Overview of Spinal Synovial Cysts

Spinal synovial cysts occur when synovial fluid (the fluid that normally lubricates the lining of joints) builds up under pressure and causes part of the joint capsule to bulge. This is usually the result of degenerative changes or trauma. These cysts are not uncommon, and they usually don’t cause symptoms in most people.

Spinal synovial cysts usually occur in the facet joints, the junctions that keep the vertebrae (bones of the spine) interlocking. They can occur anywhere in the spine, and most occur in the lower back (lumbar region).

symptom

For most people, synovial cysts cause no symptoms. If a synovial cyst compresses a nerve, it may cause back pain, weakness, or numbness.

Synovial cysts can affect one or both sides of the spine, and they can occur at one spinal segment or at multiple levels. The severity of symptoms depends on the size and location of the cyst.

Most of the time, cysts cause radiculopathy due to irritation of the spinal nerves.

Effects of synovial cysts include:

  • Radiculopathy symptoms occur when a cyst or inflammation of the cyst comes into contact with a spinal nerve root. This can lead to sciatica, weakness, numbness, or difficulty controlling specific muscles.
  • Neurogenic claudication (impingement and inflammation of spinal nerves) can cause cramping, pain, and/or tingling in the lower back, legs, buttocks, and buttocks.
  • If the spinal cord is involved, it can lead to myelopathy — problems with the spinal cord that cause numbness and weakness, as well as problems with balance.
  • Rarely, cauda equina-related symptoms include bowel and/or bladder problems, progressive leg weakness, and saddle anesthesia (loss of sensation in the inner thighs, buttocks, and perineum).
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Synovial cysts in the mid-back and neck are rare. When they do occur, thoracic and cervical synovial cysts can cause a range of symptoms, such as numbness, tingling, pain, or weakness.

reason

Spinal synovial cysts are often caused by degenerative changes, such as osteoarthritis, that may develop in the joints over time.

With wear, facet cartilage (the elastic material in joints that provides protection and shock absorption) erodes. During this process, the synovium may form a cyst.

Trauma large and small can also have degenerative and inflammatory effects on the joints, which can lead to the formation of synovial cysts.

About one-third of patients with spondylo-synovial cysts also have a condition called spondylolisthesis, in which the lower vertebra slides forward onto the bone below it. Spondylolisthesis is thought to lead to the formation of synovial cysts due to the reduced stability of the facet joints.

Instability can occur in any area of ​​the spine, but L4-5 are the most common levels. If instability occurs, cysts may develop. However, it is important to note that cysts can form without instability.

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diagnosis

Cysts are usually diagnosed by magnetic resonance imaging (MRI). They can also sometimes be seen on ultrasound, X-ray, or computed tomography (CT) scans.

treat

Some cysts are still so small that they cause few, if any, symptoms. Cysts only need treatment if they cause symptoms.

lifestyle changes

Your healthcare professional may recommend that you avoid certain activities that can make your symptoms worse.

You may be advised to stretch and start exercising that won’t aggravate the condition. Physical therapy or occupational therapy may also be recommended.

The intermittent use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen) may help relieve occasional pain.

Outpatient procedure

For cysts that cause significant pain, numbness, weakness, and other problems, aspiration procedures that drain fluid from the cyst may be beneficial.

In one study, researchers found that the success rates of these procedures ranged from 0% to 50%. If the fluid buildup returns, the person who has the suction usually needs to repeat the procedure.

Epidural injections of corticosteroids can reduce inflammation and may be a suitable option for significant pain relief. Patients are advised to receive no more than 3 corticosteroid injections per year.

surgical options

For more severe or persistent cases, your doctor may recommend decompression surgery to remove the cyst and surrounding bone, thereby reducing pressure on the nerve roots.

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There are several surgical options, ranging from minimally invasive endoscopic procedures to larger open procedures. The best surgical option for each patient depends on the severity of their condition and the presence or absence of associated disease.

Surgical options include:

  • Laminectomy: surgical removal of the bony structures that protect and cover the spinal canal (lamina)
  • hemilaminectomy: a modified laminectomy in which a small portion of the laminae is removed
  • Facet joint resection: With laminectomy or hemilaminectomy, the part of the affected facet joint where the synovial cyst is located is removed
  • Fusion of facet joints and vertebrae: reduces mobility in this area,

Most people experience immediate pain relief after a laminectomy or hemilaminectomy. The fusion may take six to nine months to fully heal.

if no surgery If the joint from which the cyst originated fuses, the pain may return and another cyst may develop within two years.

These surgeries are not without risks. Complications may include infection, bleeding, and spinal cord or nerve root damage.

VigorTip words

If a spinal synovial cyst is causing symptoms, there are some treatments that can help. If your cyst is not causing symptoms, your doctor will work with you to monitor for signs of degenerative disc disease, spinal stenosis, or cauda equina syndrome.

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