Lumbar Intraspinal Synovial Cysts Research Articles

Long Term Radiological and Clinical Outcome of Symptomatic Lumbar Intraspinal Synovial Cyst: A Retrospective 4-Year Study.

To examine the prevalence of symptomatic lumbar synovial facet cysts in lumbar spinal magnetic resonance imaging (MRI) of patients who admitted to neurosurgery clinic, retrospectively. Also, we aimed to report the clinic and radiologic outcome of patients with symptomatic spinal synovial cyst, who undergo conservative treatment. One thousand two hundred forty-three patients who admitted to Ordu University Neurosurgery outpatient clinic between 2015-2019 and underwent lumbosacral MRI and lumbosacral computed tomography examinations were reviewed retrospectively. The disappearance of cysts during radiologic follow up was accepted as spontaneous complete resolution, besides reduction in cyst dimensions and/or contrast enhancement were considered as radiologic regression. Decrease in radiculopathy, back pain and neurologic deficit complaints were also considered as clinical improvement. Thirteen patients (8 men, 5 women) with lumbar synovial cysts who admitted to the neurosurgery outpatient clinic with low back and radicular pain complaints were included in the study. Nine patients (69.2%) had clinical and radiological improvement, 1 female patient (7.7%) was operated due to the leg pain, progressive motor deficit and lumbar disc hernia. Radiological spontaneous complete resolution was detected in 3 patients (23.1%). Spontaneous complete resolution period was determined between 3 months to 24 months. The symptomatic lumbosacral synovial cyst treatment algorithm has not been fully demonstrated. However, as in our series, spontaneous complete resolution of cysts and effectiveness of conservative treatment in symptomatic patients should not to be underestimated and immediate invasive procedures should be postponed.

A Staged Treatment of Symptomatic Lumbar Intraspinal Synovial Cysts

Background: Lumbar intraspinal synovial cyst (LISC) refers to a cyst that arises from the zygapophyseal joint capsule of the lumbar spine and contains serous or gelatinous fluid. In cases of LISCs resistant to conservative treatments, various minimally invasive percutaneous spinal techniques (MIPSTs) may be applied prior to open surgery. Objectives: The outcomes of 3-staged MIPSTs for the treatment of symptomatic LISCs resistant to conservative treatments were evaluated. Study Design: An institutional review board approved retrospective chart review. Setting: University hospital inpatients referred to our pain clinic. Methods: Review of charts of all patients who underwent MIPSTs for symptomatic LISCs resistant to conservative treatments during a time period of 13 years at a university hospital pain clinic. Patients with symptomatic LISCs resistant to conservative treatments were treated with 3-staged MIPSTs, including image-guided intraarticular aspiration, cyst distention and rupture, and injection of corticosteroids (ARI), endoscopic cyst enucleation (ECE), and endoscopic superior facetectomy (ESF) by a single pain specialist. A symptom-free period after each intervention was evaluated. Recurrence was defined as the same recurrent symptomatic radicular pain with confirmation of the LISC on magnetic resonance imaging. All patients with a minimum follow-up time of 3 years were included. Results: Of the 40 patients who underwent ARI, 3 patients failed to complete a follow-up and 19 patients (51.4%) who had recurring symptoms received ECE. Ten patients (52.6%) who had rerecurring symptoms after ECE received ESF. There was no recurrence after ESF. Limitations: This retrospective and observational study with a limited number of patients does not represent a high level of evidence. Conclusions: This information provided the recurrence rate after each intervention. Half of the patients who went on to receive ARI experienced recurrence, whereas half of the patients with recurrence who received ECE experienced re-recurrence. ESF treatment resulted in no recurrence within the 3-year study period. Key words: Conservative treatment, endoscopic surgical procedures, facet joint, intraarticular injection, minimally invasive surgical procedures, needle biopsy, nerve root compression, radiculopathy, synovial cysts

A case of lumbar intraspinal synovial cyst containing gas

A case of lumbar intraspinal synovial cyst containing gas

Postlaminectomy Bilateral Lumbar Intraspinal Synovial Cysts.

Lumbar intraspinal synovial cysts are included in the difference diagnosis of lumbar radiculopathy. Developing imaging modalities has result in increased reporting about these lesions. However, the case of bilateral new lumbar intraspinal synovial cysts after laminectomy has been rarely reported. We report of a rare case with bilateral lumbar intraspinal synovial cysts after laminectomy, requiring surgical excision.

Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases.

