Toward Clarity of Management Options in Spinal Synovial Cysts

Abstract

Synovial cysts represent an uncommon cause of spinal stenosis. However, their frequent association with back pain and radicular symptoms and the relative ease of diagnosis via magnetic resonance imaging make them an increasingly prevalent diagnosis for many patients. The current article in this issue of WORLD NEUROSURGERY by Bydon et al., entitled “Treatment of Synovial Cysts,” provides a thorough review of treatment options for patients with synovial cysts. The authors’ description of conservative treatment covers both observation and steroid injections. A case can certainly be made for observation in patients with mild symptoms and is clearly appropriate in patients with small, asymptomatic, incidentally discovered cysts. Although reliable data regarding the overall incidence of spontaneous cyst regression are lacking (there are case reports, but no higher-level evidence regarding the true frequency of cyst regression), most of us in the field have observed this phenomenon in our patients now and then. Whatever the exact percentagesmightbe,wecanreliablycounselourpatientsthatarelatively