Intraspinal synovial cysts: natural history and diagnosis by CT.

Hemminghytt, S; Daniels, David L.; Williams, A L; Haughton, Victor M.

doi:10.1148/radiology.145.2.7134440

Cited by 142 publications

(64 citation statements)

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“…The former consists of bed-rest, analgesic drugs and orthosis [22,28,40], while the latter consists of CT-guided aspiration of the cyst contents plus epidural or intra-articular injection of cortisone [28]. While these therapeutic methods may play a role in lumbar synovial cysts, which mainly give radicular symptoms (as long as the diagnosis is certain), in our view they are not appropriate in patients with cervical cysts, who usually present with severe myelopathy.…”

Section: Discussionmentioning

confidence: 93%

Cervical synovial cysts: case report and review of the literature

Lunardi

Acqui

Ricci

et al. 1999

European Spine Journal

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IntroductionSynovial cysts are cystic dilatations of the synovial sheaths; they are bordered not only by the connectival tissue structures of these sheaths but also by the mono-or pluri-stratified cuboid synovial epithelium. Anatomical continuity with the synovial sheaths of the joint cavities from which the cyst probably originates may not always be observed.While synovial cysts are quite a frequent occurrence in joints and tendon sheaths [3,10,23], especially in the joints of the hands and wrists [45], they are very rare in the spine [13,18,25,40,47,62]. In the lumbar spine 220 cases have been described [1,2,16,21,28,34,38,40,43,45,48,51,[54][55][56]60].The incidence of synovial cysts with a cervical location was evaluated, with reference to veterinary literature too [15], and was found to be an occurrence specific to humans, of which, to our knowledge, only 22 cases have been reported to date.We describe another case of cervical synovial cyst and discuss the pathological, etiopathogenetic, and clinical aspects of this rare pathology. Case reportA 58-year-old man was referred to us with a progressive spastic paraparesis, which had started 8 months earlier. About 2 months prior to admission, he had begun to suffer from genital-sphincteric ailments such as urinary retention and difficult erection.Examination revealed a severe motor deficit in the lower limbs (he was able to raise his legs while lying in bed for a few seconds only), as well as an increased response to knee and ankle jerks. There was superficial and deep hypoesthesia below C8 and apallesthesia below the iliac crests. There was also urinary retention, which required catheterization. AbstractThe authors describe the case of a 58-year-old man with a 6-month history of severe myelopathy. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at a right posterolateral site at the level of the articular facet. At operation the mass appeared to originate from the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. Once the mass had been removed, there was a significant amelioration of the patient's symptoms. As previously suspected, histological aspect was synovial cyst. Cervical synovial cysts are extremely rare and, as far as we know, only 22 cases have so far been described in the literature. Diagnostic radiological investigations used were CT scan and MRI. At CT scan the most important diagnostic findings are a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst. At MRI the contents of the cyst are iso/hypointense on T1-and hyperintense on T2-weighted images. There may also be a hypointense rim on T2-weighted images, which enhances after i.v. administration of gadolinium. Surgical treatment consists of removal of the mass. Fixation of the vertebral segments involved is not always necessary.

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Section: Discussionmentioning

confidence: 93%

Cervical synovial cysts: case report and review of the literature

Lunardi

Acqui

Ricci

et al. 1999

European Spine Journal

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“…Degeneration will cause protrusion of the synovial membrane through defects of the joint capsule. This herniation causes the formation of a para-articular cavity filled with synovial fluid [14]. The aetiopathogenesis of synovial cysts remains a matter of debate [4].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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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.

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“…18,25) Synovial cysts may adhere any tissue in the spinal canal, so surgeons must be alert to cerebrospinal fluid fistula at the end of operation. 1,13,18) Larger cyst is more likely to adhere to the dura mater. 18) One of our patients with synovial cyst suffered recurrence of symptoms 1 year later, and another with LF cyst had adherence of the cyst wall to the dura mater during exploration.…”

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confidence: 99%

Lumbar Synovial Cysts: Experience With Nine Cases

Ayberk

Ozveren

Gok

et al. 2008

Neurol. Med. Chir.(Tokyo)

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Nine patients treated surgically for lumbar spinal synovial cyst were reviewed. Four patients had synovial, two had ganglion, one had posterior longitudinal ligament, and two had ligamentum flavum cyst. Synovial cysts had a single layer of epithelial cells in the inner layer of the cyst with continuity with the facet joint. Ganglion cyst had no continuity with the facet joint and epithelial lining was present in one and absent in one case. Posterior longitudinal ligament and ligamentum flavum cysts had no continuity with the facet joint and no epithelial lining. Magnetic resonance imaging showed the cysts better than computed tomography. All patients treated for nerve root compression or lumbar spinal canal narrowing. One patient suffered recurrence 1 year later and was reoperated. Operative results were excellent in six and good in three patients. Lumbar spinal synovial cysts should be considered in differential diagnosis of lumbar radiculopathy/neurogenic claudication and is surgically treatable.

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Intraspinal synovial cysts: natural history and diagnosis by CT.

Cited by 142 publications

References 0 publications

Cervical synovial cysts: case report and review of the literature

Cervical synovial cysts: case report and review of the literature

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

Lumbar Synovial Cysts: Experience With Nine Cases

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