Lumbar Synovial Cysts Research Articles

151. An Independent Assessment of Long Term Outcomes Following Decompression for Lumbar Synovial Cysts

151. An Independent Assessment of Long Term Outcomes Following Decompression for Lumbar Synovial Cysts

CT Guided Aspiration of a Cervical Synovial Cyst

Synovial cysts are cystic dilations of synovial sheaths with or without anatomical continuity within a joint space that occasionally involve the lumbar spine. Image-guided aspiration has been used successfully in the management of lumbar synovial cysts. Synovial cysts of the cervical spine are rare, tend to present with myelopathic symptoms, and are classically treated using operative intervention.We report a novel approach for cervical synovial cyst aspiration under CT guidance. A 66-year-old woman presented to the clinic complaining of severe pain, tingling, and dysesthesia in her right upper extremity in the C5, C6 and C7 nerve root distribution. MR imaging of her cervical spine showed a synovial cyst within the right C6-C7 neural foramen with significant compression and obliteration of the C7 nerve root. The patient underwent CT-guided aspiration of the cyst using a double needle technique, where one needle was used to open up the epidural space while another aspirated the cyst. This was followed by epidural injection of local anesthetic and steroids. Immediately after injection, the patient experienced complete relief of her right forearm pain, tingling, and dysesthesias. The patient tolerated the procedure well and there were no postprocedure complications. At four year follow-up the patient is free of any symptoms. Image-guided aspiration of cervical synovial cysts is feasible using CT fluoroscopy. Aspiration of these cysts combined with epidural steroid injection can provide long-lasting symptomatic relief in some patients.

Microdecompression for lumbar synovial cysts: an independent assessment of long term outcomes

BackgroundOutcomes of surgical intervention for lumbar synovial cysts have been evaluated in the short and intermediate term. Concerns regarding cyst recurrence, the development of late instability at the involved level, and instability/stenosis at adjacent levels (when concomitant) fusion is performed suggest that long term follow-up is needed. This study aims to fill that void.MethodsForty-six patients operated by a single surgeon not involved in the study were followed up long term at an average of 9.7 years (range 5 to 22 years) post-operatively. All patients underwent decompression (+/- concomitant arthrodesis in the presence of associated degenerative spondylolisthesis) using the operative microscope for magnification/illumination. Outcomes were assessed using a customized questionnaire evaluating: relief of pain/claudicant symptoms, numbness/parasthesias, and weakness; as well as late onset low back pain, new radicular symptoms, need for additional surgery, and patient satisfaction. Outcomes in patients with or without fusion were compared as well.Results87% of patients noted resolution of their pre-operative pain, numbness, and weakness. 28% of patients developed late onset low back pain. 17% developed late onset radicular symptoms in a new nerve root distribution. 15% required subsequent additional surgery. 89% of patients were satisfied with the surgical outcome. No differences were found for any outcome measure between patients undergoing concomitant fusion and those undergoing decompression alone using the two-sample t-test.ConclusionThis study provides outcome data at an average of nearly ten years post-operative. This information should allow surgeons to provide realistic expectations for their patients regarding outcomes and should enhance the informed consent and surgical decision-making process.

Spinal Synovial Cysts and Intersegmental Instability: A Chiropractic Case

Objective This article presents a case in which synovial cysts appeared to cause compromise of the neural foramina and thecal sac with presenting neurological signs. Clinical Features A 67-year-old female patient with a history of lumbar synovial cysts and synovectomy presented with recurrence of bilateral low back, leg pain, and apparent neurological compromise along with a recurrence of lumbar synovial cyst as evidenced on magnetic resonance images. Interventions and Outcome Flexion distraction therapy, performance of Williams low back exercises and interferential therapy resulted in 50% relief. Frequency of care was progressively diminished as she improved. The patient experienced recurrence of severe episodes; multifidi strengthening exercises were provided to address a concomitant spondylolisthesis and instability, resulting in a cessation of these episodes and improvement in functional activities. Conclusion Distraction therapy seemed to alleviate the constant pain without surgical intervention. In this case, the synovial cyst may have been an incidental finding versus a primary cause of the low back and leg pain. For similar patients, in the absence of correlative progressive neurological signs, surgical intervention may not be necessary.

Synovial Cyst: An Uncommon Cause of Back Pain

Synovial cyst is an uncommon cause of back pain and radiculopathy. This case report describes the magnetic resonance imaging findings of two lumbar synovial cysts with special emphasis on the differential diagnoses of other extradural cystic lesions.

