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Spinal lumbar synovial cysts. Diagnosis and management challenge

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Abstract

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.

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References

  1. Abrahams JJ et al (1988) CT-guided needle aspiration biopsy of an intraspinal synovial cyst (ganglion): case report and review of the literature. AJNR Am J Neuroradiol 9.2:398–400

    Google Scholar 

  2. Awward EE et al (1991) Synovial cyst of the midthoracic spine. AJNR Am J Neuroradiol 12.3:562–563

    Google Scholar 

  3. Baker WM (1885) Formation of synovial cysts in connection with joints. St. Bartholomews Hospital Reports 21:177–190

    Google Scholar 

  4. Baker WM (1994) On the formation of synovial cysts in the leg in connection with disease of the knee-joint 1877. Clin Orthop 299:2–10

    PubMed  Google Scholar 

  5. Bandiera S, et al. (1999) Hemorrhagic synovial lumbar cyst: a case report and review of the literature. Chir Organi Mov 84.2:197–203

    Google Scholar 

  6. Banning CS, Thorell WE, Leibrock LG (2001) Patient outcome after resection of lumbar juxtafacet cysts. Spine 26(8):969–972

    Article  PubMed  CAS  Google Scholar 

  7. Baum JA, Hanley EN Jr (1986) Intraspinal synovial cyst simulating spinal stenosis A case report. Spine 11.5:487–489

    Article  Google Scholar 

  8. Bjorkengren AG et al (1987) Symptomatic intraspinal synovial cysts: opacification and treatment by percutaneous injection. AJR Am J Roentgenol 149.1:105–107

    Google Scholar 

  9. Bureau NJ et al (2001) Lumbar facet joint synovial cyst: percutaneous treatment with steroid injections and distention. Radiology 221(1):179–185

    Article  PubMed  CAS  Google Scholar 

  10. Casselman ES (1985) Radiologic recognition of symptomatic spinal synovial cysts. AJNR Am J Neuroradiol 6.6:971–973

    Google Scholar 

  11. Conrad MR, Pitkethly DT (1987) Bilateral synovial cysts creating spinal stenosis: CT diagnosis. J Comput Assist Tomogr 11.1:196–197

    Article  Google Scholar 

  12. Deshmukh NV, Kanse P (2003) Lumbar facet synovial cyst. Postgrad Med J 79.933:419, 423–419, 424

    Google Scholar 

  13. Doherty PF et al (1993) Bilateral synovial cysts of the thoracic spine a case report. Surg Neurol 39.4:279–281

    Article  Google Scholar 

  14. Doyle AJ, Merrilees M (2004) Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic resonance imaging. Spine 29(8):874–878

    Article  PubMed  Google Scholar 

  15. Duplay J, Grellier P, Roche JL (1981) Non discal surgical sciatic neuralgia (author’s transl). Sem Hop 57.25–28:1242–1245

    Google Scholar 

  16. Eyster EF, Scott WR (1989) Lumbar synovial cysts: report of eleven cases. Neurosurgery 24(1):112–115

    Article  PubMed  CAS  Google Scholar 

  17. Eustacchio S et al (2003) Intraspinal synovial cyst at the craniocervical junction. Zentralbl Neurochir 64.2:86–89

    Google Scholar 

  18. Fardon DF, Simmons JD (1989) Gas-filled intraspinal synovial cyst. A case report. Spine 14.1:127–129

    Article  Google Scholar 

  19. Freidberg SR, Fellows T, Thomas CB, Mancall AC (1994) Experience with symptomatic spinal epidural cysts. Neurosurgery 34(6):989–993; discussion 993

    Google Scholar 

  20. Hemminghytt S et al (1982) Intraspinal synovial cysts: natural history and diagnosis by CT. Radiology 145.2:375–376

    Google Scholar 

  21. Howington JU, Connolly ES, Voorhies RM (1999) Intraspinal synovial cysts: 10-year experience at the Ochsner Clinic. J Neurosurg 91.2(Suppl):193–199

    Google Scholar 

  22. Hsu KY et al (1995) Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment. Spine 20.1:80–89

    Google Scholar 

  23. Jabre A, Shahbabian S, Keller JT (1987) Synovial cyst of the cervical spine. Neurosurgery 20.2:316–318

    Google Scholar 

  24. Jackson DE Jr et al (1989) Intraspinal synovial cysts: MR imaging. Radiology 170.2:527–530

    Google Scholar 

  25. Jost SC, Hsien Tu P, Wright NM (2003) Symptomatic intraosseous synovial cyst in the cervical spine: a case report. Spine 28.17:E344–E346

    Article  Google Scholar 

  26. Kaneko K, Inoue Y (2000) Haemorrhagic lumbar synovial cyst. A cause of acute radiculopathy. J Bone Joint Surg Br 82.4:583–584

    Article  Google Scholar 

  27. Kao CC et al (1968) Lumbar intraspinal extradural ganglion cyst. J Neurosurg 29.2:168–172

    Google Scholar 

  28. Kao CC, Winkler SS, Turner JH (1974) Synovial cyst of spinal facet. Case report. J Neurosurg 41.3:372–376

    Google Scholar 

  29. Khan AM, Synnot K, Camissa FP, Girardi FP (2005) Lumbar synovial cysts of the spine: an evaluation of surgical outcome. J Spinal Disord Tech 18(2):127–131

