The Prevalence of Incidental and Symptomatic Lumbar Synovial Facet Cysts

Janssen, Stein J.; Schwab, Joseph H.

doi:10.1097/bsd.0000000000000648

Cited by 17 publications

(17 citation statements)

References 19 publications

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“…SSC arise from facet joints as a serous, mucoid, or haemorrhagic fluid collection, that projects beyond the joint limits. They have a variable prevalence that goes from 1% in CT studies to a 2.2% as a casual finding during laminectomies [ 15 ], and to a 6.5% in MRI studies, being symptomatic in approximately half of the cases [ 2 ]. Even though they have a controversial origin [ 16 ], the most accepted theory is that it is a complex early disc degeneration process, with a pressure increase and facet hypertrophy associated with degenerative spondylolisthesis, which shows the role of instability in the development of facet joint cysts [ 1 ], being responsible for the symptoms [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

Ruiz-Picazo

Ramírez-Villaescusa

Verdejo-González

2020

Case Reports in Orthopedics

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Introduction. Spinal synovial cysts (SSCs) constitute an uncommon degenerative lesion of the spine. They are usually asymptomatic but they may also cause symptoms of variable severity. SSCs are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy, and neurological deficit. There are different treatment options that range from conservative management to interventions like image-guided epidural steroid injection or direct cyst puncture and finally to open or endoscopic spinal canal decompression and spinal bone fusion with/without instrumentation. A discussion of current management options for this unusual disease is presented. Material and Methods. A 52-year-old female patient presented with low back pain and left leg pain. Plain radiography demonstrated instability at the L4-L5 level. Magnetic resonance images (MRIs) revealed a bilateral cystic lesion at the L4-L5 level with associated instability and degenerative disc disease at the level L5-S1. Initially, conservative treatment was performed by aspiration of the left cyst and infiltration with corticosteroids with improvement of the pain for 1 year. After this period, the radicular and the low back pain reoccurred. Results. Following leg pain recurrence, a hybrid L4-S1 fusion was performed. After surgery, there was clinical improvement and six months later, the patient returned to daily activities. The radiological study after five-year follow-up shows adequate implant position, without signs of loosening, compatible with solid fusion. Conclusion. After reviewing the literature, the optimal management for patients with symptomatic lumbar synovial cyst must be very individualized, which is essential to achieve a favorable outcome.

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Section: Discussionmentioning

confidence: 99%

“…In a prevalence MRI study, synovial facet cysts occurred in 6.5%, with 46% of the cases being incidentalomas. [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

Ruiz-Picazo

Ramírez-Villaescusa

Verdejo-González

2020

Case Reports in Orthopedics

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“…Janssen et al investigated the prevalence of incidental and symptomatic LFC in 19,010 consecutive patients who underwent lumbar spine MRI and found LFC in 6.5% (1228/19010) of patients, which was strongly associated with aging [5]. Additionally, 54% of LFC identi ed by MRI had radiculopathy symptoms, and a large cyst size and anterior cyst location were associated with an increased likelihood of having neurological symptoms.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of percutaneous rupture for lumbar facet cysts: A retrospective study

Kanzaki

Morishita²,

Ishihara³

2022

Preprint

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Background: Percutaneous rupture of lumbar facet cysts (LFC) is the only non-surgical treatment able to directly reduce cysts. However, this is not yet a common procedure, and its effectiveness, including the evaluation of complications, remains unclear. This study aimed to evaluate the clinical outcomes of percutaneous rupture for LFC and elucidate whether this minimally invasive procedure could become an alternative to surgeries for cases resistant to conservative treatments. Methods: This study investigated 51 symptomatic patients with LFC for whom conservative treatments were ineffective and who underwent percutaneous rupture of the LFC. All patients were followed-up for >2 years after the treatment. Clinical evaluations (Visual Analogue Scale [VAS], recovery rate calculated with Japanese Orthopedic Association scores) and radiographic evaluations (size of LFC based on magnetic resonance imaging [MRI]) were performed from pretreatment to final follow-up. Results: Successful LFS rupture, without hospitalization and general anesthesia, was achieved in 43 patients. No serious complications occurred during treatment through the last observation. Satisfactory clinical results were obtained (VAS: 11.1 mm, recovery rate: 83.1 %), and significant reduction of LFC was recognized in all cases based on post-treatment MRI. No successful rupture cases required subsequent surgical treatments, although there were 3 cases of LFC recurrence that required an additional percutaneous rupture treatment. Conclusions: Percutaneous rupture for LFC is not only a safe and minimally invasive procedure without any serious complications or requirements for hospitalization and general anesthesia, but also a very useful procedure that can prevent surgery for cases resistant to conservative treatments.

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“…Synovial cyst formation is common, particularly in mobile segments of the lumbar spine [1]. However, development of these cysts in the rigid thoracic spine is much more rare, with relatively few cases of this pathology reported [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…We present a patient who had a new diagnosis of upper thoracic (T1-2) synovial cyst that was almost entirely medially projecting into the spinal canal and caused acute paraplegia while hospitalized for therapies and surgical planning. 1 1 1…”

Section: Introductionmentioning

confidence: 99%

Upper Thoracic Spine Synovial Cyst Resulting in Paraplegia Following Transient Hypotension

Schmidt¹,

Strayer²,

Stadler³

2020

Cureus

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Development of synovial cysts in the rigid thoracic spine is rare. Additionally, synovial cysts with compression of nerve roots typically cause subacute or chronic radiculopathy. We present a patient who had a new diagnosis of upper thoracic (T1-2) synovial cyst that caused acute paraplegia while hospitalized for therapies and surgical planning. The patient is a 56-year-old male with a history of congestive heart failure secondary to alcoholic cardiomyopathy. He presented with a progressive bilateral lower extremity discoordination, urinary incontinence, and altered perineal sensation. His examination revealed intact strength to bedside assessment, intact rectal tone, but upgoing toes on Babinski testing. Given concern for myelopathy, MRI thoracic spine was obtained and demonstrated large T1-2 synovial cyst causing severe compression with associated T2 signal change within the spinal cord. He underwent expedited cardiac optimization that included resumption of outpatient antihypertensive medications and the addition of a single dose of intravenous diuretic. The patient had subsequent transient hypotension following significant diuresis and developed acute paraplegia in his bilateral lower extremities. Fluids and vasopressors were initiated, and he underwent emergent surgery for decompression and synovial cyst resection. The patient did very well and had normalization of his neurological exam within 24 hours. We present a case of acute paraplegia secondary to hypotension and spinal cord hypoperfusion in a patient with upper thoracic synovial cyst. This is rare pathology with an even more unique presentation. The authors recommend careful perioperative hemodynamic monitoring to help avoid acute worsening in this patient population.

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The Prevalence of Incidental and Symptomatic Lumbar Synovial Facet Cysts

Abstract: Level III, diagnostic study.

Cited by 17 publications

References 19 publications

An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

Usefulness of percutaneous rupture for lumbar facet cysts: A retrospective study

Upper Thoracic Spine Synovial Cyst Resulting in Paraplegia Following Transient Hypotension

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