Treatment of lumbar synovial cysts using minimally invasive surgical techniques

Lumbar synovial cysts are a potential cause of radiculopathy and back pain, and the definitive treatment is the complete excision of the cyst. This report summarizes the authors' preliminary clinical experience with the minimally invasive resection of lumbar synovial cysts. Nineteen patients (nine men and 10 women) with symptomatic synovial cysts underwent minimally invasive resection. The mean patient age was 64 years of age (range 43-80 years). The presenting symptom was radiculopathy in 16 patients, low-back pain in two, and lower-extremity weakness in one. There were 16 cases of a cyst located at the L4-5 level, two at L3-4, and one at L5-S1. The mean cyst diameter was 13.7 mm (range 3-30 mm). The mean follow-up time was 16 months (range 4-29 months). Clinical outcomes were graded, based on the Macnab modified criteria, as excellent, good, fair, or poor. Eighteen patients (95% of cases) reported either excellent (10 patients) or good (eight patients) results, and a fair result was reported by one patient (5% of cases). The mean operative time was 158 minutes (range 75-270 minutes), and the average intraoperative blood loss was 31 ml (range 10-100 ml). Two patients had intraoperative dural tears that resulted in cerebrospinal fluid leaks that resolved following primary closure. Synovial cysts can be safely and effectively treated using minimally invasive surgical techniques. Long-term follow up is required to determine whether this approach results in less need for fusion than conventional surgical approaches.

Degenerative disease of the lumbar spine

In the past 15 years there has been an explosion of technical advances in the management of degenerative disease of the lumbar spine. From a conceptual point of view it has become apparent that in certain circumstances augmentation of pedicle screw fixation with transforaminal interbody fusion of the lumbar spine produces results that are superior to pedicle screw fixation alone in terms of success of the operation and patient satisfaction. Intraoperative image guidance has made the placement of lumbar instrumentation safer and more accurate. In the final analysis, the development of less invasive approaches to decompression and fusion of the lumbar spine has resulted in less postoperative pain, shorter hospital stays, decreased costs, and better preservation of the paraspinous musculature. In this issue of Neurosurgical Focus, specific aspects of these advances are discussed. Minimally invasive surgical techniques for the excision of lumbar synovial cysts as well as for the placement of pedicle screws and the performance of transforaminal lumbar interbody fusion are described. The use of new and conventional intraoperative imaging is integral to the procedures detailed in several of these articles. The technical note on the management of high-grade spondylolisthesis represents a novel approach to a difficult problem. The advances described in most of these articles would not have been imagined 25 years ago, and it is likely that 10 or 15 years from now, technical and conceptual advances will be even more far-reaching. We live in exciting times.

Spinal lumbar synovial cysts. Diagnosis and management challenge

Sophisticated and newer imaging capabilities have resulted in increased reporting and treatment options of spinal lumbar synovial cysts (LSS). Most of the patients with lumbar cysts tend to be in their sixth decade of life with a slight female predominance. The incidence of LSS is thought to be less than 0.5% of the general symptomatic population. They may be asymptomatic and found incidentally or the epidural growth of cysts into the spinal canal can cause compression of neural structures and hence associated clinical symptoms. Most of the symptomatic LSS patients present with radicular pain and neurological deficits. Spinal synovial cysts are commonly found at L4-5 level, the site of maximum mobility. They may be unilateral or bilateral and at one or multilevel. MRI is considered the tool of choice for its diagnosis. The etiology of LSS is still unclear, but underlying spinal instability, facet joint arthropathy and degenerative spondylolisthesis has a strong association for worsening symptoms and formation of spinal cysts. Synovial cysts resistant to conservative therapy should be treated surgically. Resection and decompression with or without fusion and instrumentation remains an appropriate option. Synovial cysts may recur following surgery. The optimal approach for patients with juxtafacet LSS remains unclear. The best surgical treatment option for each particular individual should be tailored depending upon the symptoms, radiological findings and other co morbidities.

