Spinal Synovial Cysts

Spinal Synovial Cysts

Spinal synovial cysts (aka synovial cysts or spinal cysts) are abnormal fluid-filled sacs bulging out of small joints (facet joints) at the back of the vertebrae. Synovial cysts usually develop as a result of aging related changes. They can be found throughout the spine but are most common in the lumbar part (low back).
These cysts are benign, which means they are not cancerous. Despite their generally benign behaviour, they can cause severe symptoms due to compression of neural structures in the spinal canal.

What are the symptoms of spinal synovial cysts?

Posteriorly or backwards projected synovial cysts usually are absolutely asymptomatic or may be associated with back pain.
For anteriorly projected spinal cysts, depending on the size and location in the spinal canal, symptoms may be similar to those of intervertebral disc herniation or spinal stenosis, including:

• Back pain. May be encountered in the early stages of the disease. If the pain is experienced, it is usually much less expressed than leg pain.
• Leg pain (radicular leg pain aka sciatica or pinched nerve pain). This pain is usually much more severe than back pain. The pain may be sharp, shooting, persisting.
• Tingling and/or numbness in the leg/ both legs if cysts are bilateral.
• The localization of pain and numbness depends on the level at which the synovial cyst is located (between which vertebrae). Symptoms may manifest themselves in the buttocks; front or back of thigh; lower leg; front, back or side of the leg; at the foot.
• Pain is provoked by movement. Patients will complain of pain exacerbation after lengthy sitting, standing or walking a short distance. Sneezing, coughing and laughing can cause severe pain.
• Muscle weakness. Dangerous symptom showing a very severe nerve compression.
• Change in bowel or bladder function.
• Leg muscle cramps.

In case there is a need for our specialist opinion, we are always happy to help. We provide appointments and consultations for both – residents of Latvia and patients from Abroad, including remote appointments via video-call. There are a number of ways to schedule appointment with one of our specialists – electronically (for Latvian residents) or requesting a remote appointment via video call by email or through the telephone contact-for International patients or Latvian residents.

What are the risk factors for spinal synovial cysts?

Synovial cysts are more common in people over the age of 50. They may be related to chronic inflammation of overloaded and enlarged facet joints usually resulting from degenerative changes and instability.
Systemic diseases that affect the joints, like rheumatoid arthritis, can also be associated with synovial cysts.

How is diagnosis established?

The cyst is usually found through magnetic resonance imaging (MRI), which is the best scan to evaluate spinal cord, nerve roots, facet joints, disc space and spinal canal space. The cyst will clearly appear as a bubble-like growth near a facet joint, which is posterior connection between the upper and lower vertebrae (see image).

Image: MRI of lumbar spine, showing degenerative changes and facet joint osteoarthritis (yellow arrows) at L5/S1, left-sided facet joint large synovial cyst (red asterisk) compressing left -sided S1 nerve root (green arrow).

What treatments are available?

Conservative treatment may include rest, anti-inflammatory medications, painkillers and epidural steroid injections. Though these approaches may temporarily relieve the symptoms, resulting in further discomfort.
Surgery may be recommended for persistent cysts that cause pain and impaired movement. The goal of surgery is to remove the cyst and decompress the spinal cord and/or nerve roots. The approach to cyst is quite similar to a microdiscectomy. Usually it is minimally invasive surgery which is done through small tailored 18 to 25mm skin incision.
Sometimes after removing the cyst or in case of recurrent cyst, the surgeon may need to fuse the affected joint (lumbar fusion surgery). This type of surgery fuse the upper and lower vertebrae (and facet joints) and prevents the cyst from re-forming by preventing any movement at the affected joint.
No one treatment is right for everyone. We will determine the best treatment for each patient and each situation.

We provide world class neurosurgical treatment for Latvian residents and International patients. Learn more here if you are international patient considering having treatment with us.
In case you are considering having a Surgery with us, you can learn more about experience of our International and Latvian patients by checking testimonials page.

The venue for surgical interventions is well equipped and comfortable private hospital in Riga – “Aiwa clinic”. You can assess the conditions in our hospital by reviewing images at the photo gallery.