The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach. All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times. There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m(2). Sixty-nine percent (9 of 13) of the cysts were at L4-5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series. The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.

Hemilaminoplasty for the treatment of lumbar intraspinal synovial cysts (LISCs) and literature review.

The present report intended to introduce the hemilaminoplasty technique and evaluate the efficacy of our surgical procedure for LISCs. This retrospective study was conducted to analyze the results in 24 LISCs who had undergone our hemilaminoplasty between 2000 and 2012 in two hospitals. All were confirmed by pathological histology and mid- to long-term follow-up had been performed in all cases with a mean of 4.9years. Using the Japanese Orthopedic Association scoring system (JOA score) and visual analog scale (VAS), symptoms resulting from cyst compression were quantified at various stage for statistical analysis. The JOA score and VAS of back/leg pain following surgery were improved significantly (P<0.01). At final follow-up, with normal aging there was a little decrease in JOA score and VAS of back/leg pain, but still significantly improved (P<0.01). Similarly, mean improvement rate of JOA was 83.5% at 1year after surgery while 75.6% at final visit. Successful bone healing was obtained at a mean of 3.8months after surgery. No cyst reformation and recurrent back/leg pain were observed around the surgical sites. These lesions could be regarded as a result of facet arthrosis/instability and repetitive facet minor trauma with herniation of synovium through the defective joint capsule. Improvement in lumbago and leg pain may be a consequence of complete cyst resection via hemilaminoplasty plus partial facetectomy with anatomical reconstruction of the posterior spinal elements.

Lumbar intraspinal synovial cyst with urine incontinence: A case report and review of the literature

Synovial cysts are rarely observed in cases with epidural compressive syndromes. They are intraspinal lesions that may mimic disc hernias by causing radicular symptoms. A 28-year-old female patient presented with radicular complaints such as back pain for 6 months, urinary incontinence for 1 month, and progressive right leg pain and numbness for the last 2 weeks. Physical examination revealed weakness (4/5) in gastrocnemius muscle, right L5-S1 hypoesthesia, and urinary incontinence. On magnetic resonance imaging, an intraspinal cyst was seen at the level of L5-S1. The patient was operated with bilateral L5 hemipartial laminectomy, foraminotomy, and cyst excision. Her symptoms, especially urinary incontinence, regressed at the early postoperative period and completely disappeared together with normal motor and sensory examination findings at the control visit at 1 year.

Spontaneous resolution of a symptomatic synovial cyst of the lumbar spine

We present a case of spontaneous resolution of a lumbar intraspinal synovial cyst. We discuss the management options, including conservative management.

Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review

This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Although the relevant reports in the international literature are increasing, the controversy about conservative versus surgical treatment and the need for concomitant fusion still exists. Data from seven patients (age range 58-69 years, mean age 61 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concomitant local pathology, treatment and results of treatment were recorded. A follow-up of at least 6 months (range 6-48 months) was conducted and results were noted. All patients had back pain, while five also experienced unilateral radicular leg pain and one had bilateral leg pain. One patient had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. No fusion was performed. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. Review of the literature revealed a trend towards surgery, as this is correlated to a more favorable outcome compared with conservative treatment. Fusion should be performed on a case-by-case basis only. Surgery is a safe and effective treatment choice in this increasingly appearing ailment. A prospective, randomized trial should clarify issues under debate.

脊柱管内滑膜嚢腫５症例の治療経験

We reviewed the clinical presentations, radiological studies, and operative and histologic findings in five patients with lumbar intraspinal synovial cysts treated surgically. The mean age at operation was 51.6 years, and the mean follow-up period was 16 months. All patients presented with radiculopathy and one with cauda equina syndrome. Ring enhancement was characteristic to diagnosis by magnetic resonance imaging. Most of the lumbar intraspinal synovial cysts were associated with significantly degenerated facet joints. Surgical decompression and resection of the synovial cysts were successful for relieving symptoms completely.

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

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.