Lumbar Synovial Cyst

A 48-yr-old man developed insidiously stabbing pain in the right posterolateral thigh and calf over a 7-mo period. Symptoms progressively worsened, accompanied by intermittent numbness in the same distribution. He denied weakness and bowel or bladder dysfunction. Aggravating factors included standing, walking, prolonged sitting, and Valsalva maneuver. Supine lying alleviated his pain. On physical examination, the patient had 2+ symmetric patellar and Achilles reflexes, normal 5/5 lower limb strength in all major muscle groups, and intact vibratory, light touch, and pinprick sensation in all lower limb dermatomes. Bilateral seated and supine straight-leg raises were negative. Magnetic resonance imaging demonstrated normal vertebral body height, alignment, and marrow signal. On T2-weighted images, L4-L5 disk dessication was noted. Severe facet joint arthropathy was present at L4-L5, associated with a synovial cyst extending medially, causing moderate central canal stenosis and compromise of the right L5 nerve root (Fig. 1). L5-S1 mild facet arthropathy was also noted (Fig. 2).FIGURE 1: T2-weighted magnetic resonance image of lumbar spine, axial image. A large synovial cyst arising from the right facet joint causes marked indentation of the thecal sac with nerve-root deviation.FIGURE 2: T2-weighted magnetic resonance image of the lumbar spine, sagittal image. L4-L5 synovial cyst is seen.The patient underwent a trial of neutral-based spine stabilization exercises, nonsteroidal anti-inflammatory medication therapy, and flexion/distraction manual therapy. Given the persistence of his radicular symptoms, a fluoroscopically guided L4-L5 synovial cyst aspiration was performed. At the same session, this was followed by an intraarticular right L4-L5 facet lidocaine/corticosteroid injection and a selective segmental right L5 epidural. Two weeks after aspiration and injection, the patient reported an 80% reduction in right leg pain, a marked improvement in function, and an ability to perform stabilization exercises. Eight weeks after the procedure, continued functional improvement was noted. Synovial cysts most commonly involve the joints of the limbs. Intraspinal synovial cysts are found uncommonly. They can serve as a cause of lumbar radiculopathy and low back pain. The pathogenesis of lumbar zygapophyseal joint cysts is unclear, but most cases are related to degenerative changes. There seems to be a relationship to abnormal and increased motion of the involved segment, most commonly at L4-L5, followed by L5-S1. Facet synovial cysts are frequently associated with degenerative spondylolisthesis.1 Some lumbar synovial cysts may be associated with trauma. Less common ganglion cysts can be seen in the same location but are differentiated by their lack of a synovial lining. Magnetic resonance imaging is the neuroradiographic technique of choice for imaging extradural spinal masses. A combination of its signal characteristics and site of the cyst enables an accurate diagnosis to be made on magnetic resonance imaging in the majority of cases.2 Slipman and Chow3 reported good or excellent results in 30% of patients with zygapophyseal joint cyst-induced radicular pain who were treated with the percutaneous manner above. Given the possible loculations and viscous nature of the cystic material, Lutz and Shen further recommended using a 20-gauge needle with a 10-ml syringe for aspiration.1 Surgical decompression and excision of the cyst remain the definitive treatment of choice for patients with intractable pain or significant neurologic deficit, unresponsive to nonoperative care. As synovial cysts reflect disruption of the facet joint and some degree of instability, decompression and primary fusion should be considered to improve operative results for patients with coexistent lumbar synovial cysts and degenerative spondylolisthesis.4

Retrospective study of 77 patients harbouring lumbar synovial cysts: Functional and neurological outcome

Synovial cysts represent an uncommon and probably underestimated pathological entity of the degenerative lumbar spine. The authors report a retrospective analysis of the clinical presentation, radiological studies and operative findings in 77 patients surgically treated for symptomatic lumbar synovial cysts at their institution. Between January 1992 and June 1998, a total of 77 patients presenting with symptomatic lumbar synovial cysts were operated on in the author's department. Operative procedure, complications, results and pathological findings were correlated with preoperative assessment. There were 41 men and 36 women with an average age of 63 years (range 44-90 years). On the basis of their symptom complex on presentation, two populations were identified: patients who presented with a single radicular pain (group I = 51 patients), and patients who presented with bilateral neurogenic claudication (group II = 26 patients). Neurological examination on presentation demonstrated motor deficit (12%), sensory loss (26%) and reflex changes (35%). Degenerative disc disease and facet joint osteoarthritis was a frequent finding in patients with pre-operative MRI. Facet joint orientation was >45 degrees in 76.6% of patients. Preoperative spondylolisthesis was found in 48% on radiological studies. All the patients were treated surgically with resection of the cyst. No fusion was performed as a first line procedure. However subsequent fusion was necessary in one patient who developed symptomatic spondylolisthesis. Mean follow-up period was of 45 months ranging from 18 to 105 months. Only one recurrence occurred during the follow-up period. An excellent or good functional outcome was seen in 97.4% of cases, and 89% of the patients with motor deficit recovered. Surgical resection of lumbar synovial cysts is an effective treatment associated with very low morbidity. Synovial cysts are associated with increased grade and frequency of facet joint asteoarthritis but not with increased grade or frequency of degenerative disc disease compared with patients without cysts. In the author's opinion, at the present time, there is no reliable criterion which allows the development of a symptomatic spinal instability to be predicted in patients with a preoperative spondylolisthesis and therefore fusion as a first line procedure is still debatable.

