Microsurgical Resection of a Lumbar Synovial Cyst: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Brian J A Gill ◽  
Kyle Lindsey McCormick ◽  
Paul C McCormick
Keyword(s):  
Degenerative Spondylolisthesis ◽  
Synovial Cyst ◽  
Radicular Pain ◽  
Surgical Anatomy ◽  
Neurogenic Claudication ◽  
Presenting Symptoms ◽  
Patient Consent ◽  
Synovial Cysts ◽  
Cyst Recurrence ◽  
Microsurgical Resection

Abstract Lumbar spine synovial cysts develop from degenerated zygapophyseal joints. Symptomatic patients present with radicular pain and weakness or neurogenic claudication.1 In the absence of significant concomitant degenerative spondylolisthesis, symptomatic patients can be managed with a laminectomy and microsurgical resection of the cyst, without the need for instrumented fusion.2,3 In this video, we present the microsurgical resection of a left-sided L4-5 synovial cyst in a 68-yr-old man with radicular pain refractory to conservative management. The radiographical features, relevant surgical anatomy, and salient operative steps are reviewed, and strategies for preventing cyst recurrence are emphasized. There were no complications, the postoperative course was unremarkable, and the patient was discharged on postoperative day 1 with significant improvement in his presenting symptoms. No identifying information is present, and patient consent was obtained for the procedure and for publishing the material included in this video.

Synovial Cysts of the Spine

Neurosurgery ◽  
1988 ◽  
Vol 22 (4) ◽  
pp. 642-647 ◽  
Author(s):  
Burton M. Onofrio ◽  
Alexander D. Mih
Keyword(s):  
Degenerative Change ◽  
Degenerative Spondylolisthesis ◽  
Signs And Symptoms ◽  
Positive Contrast ◽  
Surgical Excision ◽  
Anatomical Location ◽  
Computed Tomographic ◽  
Presenting Symptoms ◽  
Dural Sac ◽  
Synovial Cysts

Abstract A series of 13 patients with synovial or ganglion cysts of the spinal facet joints causing nerve root compression is reported. These cysts were found in both the cervical and the lumbar spine, and the anatomical location of each cyst corresponded to the patient's signs and symptoms. In no case was there evidence of intervertebral disc abnormality found at operation. The patients ranged from 49 to 77 years of age and included 4 men and 9 women. Radiographic evidence of facet degenerative change and degenerative spondylolisthesis was frequently but not invariably noted. The extradural defects defined with positive contrast myelography or postmyelography computed tomographic scanning were usually posterior or posterolateral to the common dural sac and were misinterpreted as extruded discs in the majority of cases. Treatment consisted of laminectomy and surgical excision of cysts. All patients reported improvement or resolution of their presenting symptoms.

scholarly journals A novel approach to symptomatic lumbar facet joint synovial cyst injection and rupture using iGuide navigational software: A case report and review

2016 ◽  
Vol 22 (5) ◽  
pp. 596-599
Author(s):  
David J Wang ◽  
Stephen P Lownie ◽  
David Pelz ◽  
Sachin Pandey
Keyword(s):  
Facet Joint ◽  
Symptom Relief ◽  
Percutaneous Treatment ◽  
Synovial Cyst ◽  
Neurogenic Claudication ◽  
Novel Approach ◽  
Successful Approach ◽  
Synovial Cysts ◽  
Cyst Rupture ◽  
Lumbar Facet

Spinal synovial cysts are benign protrusions of facet joint capsules caused by degenerative spondylosis, most frequently involving the L4–5 level, and commonly lead to symptoms of back pain, radiculopathy and neurogenic claudication. Although percutaneous treatment via facet joint steroid injection with cyst rupture can provide significant symptom relief, cyst rupture is not always achievable via an indirect trans-facet approach due to limited access from severe degenerative changes. In this case, we describe a successful approach to direct cyst access using a laser-guided navigational software in a patient with severe facet joint osteophytosis. We provide a brief review of literature.

scholarly journals Minimally invasive CT guided treatment of intraspinal synovial cyst

2014 ◽  
Vol 48 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Sergeja Kozar ◽  
Miran Jeromel
Keyword(s):  
Synovial Cyst ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Low Back ◽  
Facet Joints ◽  
Resonance Imaging ◽  
Ct Guided ◽  
Synovial Cysts ◽  
Magnetic Resonance Imaging Mri