Poster 67: Lumbar intraspinal synovial cyst: a case report

Setting: Tertiary medical center physical medicine and rehabilitation unit. Patient: A 67-year-old woman with intractable right lower-extremity pain and paresthesias. Case Description: The patient presented with a 2 month-history of acute onset right buttock pain with radiation into calf and foot. She also had numbness and tingling in her right foot. There was no trauma or unusual activity, however, she had subtle right leg discomfort for many years prior to onset of pain. The patient had no subjective weakness or difficulty in bowel or bladder control. Neurologic examination revealed absent right ankle jerk and reduced sensation in S1 distribution. Motor strength was normal. Lumbar spine magnetic resonance imaging (MRI) revealed a juxta-facet intraspinal synovial cyst at the right L5-S1 level. This caused deformity and compression of the right S1 nerve root. There were also smaller extraspinal synovial cysts at L5-S1 level posteriorly. Assessment/Results: The patient underwent right L5 partial, inferior hemilaminectomy, L5-S1 medial facetectomy, foraminotomy of the S1 nerve root, and gross total resection of the L5-S1 level synovial cyst. Postoperatively, she reported relief of right lower-extremity pain for several hours. She then developed recurrence of right leg pain without weakness. MRI revealed hematoma formation at the operative bed. The hematoma was evacuated promptly, resulting in complete resolution of symptoms. Discussion: This case represents a classic presentation of a large intraspinal synovial cyst causing radiculopathy and outcome of surgical excision with the infrequent postoperative complication of hematoma. Conclusion: Intraspinal synovial cysts can cause intractable radicular pain. MRI studies are warranted for intractable radiculopathies.

Symptomatic intraspinal synovial cysts of the lumbar spine: correlation of MR and surgical findings.

The purpose of the study was to determine the frequency of associated MR imaging findings in patients with symptomatic lumbar intraspinal synovial cysts, and to correlate MR with surgical findings. MR imaging studies of 18 patients with surgically and histopathologically proven lumbar intraspinal synovial cysts were retrospectively analyzed and correlated with surgical findings. The diameters of the synovial cysts ranged from 10 mm to 28 mm, with a mean of 16 mm. A nonhemorrhagic cyst was found in 15 patients (83%), and a hemorrhagic cyst in three patients (17%). Degenerative spondylolisthesis was found in six patients (33%) at the level of the synovial cyst, with displacement ranging from 3 to 5 mm, mean 4 mm. Surgery revealed instability and hypermobility of the facet joint at the level of the synovial cyst in all patients with degenerative spondylolisthesis, and in five additional patients. Symptomatic synovial cysts of the lumbar spine were associated with degenerative spondylolisthesis in six of 18 patients (33%) and with instability of the facet joint in 11 (61%). These findings may support the theory that increased segmental motion plays a role in the pathogenesis of synovial cysts.

Lumbar intraspinal synovial cyst containing gas as a cause for low-back pain

To discuss intraspinal synovial cysts caused by degenerative changes involving the posterior articular facets in the lumbar spine and to provide differential considerations for patients with low-back pain. A 70-year-old man with low-back and gluteal pain demonstrating eventual progression of radiating pain into the left thigh, calf, ankle, and foot over a 5-month period. Radiographs of the lumbar spine revealed mild degenerative disk disease at L5-S1 with associated vacuum phenomena of the L5 disk. Degenerative osteophytes were present at L3, L4, and L5. Moderate posterior joint arthrosis was evident at L4-L5 and L5-S1. Computed tomography and magnetic resonance imaging studies revealed an intraspinal gas-containing synovial cyst at the left lateral aspect of the central canal at the level of the left L4-L5 facet articulation. The patient underwent surgical excision of the synovial cyst with remission of symptoms. Gas-containing intraspinal synovial cysts can be a significant finding and a causative factor in patients with low-back pain and pain radiating into the lower extremities. Both computed tomography and magnetic resonance imaging are important in defining intraspinal synovial cysts as a cause of back pain in patients whose low-back pain does not respond to chiropractic care.

Lumbar intraspinal synovial cyst containing gas as a cause for low-back pain

Objective: To discuss intraspinal synovial cysts caused by degenerative changes involving the posterior articular facets in the lumbar spine and to provide differential considerations for patients with low-back pain.Clinical Features: A 70-year-old man with low-back and gluteal pain demonstrating eventual progression of radiating pain into the left thigh, calf, ankle, and foot over a 5-month period. Radiographs of the lumbar spine revealed mild degenerative disk disease at L5-S1 with associated vacuum phenomena of the 1.5 disk. Degenerative osteophytes were present at L3, L4, and L5. Moderate posterior joint arthrosis was evident at L4–L5 and L5-S1. Computed tomography and magnetic resonance imaging studies revealed an intraspinal gas-containing synovial cyst at the left lateral aspect of the central canal at the level of the left L4–L5 facet articulation.Intervention and Outcome: The patient underwent surgical excision of the synovial cyst with remission of symptoms.Conclusion: Gas-containing intraspinal synovial cysts can be a significant finding and a causative factor in patients with low-back pain and pain radiating into the lower extremities. Both computed tomography and magnetic resonance imaging are important in defining intraspinal synovial cysts as a cause of back pain in patients whose low-back pain does not respond to chiropractic care.

