Synovial Cyst

Synovial cysts are benign, fluid-filled sacs that develop in the facet joints of the lumbar spine as a result of degeneration. If large enough, these sacs can cause spinal stenosis.

Symptoms

Radicular symptoms with pain, numbness, or weakness extending into the legs. If severe, loss of coordination and bowel and bladder incontinence may occur.

About this Condition

Synovial cysts are benign, fluid-filled sacs that develop in the facet joints of the lumbar spine as a result of degeneration. If large enough, these sacs can cause spinal stenosis – a narrowing of the spinal canal that places pressure on spinal nerves and causes a dull, aching pain in the lower back when standing or walking, radicular symptoms with pain, numbness, and weakness extending into the legs, and if severe, loss of coordination and bowel and bladder incontinence.

The synovium is a thin film of tissue that produces fluid to help lubricate the joints. When facet joints in the lumbar spine begin to degenerate, this fluid may build up in an attempt to protect the joint. In some patients, small amounts of the fluid escape from the joint capsule but remain within the synovium, creating a sac-like protrusion.

Many older patients have synovial cysts in their lumbar spines but have no symptoms. Occasionally, however, these cysts can cause pain in the lower back that travels down the legs. The pain is relieved when sitting as this position widens the spinal canal and relieves pressure on the nerves. A synovial cyst can be seen on a. MRI.

[Source: Spine Universe]

This content is for your general education only. See your doctor for a professional diagnosis and to discuss an appropriate treatment plan.

Conservative Treatments

Medication and Pain Management

The goal when prescribing medications should be maximum reduction of pain and discomfort with minimal risk of overuse of the medications and avoiding side effects.

Non-steroidal anti-inflammatory medications (NSAIDs) include common over-the-counter drugs such as aspirin, ibuprofen and naproxen among others. These drugs are potent long-term pain reducers that work without concerns of dependence.

Opioid therapy to control chronic back pain is less ideal because of potential toxicity to the body and physical and psychological dependence. Treatment by this class of drugs should generally be a short term option when patients do not respond to alternatives.

Pain can often be reduced through the use of muscle relaxants, anti-seizure pain medications such as Neurontin, Topamax, and Lyrica, anti-depressants, and oral steroids.

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Injections

In some cases, your doctor may give you an injection of a corticosteroid to help relieve your pain and reduce inflammation. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels, corticosteroids suppress inflammation, which in turn relieves pressure and pain. They are most effective when used in conjunction with a rehabilitation program. In addition, corticosteroids can cause serious side effects, so the number of injections you can receive is limited—usually no more than three in one year.

A steroid is often combined with an anesthetic and injected into the area around the irritated spinal nerves that are causing the pain. This area is called the epidural space, and it surrounds the sheath-like protective membrane, or dura, that covers the spinal nerves and nerve roots. Steroids reduce nerve irritation by inhibiting production of the proteins that cause inflammation.  The anesthetic blocks nerve conduction in the area where it's applied, numbing the sensation of pain.

An epidural spinal injection may be done either for diagnostic or therapeutic reasons. By injecting medication around a specific nerve root, your doctor can determine if that particular nerve root is the cause of the problem. When administered for therapeutic reasons, a spinal epidural injection may provide long- or short-term relief, anywhere from a week to several months. In some instances, an epidural spinal injection may break the cycle of inflammation and provide permanent relief.

It's important to note, however, that an epidural spinal injection is typically not considered a cure for symptoms associated with spinal compression. Rather, it's a treatment tool that a doctor can use to help ease pain and discomfort as the underlying cause of the problem is being addressed through a rehabilitative program such as physical therapy, or while the patient is considering surgical treatment options.

Physical Therapy / Occupational Therapy

Physical and occupational therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a therapist can design a rehabilitation program to help prevent recurrent injuries.

These programs often include heat, cold and electrotherapy to help alleviate pain, decrease swelling, increase strength and promote healing. Methods include therapeutic exercise, manual therapy, functional training and use of assistive devices and adaptive equipment to increase strength, range of motion, endurance, wound healing and functional independence.

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Surgery

METRx Synovial Cyst Removal

Synovial cysts can be removed using the METRx system in conjunction with an endoscope or microscope. Removal of these cysts using minimally invasive techniques minimizes soft-tissue trauma and blood loss and will also result in a smaller incision. If the synovial cysts are associated with spondylolisthesis this technique can minimize the risk of progressive instability and the need for fusion.

Please keep in mind that all treatments and outcomes are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.