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

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> 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.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> 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.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> 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.</jats:p>

Lumbar Synovial Cysts: Experience With Nine Cases

“…21) These lesions usually present with common symptoms of radiculopathy, neurogenic claudication, myelopathy, neurological deficit, and even cauda equina syndrome. 18,23) Here we discuss our experience with various types of lumbar spinal synovial cyst, including the evaluation, treatment modalities, and pathologies in the differential diagnosis of lumbar radiculopathy, especially in older patients.…”

“…3,7) Magnetic resonance (MR) imaging has increased detection compared to older methods of myelography and computed tomography (CT) in patients with low back pain and radicular pain. 18,28) The overall prevalence of anterior and posterior facet joint cysts are 2.3% and 7.3%, respectively, and back pain is the primary symptom for cysts located posterior to the facet joint, possibly because the ligamentum flavum (LF) acts as a mechanical barrier against the formation of anterior cysts. 7) Synovial cysts within the lumbar spinal canal are usually classified as synovial cyst, ganglion cyst, posterior longitudinal ligament (PLL) cyst, or LF cyst based on their location, 9) origin, 1,34) and pathologic features.…”

Clinical characteristics of intraspinal facet cysts following microsurgical bilateral decompression via a unilateral approach for treatment of degenerative lumbar disease

“…Therefore, primary synovial cysts are typically observed in the mobile segments of the lumbar spine where spondylosis most frequently occurs. The most common sites, in descending order of incidence, are L4-5 and L3-4 [9,20]. These lumbar levels appear in association with the degeneration of the facet joint and are probably caused by repetitive trauma and a microinstability that produce areas of focal weakness in the facet capsule.…”

“…A few reports found that low back pain preceded radicular symptoms in most patients [9,11]. Because most intraspinal facet cysts are associated with spinal column arthropathy, non-localised back pain is usually not attributable solely to the cyst.…”

“…Intraspinal facet cysts in the lumbar spine, including synovial and ganglion cysts, are considered an uncommon cause of low back pain, radicular pain, and cauda equina syndrome. Although many cases of primary intraspinal facet cysts in the lumbar spine have been reported [9][10][11][12], few have documented the incidence of postoperative intraspinal facet cysts after decompression surgery or identified preoperative risk factors [13,14]. Therefore, we conducted a retrospective analysis of 230 patients treated for lumbar degenerative diseases using MBDU, focusing on the incidence, clinical characteristics, and risk factors for postoperative intraspinal facet cysts.…”