Hemorrhagic lumbar synovial facet cyst secondary to anticoagulation therapy

Background context Acute onset of radicular symptoms has been reported following hemorrhage into lumbar synovial cysts after trauma or in cases of spinal instability. No previous cases have been linked to anticoagulation therapy. Purpose To present a case of symptomatic hemorrhagic lumbar synovial cyst occurring after anticoagulation therapy. Study design A case report and review of the literature. Methods A patient presented with low back and radicular pain secondary to a large synovial facet cyst. Magnetic resonance imaging revealed a large facet cyst compressing the thecal sac and L3 exiting nerve root. Results The synovial cyst was excised during a lumbar decompression and fusion. Gross blood was present in the cyst. Conclusions This is the first reported case of symptomatic hemorrhagic lumbar facet cyst associated with anticoagulation therapy.

Epidural hematoma secondary to a rupture of a synovial cyst

Background content With modern advances in imaging studies, synovial cysts are becoming more evident as a common component of erosive lumbar degenerative disc disease causing spinal stenosis and radiculopathy. Whereas hemorrhage can occur inside the cyst and is reported, rupture causing epidural hematoma is a rare complication and finding of this disorder. Purpose To report a rare clinical presentation of a synovial cyst and spinal stenosis, where rupture of the cyst leads to an early cauda equina syndrome. Study design Case report with a review of literature. Methods Clinical history, physical findings, and magnetic resonance imaging studies of a patient with an intraspinal synovial cyst at L4-5 1 week before a sudden worsening of symptoms are reported. Results A case report is presented of a male with a known synovial cyst at L4-5, presenting initially with neurogenic claudication. This patient developed sudden worsening of symptoms with bilateral lower extremity pain, weakness, and radiculopathy with difficult voiding. The patient had developed an epidural hematoma, secondary to rupture of a synovial cyst, documented at surgical decompression. Conclusions Although synovial cyst associated with erosive facet and erosive degenerative disc disease are common, rupture of the cyst is not. A case report of a ruptured synovial cyst leading to an early cauda equina syndrome is presented. This case illustrates the spectrum of clinical features and presentations possible with spinal stenosis complicated by lumbar synovial cyst formation.

Symptomatic Epidural Hematoma Caused by Lumbar Synovial Cyst Rupture: Report of Two Cases and Review of the Literature

Juxtafacet cysts of the lumbar spine are a recognized cause of back pain, radicular symptoms, neurogenic claudication, and, less often, cauda equina compression syndrome. Hemorrhagic rupture of a juxtafacet cyst and the resulting epidural hematoma may cause chronic and/or acute cauda equina compression. We report two cases of ruptured hemorrhagic lumbar synovial cysts resulting in epidural hematoma and progressive symptomatic cauda equina compression. Surgical excision of the epidural hematoma and the associated cyst resulted in complete resolution of symptoms. Rarely, juxtafacet cysts of the lumbar spine may rupture and hemorrhage into the epidural space causing symptomatic cauda equina compression. It is important to consider this entity when evaluating the patient with cauda equina compression. The findings of these cases give insight into the clinical presentation, operative treatment, and outcome in these patients.

