General Spine

Avetis, Azizyan, BS
Alexander, Khalessi, MS, MD, Non ASSR Member
Patrick, Hsieh, MD, Non ASSR Member
Alexander, Fedenko, MD, PhD, Non ASSR Member
John, L., Go, MD, Non ASSR Member
Alexander, Lerner, MD, Non ASSR Member

Excerpta

We will discuss the radiological features of PVNS in the cervical spine, its differential diagnosis, and pathological features.

Purpose

1. Present the radiological findings of the rare synovial disorder in the cervical spine.
2. Discuss the differential diagnosis based on imaging characteristics.
3. Correlate imaging with surgical and pathological findings.

Methods & Materials

The patient is a previously healthy 38 year old woman who presented with neck pain that slowly progressed over the course of several of years. She does not recall any inciting events and denies any peripheral neurological deficits. MRI of cervical spine with and without IV contrast was obtained as well as cervical spine CT.

Results

CT and MRI revealed a solitary lesion arising from the left atlantoaxial facet joint measuring 3.2cm in its longest dimension. There were associated erosions of adjacent osseous structures including partial erosion of the odontoid process. The mass was found to be hypointense on T1 and T2 weighted images and demonstrated heterogeneity on T2 weighted images. On CT the lesion was mildly hyperdense with attenuation similar to adjacent soft muscle, without evidence of calcification.
An open biopsy was preformed. Final diagnosis was pigmented villonodular synovitis.

Conclusion

PVNS of the axial spine is a rare disease and presents with several diagnostic difficulties. This paper will demonstrate the radiological manifestations of this entity in the spine with a demonstration of the pathology seen and a differential diagnosis for intra-articular lesions of the spine.

References/Financial Disclosures

Finn MA, McCall TD, Schmidt MH. Pigmented villonodular synovitis associated with pathological fracture of the odontoid and atlantoaxial instability. Case report and review of the literature. J Neurosurg Spine 2007;7:248â