Juxtafacet cysts of the cervical spine

OBJECTIVE: We report a retrospective series of 13 patients who presented with symptoms and signs caused by cervical juxtafacet cysts. Clinical findings, radiographic features, surgical management strategies, and possible causes are reported and discussed. METHODS: We reviewed clinical histories, radiographic studies, surgical notes, and pathological records of all 13 patients who underwent surgery for subaxial cervical juxtafacet cysts from 1984 to 1997 at the Mayo Clinic in Rochester, MN. During the summer of 1997, surgical outcomes were assessed by direct or telephone interview. RESULTS: Nine patients were men and four were women. The average age at the time of presentation was 66 years. One patient had undergone a previous anterior cervical fusion below the level of the cyst. Ten patients presented with radiculopathies. Two patients presented with myeloradiculopathies. One patient presented with a cervical myelopathy. Computed tomographic myelography and magnetic resonance imaging were essential in establishing a preoperative diagnosis. The cysts were located at C7-T1 in nine patients, at C4-C5 in two patients, at C6-C7 in one patient, and at C3-C4 in one patient. All patients underwent posterior laminectomy or hemilaminectomy, excision of the cyst, and decompression of the thecal sac and/or nerve root. Two patients underwent concurrent posterior fusion procedures for instability. All patients experienced good to excellent relief of their radicular pain. All three myelopathies stabilized after surgery. There were no major complications or recurrences. CONCLUSION: Juxtafacet cysts seem to be a degenerative change of the cervical spine rather than a traumatic event. Similar to their counterparts in the lumbar spine, they tend to arise in segments with increased mobility. Surgical treatment is effective.