Lumbar nerve root compression by intraspinal synovial cysts. Report of 8 cases.

We evaluated the clinical appearance and results of surgical treatment in 8 patients with leg symptoms due to a lumbar intraspinal synovial cyst. The most frequent symptom was radicular leg pain due to unilateral single-root compression affecting the L5 or S1 nerve root. There were 2 cases with large cysts causing compression of the cauda equina, with spinal claudication as the main symptom. All cysts arose from arthrotic facet joints. Surgical excision gave good results and no recurrences have been noted 0.5-2 years postoperatively.

Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment.

This study analyzed the clinical history, physical examination, diagnostic studies, and operative and histologic findings in 19 patients with lumbar intraspinal synovial and ganglion facet cysts evaluated and treated over a 10-year period. The results were correlated to provide a greater understanding of lumbar facet cysts and rationale for conservative or surgical treatments. The 19 patients included 13 women and 6 men ranging in age from 38 to 79 years. 84.4% of the patients presented with radicular pain. 26.3% had significant motor deficit. 68.4% of the facet cysts were found at L4-L5, 21.1% at L5-S1, 5.2% at L1-L2, and 5.2% at L2-L3. The clinical history and findings on physical examination, standard radiography, myelography, computed tomography-myelography, facet arthrography, post-facet arthrograph computed tomography, magnetic resonance imaging with and without contrast, and computed tomography scans were reviewed. Bilobed cysts were found on both dorsal and ventral aspects of the involved facet joints within and outside of the spinal canal on facet arthrography, computed tomography, magnetic resonance imaging, and at the time of surgery in more than 60% of the patients. Significant facet degeneration was found in 75% of standard radiographs, and on all of the magnetic resonance imaging and computed tomography scans. In six patients, symptoms improved with rest, medication, and bracing. Epidural corticosteroid injections provided short-term relief in three out of four patients. Facet corticosteroid injections provided good relief in one, partial relief in one, and no relief in one patient. Surgical decompression in eight patients resulted in three excellent, four good, and one fair outcome. Most of the lumbar intraspinal facet cysts were associated with significantly degenerated facet joints. Patients with intraspinal facet cysts may respond to conservative treatments if there is no significant neurologic deficit. Surgical decompression and removal of large facet cysts usually are successful in relieving symptoms.

Bilateral lumbar intraspinal synovial cysts: Gd-enhanced MRI

We report a case of bilateral synovial cysts at L4–L5 level, examined by myelography, computed tomography (CT) and magnetic resonance imaging (MRI). On myelography, the lesions appeared as extradural masses. On CT, the lesions were cystic, with calcifiedd walls and were in close proximity to the facet joints. On MRI, the cystic nature of the lesions was confirmed. The wall appeared hypo-intense both on T1- and T2-weighted images (WI), and enhanced after intravenous administration of Gadolinium-DTPA (Gd-DTPA). This enhancement is thought to represent the peripheral fibrous capsule of the lesion and might be of importance both in the detection and the differential diagnosis of these lesions.

Self-assessment questions forboard/FRCS (Orth) examinations: Knox A.M., Fon G.T. The appearance of lumbar intraspinal synovial cysts. Clin Radiol 44; 1991; 397-401

Self-assessment questions forboard/FRCS (Orth) examinations: Knox A.M., Fon G.T. The appearance of lumbar intraspinal synovial cysts. Clin Radiol 44; 1991; 397-401

The appearances of lumbar intraspinal synovial cysts

Intraspinal synovial cysts most commonly occur in the lower lumbar spine and may cause radicular symptoms. Eight symptomatic patients are described, each of whom had a single synovial cyst with associated facet joint degeneration. Four were at the L4-5 level and two each at L3-4 and L5-S1. Myelography in four patients revealed a posterolateral indentation on the contrast column in each case. Computed tomography (CT) revealed a structure of similar or greater density than the thecal sac in six cases and of gas density in one case. Two of the former cases also contained gaseous elements, three cases had a mildly dense rim and in the eighth case calcification was demonstrated within the cyst. One cyst resolved after facet joint injection with local anaesthetic and steroid.