Lumbar intraspinal synovial cysts: conservative management and review of the world's literature

Abstract

Background context Lumbar intraspinal synovial cysts are an important cause of axial and radicular spine pain. Controversy about nonsurgical versus surgical treatment persists. Purpose To evaluate the efficacy of nonsurgical management of symptomatic lumbar intraspinal synovial cysts (LISCs). Study design/setting Retrospective review set in outpatient physiatry office. Patient sample Ten patients (8 women, 2 men; average age, 60 years) with LISCs and average symptom duration of 7.9 months. Outcome measures Numerical pain rating scale (NRS-11), Roland-Morris disability outcome measure, patient satisfaction, and surgery. Methods Patients with LISCs were identified and their charts were reviewed. Those patients whose symptoms correlated with the level of LISC-induced extradural compression were eligible. All patients received conservative care and a fluoroscopic-guided lumbar spine injection. The primary author conducted telephone follow-up. Results All 10 patients had unilateral radicular pain. Seven had stable neurologic deficits. Magnetic resonance imaging and computed tomography/myelography, respectively, identified a LISC in 8 and 2 patients. Five patients had cyst aspiration followed by steroid instillation; 5 patients had cyst aspiration followed by a transforaminal epidural steroid injection. Average length of follow-up was 50.4 weeks. Only 1 patient had sustained benefit. One patient had no benefit and refused surgery. Eight patients underwent surgery and had a good result. Conclusion In our opinion, nonsurgical management in patients with LISC-induced radicular pain does not appear to be as successful as surgery.