JERRY V. MARLIN, M.D. F.A.C.S.  NEUROLOGICAL SURGERY

 

 

 

LUMBAR SYNOVIAL CYSTS

Synovial cysts are most frequently discovered nowadays with MRI scanning. Previous studies such as myelograms and post-myelogram CT scans were quite useful especially when viewing the skeletal or bony anatomy of the facet joints. These lesions can be present for long periods of time on the surface of the lumbar facet joints. Synovial cysts have also been found to have formed rather quickly over months instead of years on repeat MRI scans of the lumbar spine. Osteoarthritis affecting facet joints or history of trauma or repetitive traumatic strain on the joints or spinal motion segments are often discovered during physician evaluation.

Synovial cysts can enlarge and create pressure on the nerve roots within the spinal canal or foramen under the facet joints. Leg pain often radicular in quality, numbness, weakness or bladder control problems can occur with nerve root compression in the spinal canal. Local back pain is often associated with these lesions. Microsurgical findings include firm cheesy masses often with small amount of fluid, non-infectious, extruded from the medial aspect of the facet joint. The expansion into the spinal canal often causes inflammation and significant adherence of this mass to the nerve root or dura. Cerebral spinal fluid leakage can occur even with meticulous microsurgical dissection when removing the lesion. Often thickened ligamentum flavum or elastic yellow ligament between the lamina and inside of the facet is found in conjunction with the synovial cyst.

The results of surgery are often dramatic with improvement of nerve root function and reduction in pain. Long term care includes avoidance of increasing weight gain and reconditioning exercises to strengthen the spinal musculature. Walking exercises, aquatics exercises, bicycle use often are comfortably performed in moderation. Corsets to support the spine can be useful but not as beneficial as strong supporting musculature and proper posture along with proper biomechanical lifting techniques.

Left sided white-yellow cyst pushing the purple-blue dura to the right. Inside the dura are the cauda equina nerve rootlets and under the mass was the L5 traversing nerve root at this L4-5 level of the lumbar spine.

Copyright 2001 JERRY V. MARLIN M.D.
Last modified: 01/06/03