subject>Arthritis, Rheumatoid - complications</subject><subject>Cervical Vertebrae - surgery</subject><subject>Decompression, Surgical - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Postoperative Period</subject><subject>Spinal Cord Diseases - surgery</subject><subject>Synovial Cyst - diagnostic imaging</subject><subject>Synovial Cyst - surgery</subject><subject>Tomography, X-Ray Computed</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNpdkV9PHCEUxUnTpq6238A0PPoylgszw_C4rlqbuKmxJn2c3GUgQ2VlBCa63760_mlTXgg355x78oOQQ2DHwJT8fHL9_Zj9c0St1BuygIZ3FUCj3pIFEy2veC3aPbKf0s8iagWo92RPcMlAim5B7JKuw-CsMwO9Cimb6EKky2mKAfVIbXmcGh22UzQpuXBHg6VI17PPzgc9e8zFuMwe73Ko8NGhp6tdyvSHyyNd74wPE-Zx94G8s-iT-fh8H5Cb87Ob1UV1-e3L19XystKCAaug483QouISgQsNVneyFoACOokKpOUb3uHAawVDrbhqhw4bzaxGoe1GiwNy9BRb6t_PJuV-65I2vtQzYU49r7kUrGlaXqT1k1THkFI0tp-i22Lc9cD634D7Arj_H3CxfXreMG-2Zng1vRD9m_sQfKGZbv38YGI_GvR5_JMnW1F-hXHGOmhYVSaciV8yRYXf</recordid><startdate>20200815</startdate><enddate>20200815</enddate><creator>Patel, Bharat K.</creator><creator>Bapat, Mihir R.</creator><creator>Upadhyay, Arpit S.</creator><general>Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200815</creationdate><title>A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy</title><author>Patel, Bharat K. ; Bapat, Mihir R. ; Upadhyay, Arpit S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3010-1825d6a927a123c1fc87431a3187a917f2b28ad2491d49296d8a5c0fca3cfbc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Arthritis, Rheumatoid - complications</topic><topic>Cervical Vertebrae - surgery</topic><topic>Decompression, Surgical - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Postoperative Period</topic><topic>Spinal Cord Diseases - surgery</topic><topic>Synovial Cyst - diagnostic imaging</topic><topic>Synovial Cyst - surgery</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Bharat K.</creatorcontrib><creatorcontrib>Bapat, Mihir R.</creatorcontrib><creatorcontrib>Upadhyay, Arpit S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Bharat K.</au><au>Bapat, Mihir R.</au><au>Upadhyay, Arpit S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2020-08-15</date><risdate>2020</risdate><volume>45</volume><issue>16</issue><spage>E1047</spage><epage>E1051</epage><pages>E1047-E1051</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><abstract>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. 5.</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>32701738</pmid><doi>10.1097/BRS.0000000000003499</doi></addata></record>
fulltext fulltext
identifier ISSN: 0362-2436
ispartof Spine (Philadelphia, Pa. 1976), 2020-08, Vol.45 (16), p.E1047-E1051
issn 0362-2436
1528-1159
language eng
recordid cdi_proquest_miscellaneous_2427305562
source HEAL-Link subscriptions: Lippincott Williams & Wilkins
subjects Aged
Arthritis, Rheumatoid - complications
Cervical Vertebrae - surgery
Decompression, Surgical - methods
Female
Humans
Magnetic Resonance Imaging
Postoperative Period
Spinal Cord Diseases - surgery
Synovial Cyst - diagnostic imaging
Synovial Cyst - surgery
Tomography, X-Ray Computed
title A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T12%3A35%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20Modified%20Posterior%20Approach%20for%20Decompression%20of%20a%20Multiloculated%20Atlanto-axial%20Cyst%20With%20Myelopathy&rft.jtitle=Spine%20(Philadelphia,%20Pa.%201976)&rft.au=Patel,%20Bharat%20K.&rft.date=2020-08-15&rft.volume=45&rft.issue=16&rft.spage=E1047&rft.epage=E1051&rft.pages=E1047-E1051&rft.issn=0362-2436&rft.eissn=1528-1159&rft_id=info:doi/10.1097/BRS.0000000000003499&rft_dat=%3Cproquest_cross%3E2427305562%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c3010-1825d6a927a123c1fc87431a3187a917f2b28ad2491d49296d8a5c0fca3cfbc3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2427305562&rft_id=info:pmid/32701738&rfr_iscdi=true