Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases

Abstract

Objective-Synovial cysts of the vertebral facet joints are a source of nerve root compression. DiVerent surgical procedures are in use, but no consensus has been formed so far as to which method should be used in synovial cysts. To clarify the role of surgical management, the eYcacy of operative procedures and factors influencing the outcome in our own series of 19 patients treated between 1994 and 1998 were analysed. Methods-Nineteen patients with a mean age of 65 years underwent surgery for medically intractable radicular pain or neurological deficits caused by synovial cysts. The patients' records were retrospectively analysed for neurological deficits, cysts diameter, operative approach, segmental hypermobility, and clinical outcome; CT and MRI were analysed for additional degenerative changes. Results-In 17 patients an excellent result and in two patients a good postoperative result was achieved. Twelve patients were found to have hypermobility of the facet joints and six had spondylolisthesis. There was no correlation between cyst diameter, operative approach, and outcome. No intraoperative or postoperative complications occurred. Conclusions-Age and hypermobility may play a part in the aetiology of facet joint synovial cysts. As all operative strategies showed equally good clinical outcome, total excision via a small flavectomy as the least invasive approach should be considered therapy of choice in patients with cysts causing neurological deficits. (J Neurol Neurosurg Psychiatry 2001;70:74-77) Keywords: facet joint; flavectomy; lumbar spine; spondylolisthesis; radicular pain; synovial cyst Space occupying lesions of the spinal canal often cause radicular pain or neurological deficits and are most commonly caused by either disc herniation or a bony stenosis of the spinal canal. In a few cases pain in the leg and accompanying paraesthesia is caused by neurinomas or inflammatory processes. A rare source of extradural mass eVects are cysts of the facet joints (accounting for an incidence of 0.8% in our institution). They are cited in the literature as synovial or ganglion cysts.

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

“…In another literature review, Shah and Lutz [42] identified 139 patients treated conservatively, out of which 47% finally received surgical treatment due to absence of sustained benefit. Similarly, Hsu et al had a success rate of 55% with conservative therapy, while in another series of treatment by corticosteroid injection the long-term success rate did not exceed 57% [3,5,45]. Furthermore, most authors reporting results of conservative treatment have rather short follow-up periods [24,30].…”

“…Not all authors agree with this technique, for the fear of producing spinal instability, but in a large retrospective analysis by Lyons et al [27], no correlation between the extent of laminectomy and/or facetectomy and the development of symptomatic spondylolisthesis was identified. Trummer et al found no statistically significant difference between the type of surgical approach and the final outcome [45]. The procedure of choice should be the one that the surgeon believes will best enable complete resection of the cyst and treatment of any coinciding disease in the safest way possible, because excising the cyst seems to be the singlemost important factor for a favorable outcome.…”

“…The use of newer imaging modalities such as CT and MRI has allowed the accurate preoperative diagnosis of this entity that could once be identified only during surgery [20,45]. This enables accurate preoperative planning and avoidance of therapeutic pitfalls.…”

Diagnosis and management of juxtafacet cysts

“…Their presence and potential role as a generator of symptoms must be considered. 1,2,4,5,[9][10][11][12][13][14][15][16][17][20][21][22]25 Synovial Cysts Synovial cysts are small cystic growths that occur adjacent to and attached to synovial tissue-lined joints, such as the spinal facet joints. These lesions are attached to their adjacent joints with a narrow connecting pedicle, which connects their cystic centers to the cavities of their parent joints.…”

“…Synovial cysts may also contain hemorrhagic material because they occasionally bleed within themselves, causing acute growth and exacerbation of symptoms. 1,[4][5][6]9,10,16,20,22,[25][26][27] …”