Synovial cysts are benign sacs which contain fluid. They typically develop in the facet joints of the lumbar spine and are a consequence of degeneration. Synovial cysts may become large enough to induce spinal stenosis and pressure on spinal nerves. Spinal stenosis causes certain symptoms and requires specific therapy.
Treatment is basically the same as the one applied in case of spinal stenosis. Surgical procedure is required only in those patients who wish to be more active and experience less pain during increased activities. Decompression with a fusion is definitely the most successful surgical approach in treatment of synovial cysts. It provides with significant reduction in pain. This approach is suitable for people who have to deal with mild to severe activity limitations as well as for those suffering from joint instability. It is also an excellent choice for people whose symptoms do not respond to conservative therapy.
Conservative Treatment for Synovial Cysts
There are three treatment modalities for synovial cysts, observation, injections and surgery.
For all patients who do not suffer from pain or have no difficulties related to synovial cyst there is no need for medical treatment. The pain may be induced by certain position and patients may easily deal with pain by changing position which leads to pain.
There are two types on injections administered in patients suffering from synovial cysts. Both of them, facet injections and epidural injections, successfully alleviate the pain. In the first case injections are introduced into the facet joints. The cyst is drained and what follows is injection of steroids. They increase inflammation. Epidural steroid injection technique includes injection of steroids in the epidural space around synovial cyst. This may alleviate the pain but it does not stimulate the reduction of the cyst.
Surgery for Synovial Cysts
In patients suffering from synovial cysts surgeons tend to perform either decompression alone or decompression together with a spine fusion.
Microdermocompression of the nerve root and removal of synovial cyst are performed in case there is no accompanying instability. Microdermocompression is minimally invasive surgery and the recovery is rather quick. Unfortunately, synovial cyst may re-form after certain period of time.
Decompression with spine fusion surgery is best possible treatment modality since it includes both, removal of the cyst and fusion of the joint. Fusion of the joint terminates all the motion at that level which consequently does not allow the cyst to regenerate. On the other hand, fusion also creates more stress on other non-fused levels of the spine. This is an open surgery and carries more risk comparing to the previous one. The process of healing lasts approximately 6 to 9 months.