    Article  PubMed  Google Scholar 

  30. Knox AM, Fon GT (1991) The appearances of lumbar intraspinal synovial cysts. Clin Radiol 44.6:397–401

    Article  Google Scholar 

  31. Koenigsberg RA (1998) Percutaneous aspiration of lumbar synovial cyst: CT and MRI considerations. Neuroradiology 40(4):272–273

    Article  PubMed  CAS  Google Scholar 

  32. Kurz LT et al (1985) Intraspinal synovial cyst causing sciatica. J Bone Joint Surg Am 67.6:865–871

    Google Scholar 

  33. Lemish W, Apsimon T, Chakera T (1989) Lumbar intraspinal synovial cysts. Recognition and CT diagnosis. Spine 14.12:1378–1383

    Article  Google Scholar 

  34. Lyons MK et al (2000) Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg 93.1(Suppl):53–57

    Google Scholar 

  35. Mercader J, Munoz GJ, Cardenal C (1985) Intraspinal synovial cyst: diagnosis by CT. Follow-up and spontaneous remission. Neuroradiology 27.4:346–348

    Article  Google Scholar 

  36. Metellus P et al (2003) A retrospective study of 32 lumbar synovial cysts. Clinical aspect and surgical management. Neurochirurgie 49.2–3(Pt 1):73–82

    Google Scholar 

  37. Nijensohn E et al (1990) Calcified synovial cyst of the cervical spine: CT and MR evaluation. J Comput Assist Tomogr 14.3:473–476

    Google Scholar 

  38. Onofrio BM, Mih AD (1988) Synovial cysts of the spine. Neurosurgery 22.4:642–647

    Google Scholar 

  39. Parlier-Cuau C et al (1999) Symptomatic lumbar facet joint synovial cysts: clinical assessment of facet joint steroid injection after 1 and 6 months and long-term follow-up in 30 patients. Radiology 210.2:509–513

    Google Scholar 

  40. Pendleton B, Carl B, Pollay M (1983) Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery 13.3:322–326

    Google Scholar 

  41. Pirotte B et al (2003) Synovial cysts of the lumbar spine: surgery-related results and outcome. J Neurosurg 99.1(Suppl):14–19

    Google Scholar 

  42. Reust P et al (1988) Degenerative spondylolisthesis, synovial cyst of the zygapophyseal joints, and sciatic syndrome: report of two cases and review of the literature. Arthritis Rheum 31(2):288–294

    Article  PubMed  CAS  Google Scholar 

  43. Rousseaux P et al (1989) Synovial cysts and synovialomas of the lumbar spine. Histo-pathologic and neuro-surgical aspects apropos of 8 cases. Neurochirurgie 35.1:31–39

    Google Scholar 

  44. Sabo RA, Tracey PT, Weinger JM (1996) A series of 60 juxtafacet cysts: clinical presentation, the role of spinal instability, and treatment. J Neurosurg 85:560–565

    Article  PubMed  CAS  Google Scholar 

  45. Salmon B et al (2001) A Juxtafacet cyst of the lumbar spine Clinical, radiological and therapeutic aspects in 28 cases. Acta Neurochir (Wien) 143(2):129–134

    Article  CAS  Google Scholar 

  46. Schmid G et al (2002) Lumbar intraspinal juxtafacet cysts: MR imaging and CT-arthrography. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 174.10:1247–1252

    Article  Google Scholar 

  47. Schollner D (1967) Ganglion on a vertabral joint. Z Orthop Ihre Grenzgeb 102.4:619–620

    Google Scholar 

  48. Soon CK, Razak M (2001) Haemorrhagic lumbar synovial cyst. Med J Malaysia 56(Suppl D):57–60

    PubMed  Google Scholar 

  49. Spencer RR, Jahnke RW, Hardy TL (1983) Dissection of gas into an intraspinal synovial cyst from contiguous vacuum facet. J Comput Assist Tomogr 7.5:886–888

    Article  Google Scholar 

  50. Slipman CW et al (2000) Nonsurgical treatment for radicular of pain of zygoapophyseal joint cyst origin: therapeutic selective nerve root block. Arch Phys Med Rehabil 81(8):1119–1122

    PubMed  CAS  Google Scholar 

  51. Sauvage P et al (2000) Lumbar intraspinal synovial cysts: imaging and treatment by percutaneous injection. Report of thirteen cases. J Radiol 81(1):33–38

    PubMed  CAS  Google Scholar 

  52. Tatter SB, Cosgrove GR (1994) Hemorrhage into a lumbar synovial cyst causing an acute cauda equina syndrome Case report. J Neurosurg 81.3:449–452

    Google Scholar 

  53. Tillich M et al (2001) Symptomatic intraspinal synovial cysts of the lumbar spine: correlation of MR and surgical findings. Neuroradiology 43.12:1070–1075

    Google Scholar 

  54. Trummer M et al (2001) Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases. J Neurol Neurosurg Psychiatry 70(1):74–77

    Article  PubMed  CAS  Google Scholar 

  55. Vosschulte K, Borger G (1950) Anatomische and funktinonelle Untersuchugen iiber den Bandsheibenprolaps. Langenbecks Arch klin Chir 265:329–355

    Article  Google Scholar 

  56. Yarde WL et al (1995) Synovial cysts of the lumbar spine: diagnosis, surgical management, and pathogenesis. Report of eight cases. Surg Neurol 43.5:459–464

    Article  Google Scholar 

Download references

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Correspondence to Amir M. Khan.

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Khan, A.M., Girardi, F. Spinal lumbar synovial cysts. Diagnosis and management challenge. Eur Spine J 15, 1176–1182 (2006). https://doi.org/10.1007/s00586-005-0009-4

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