An Unconventional and Novel Therapeutic Technique of Anterior Indirect Decompression in a Case of C6–C7 Synovial Cyst Associated with Radiculopathy

Synovial cysts are infrequent findings in the spine and mostly located in the lumbar area. Even rarer is the occurrence of a synovial cyst in the cervical spine. The pathology arises from the facet joint and may cause pain, radiculopathy, or myelopathy. Few cases of symptomatic subaxial synovial cysts have been reported in the literature. Surgery is indicated in the presence of severe pain and neurologic compromise and involves the decompression of the cyst and the associated neural elements. Hemilaminectomy is the surgical treatment most commonly reported in the literature. However, other procedures such as complete laminectomy, CT-guided aspiration, and anterior corpectomy have been described. On the background of available literature till date, we report an unconventional and novel therapeutic technique of anterior indirect decompression in an uncommon case of a C6-C7 synovial cyst. A 67-year-old female patient had left upper limb radicular pain along the forearm and lateral fingers for 2 months. She had severe neck pain in extension and weak triceps (4/5) with the Neck Disability Index (NDI) score of 51.11% and visual analog scale (VAS) score of 8/10. Plain x-rays were suggestive of spondylosis. T2WI of MRI scan demonstrated cystic lesion on ventral aspect of C6-C7 (L) facet suggestive of synovial cyst. Anterior cervical discectomy and fusion was done, and indirect posterior decompression of the cyst was achieved. There was a complete resolution of radiculopathy immediate postoperative period with magnetic resonance imaging (MRI) showing the evidence. Motor weakness resolved by 3 months with NDI score of 8.88% and VAS of 2/10. She was asymptomatic with no evidence of disease recurrence on MRI at 24 months.