Lumbar Synovial Cysts of the Spine

Our aim was to study the outcomes and results of surgically treated patients with synovial cysts of the lumbar spine in our institution. Retrospective data from 39 consecutive patients, treated during the period of December 1996 to August 2004, were analyzed. Twenty-eight men (70%) and 11 women (30%) of mean age 63.3 years were studied. All pre- and postoperative signs, symptoms, extension/flexion radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) with or without myelography were reviewed. All underwent surgery for synovial cysts with excision and decompression. Additional fusion in 26 patients was performed; 22 of them had degenerative spinal spondylolisthesis. Nine (23%) patients had prior decompression procedures, with three (8%) having had prior spinal instrumentation. Surgical outcomes were evaluated according to a questionnaire scoring system (scale of 1-4; 4 = excellent, 3 = good, 2 = fair, 1 = poor). Various preoperative attributes such as gender, age, weight, and height were analyzed to see if they had any effect on the outcome of surgery. Modified musculoskeletal outcomes data evaluation and management system (MODEM), questionnaire was provided to all; 24 (62%) responded. The following categories were determined: excellent (<20), very good (21-40), good (41-60), fair (61-80), and poor (81-100). Postoperative complications were also recorded. All patients had pain in their lower extremities, with 62% experiencing pain bilaterally. Ninety-five percent had pain in their back and 36% in the buttocks (36%). Eighteen (46%) patients had CT myelography. A total of 42 cysts were found. Two patients had bilateral cysts at L4-L5 level. Histology revealed two hemorrhagic cysts. The average duration of surgery was 231 minutes (range 92-391 minutes), and a mean blood loss of 930 mL (range 200-2500 mL) was recorded. Two operative dural tears and one postoperative wound dehiscence were observed. One patient had a recurrent synovial cyst at the site of original surgery. Eight patients (four each in the fusion and nonfusion group) had junctional degeneration and symptoms. A regression analysis performed on age, height, weight, and gender showed that they were not determining factors of surgical outcome. Surgery of spinal cysts at L4-L5 segment produced good and those at L5-S1 and multilevel excellent results. Patients with spinal segment fusion had superior outcomes, with 80% having excellent or good outcomes versus approximately 70% without fusion. With the modified MODEM questionnaire, 22 of the 24 (92%) patients scored between excellent, very good, and good. Two patients scored in the fair range, and none of the 24 patients scored in the range of poor. Spinal cysts are commonly found at the L4-L5 level, the site of maximum instability. MRI is the tool of choice for diagnosis. The etiology is still unclear, but underlying spinal instability has a strong association for formation of spinal cysts and worsening symptoms. Synovial cysts resistant to conservative therapy should be treated surgically. Resection and decompression with fusion remain an appropriate option. The optimal approach for patients with juxtafacet cysts remains unclear. The best surgical treatment approach for each particular individual appears to remain speculative.

Lumbar Synovial Cyst as a Cause of Low Back Pain and Acute Radiculopathy: A Case Report

The authors report the case of a 69-year old female with a persistent history of low back pain. Plain lumbar radiographs, performed at symptom initiation, revealed lumbar spondylolisthesis. Low back pain was attributed to this, and the patient received conservative treatment with partial relief of symptoms. Four years later, and as a result of acute onset of radicular symptoms, a lumbar spine magnetic resonance imaging scan was performed, revealing an epidural cystic lesion. The cyst was removed, and histopathology revealed a synovial cyst.

Lumbar Synovial Cysts

Synovial cysts of the lumbar spine contribute significantly to narrowing of the spinal canal and lateral thecal sac and nerve root compression. Cysts form as a result of arthrotic disruption of the facet joint, leading to degenerative spondylolisthesis in up to 40% of patients. Clinical findings and neurodiagnostic confirmation prompt surgical intervention consisting of varying decompressions with or without primary fusion. Most patients present in their mid-60s, with a male-to-female ratio varying from 2:1 to 1:1. Preoperative symptoms include low back pain, radiculopathy, and neurogenic claudication. Motor and sensory signs usually reflect the anatomic location of the synovial cyst and the level of resultant maximal lumbar stenosis. In descending order of frequency, they are typically found at the L4-L5, L5-S1, L3-L4, and L2-L3 levels. Lumbar synovial cyst surgery includes unilateral or bilateral laminotomies, hemilaminectomies, or laminectomies alone or in combination with in situ or instrumented fusion. Those patients undergoing decompression alone may postoperatively develop progression or the new appearance of olisthy, while those primarily fused rarely show further increase or a new onset of slip. Outcome measures spanning 1- to 2-year postoperative intervals frequently included surgeon-based rather than the current patient-based analysis, the lat-ter including the Medical Outcomes Trust Short Form-36.

Intraspinal lumbar synovial cysts: Diagnosis and surgical management

Lumbar synovial cysts are a common association of facet joint degenerative disease. However, it is relatively rare for these cysts to cause symptoms of radiculopathy and nerve root compression. We report a series of eight cases which were treated over a period of 20 months. There were five female and three male patients with a mean age of 66 years, and an average follow-up of seventeen months. All patients had pre-operative flexion/extension radiographs and MRI scans. Two patients had failed non-surgical treatment, two were associated with a Grade 1 spondylolisthesis, and all were associated with facet joint arthropathy. There were five cases occurring at L4/5 and three at L5/S1. All patients underwent identical procedures, which involved exploration, hemi-laminotomy, flavectomy and minimal facet joint excision. No patient required posterior lumbar interbody fusion and at follow-up five patients had excellent and three had good results.

Synovial cysts of the lumbar spine: surgery-related results and outcome.

The authors conducted a study to determine the surgery-related results and outcomes in patients with synovial cysts of the lumbar spine. They emphasize several specific characteristics useful in clinical management. Forty-six consecutive patients with 54 lumbar synovial cysts underwent surgery between 1990 and 2001. A retrospective analysis of the clinical presentation and follow-up data, radiological findings, and surgical techniques was performed. Clinical presentation was dominated by acute or subacute sciatic pain. No specific symptom allowed differentiation of synovial cyst from a lumbar disc herniation. Computerized tomography scanning aided in establishing the correct diagnosis in 19 of 30 cases and magnetic resonance (MR) imaging did so in all cases. Three of the 46 patients presented with bilateral lumbar synovial cysts. The L4-5 level was affected in 61%, and radiological signs of disc degeneration/spondylosis were observed in 54% of the patients. Immediate symptom relief without local recurrence was obtained by complete microsurgical excision in which bipolar coagulation was used to remove the synovial membrane and in which the interapophysial joint was preserved. During the 1st postoperative year, a newly formed symptomatic synovial cyst developed on the contralateral side or at a superior vertebral level in five patients. They underwent surgery; results were good and there was no recurrence. The findings in this series suggest that synovial cysts can occur at multiple lumbar sites within a short period of time and could be predisposed to developing in certain individuals, predominantly in women older than 40 years of age. Postoperative follow up is recommended and MR imaging mandatory in cases of recurrent sciatica.

Symptomatic Lumbar Synovial Cyst: Management with Direct CT-guided Puncture and Steroid Injection

Symptomatic Lumbar Synovial Cyst: Management with Direct CT-guided Puncture and Steroid Injection

Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience.

The authors report a retrospective analysis of 194 patients surgically treated at their institutions for symptomatic lumbar synovial cysts from January 1974 to January 1996. Patient characteristics including age, sex, symptoms, signs, and preoperative neuroimaging studies were reviewed. Surgical procedures, complications, results, and pathological findings were correlated with preoperative assessment. One hundred ninety-four patients were surgically treated for symptomatic lumbar synovial cysts. Eighty percent were diagnosed and treated between 1987 and 1996. There were 100 men and 94 women with an average age of 66 years (range 28-94 years). The most common symptoms were painful radiculopathy (85%) and neurogenic single or multiroot claudication (44%). However, sensory loss (43%) and motor weakness (27%) were also presenting symptoms. Eleven percent of patients had undergone previous lumbar surgery prior to being referred to the Mayo Clinic. Preoperative neurological examination demonstrated motor weakness (40%), sensory loss (45%), reflex changes (57%), and variants of cauda equina syndrome (13%). In 19% of patients, normal neurological status was demonstrated. There was equal left/right-sided laterality, and eight patients presented with bilateral synovial cysts. The most commonly affected level was L4-5 (64%). All patients underwent laminectomy and resection of the cyst. Concomitant fusion was performed in 18 patients in whom clinical evidence of instability had been observed. However, subsequent fusion was required in only four patients who developed symptomatic spondylolisthesis. Surgery-related complications included cerebrospinal fluid leak (three patients), discitis (one patient), epidural hematoma (one patient), seroma (one patient), and deep vein thrombosis (one patient). One patient died 3 days after surgery of cardiac dysrhythmia. Follow-up data obtained for at least 6 months postoperatively were available in 147 patients. Of these, 134 (91%) reported good relief of their pain and 82% experienced improvement in their motor deficits. Lumbar synovial cysts are a more common cause of lumbar radicular pain than previously thought. Surgical removal of the cyst is a safe and effective treatment for symptomatic relief in patients with lumbar synovial cysts. A concomitant fusion procedure may be performed in select cases. In this study, only a few patients developed symptomatic spinal instability requiring a second operation.