Abstract Background. Intraspinal synovial cysts of vertebral facet joints are uncommon cause of radicular pain as well as neurological deficits. They can be managed both conservatively and surgically. Case report. A 77-year old polymorbid patient presented with bilateral low back pain which worsened during the course of time and did not respond to the conservative treatment. A diagnosis of intraspinal synovial cyst was made using the magnetic resonance imaging (MRI). Percutaneous computed tomography (CT) guided injection with installation of local anesthetic together with corticosteroid and rupture of the cyst was successfully used. A month after the procedure his pain improved, the usage of analgesics diminished and his over-all quality of life improved. Conclusions. Percutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

The role of spinal fusion in the treatment of cervical synovial cysts: a series of 17 cases and meta-analysis

2014 ◽  
Vol 21 (6) ◽  
pp. 919-928 ◽  
Author(s):  
Mohamad Bydon ◽  
Joseph A. Lin ◽  
Rafael de la Garza-Ramos ◽  
Daniel M. Sciubba ◽  
Jean Paul Wolinsky ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Outcomes ◽  
Meta Analysis ◽  
Case Series ◽  
Symptom Resolution ◽  
Presenting Symptoms ◽  
Significant Difference ◽  
Synovial Cysts ◽  
Cyst Recurrence

Object This study was undertaken to compare surgical outcomes between patients with atlantoaxial versus subaxial cervical synovial cysts (CSCs) and to compare outcomes between patients who underwent decompression alone versus decompression and fusion for the treatment of CSCs. Methods The authors present a series of 17 cases involving patients treated at their institution and report the surgical outcomes. Due to the rarity of CSCs, a meta-analysis was conducted, and results of the literature search were combined with the case series to enhance the power of the study. Results Seventeen patients underwent surgical treatment for CSCs at our institution: 3 patients (17.6%) had atlantoaxial cysts and 14 (82.3%) had subaxial cysts. Of the 17 patients, 16 underwent a decompression and fusion; most patients experienced symptom resolution at last follow-up, and there were no cyst recurrences. A total of 54 articles (including the current series) and 101 patients were included in the meta-analysis. The mean age at presentation was 64 ± 13.9 years, and the most common symptoms were motor and sensory deficits. Forty-one patients (40.6%) presented with atlantoaxial cysts, and 60 (59.4%) with subaxial cysts. There were no significant differences between groups in terms of presenting symptoms, Nurick scores, surgical treatment, or surgical outcomes. Fifty-two patients (51.4%) underwent surgical decompression without fusion, while 49 patients (48.6%) underwent fusion. The preoperative Nurick scores were significantly lower in the fused group (p = 0.001), with an average score of 1.32 compared with 2.75 in the nonfused group. After a mean follow-up of 16.5 months, a difference of means analysis between final and preoperative Nurick scores revealed that patients who received a decompression alone improved on average 1.66 points (95% CI 1.03–2.29) compared with 0.8 points (95% CI 0.23–1.39) in the fused group (p = 0.004). However, there was no statistically significant difference in symptom resolution between the groups, and the rate of cyst recurrence was found to be 0%. Conclusions In this study, patients with CSCs had similar outcomes regardless of cyst location and regardless of whether they underwent decompression only or fusion. In the authors' institutional experience, 16 of 17 patients underwent fusion due to underlying spinal instability. While there were no reports of cyst recurrence in their series or in the literature in patients who only received decompression, this is likely due to the limited follow-up time available for the study population. Longer follow-up and prospective and biomechanical studies are needed to corroborate these findings.

Radicular pain caused by synovial cyst: an underdiagnosed entity in the elderly?

2000 ◽  
Vol 92 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Dhany R. Charest ◽  
Brendan G. Kenny
Keyword(s):  
Preoperative Diagnosis ◽  
World Literature ◽  
The Elderly ◽  
Synovial Cyst ◽  
Radicular Pain ◽  
Age Group ◽  
Content Type ◽  
The World ◽  
Synovial Cysts ◽  
Fine Print

Object. Synovial cyst is a recognized but infrequent cause of nerve root or spinal canal compression. The authors undertook a review of 839 decompressive spinal procedures performed over a 5-year period. They found seven cases in which the symptoms were caused by synovial cysts. Methods. Six of these cases were in a subgroup of 80 patients who were older than 60 years of age, which represents 7.5% of the total for this age group. More than 200 cases of this abnormality have been reported in the world literature, but the incidence, prevalence, and natural history remain unknown. Conclusions. The authors propose that the incidence of synovial cysts may be more common than recognized in the elderly and suggest that preoperative diagnosis may help limit the extent of the surgical approach.

Intraspinal synovial cysts: 10-year experience at the Ochsner Clinic

1999 ◽  
Vol 91 (2) ◽  
pp. 193-199 ◽  
Author(s):  
Jay U. Howington ◽  
Edward S. Connolly ◽  
Rand M. Voorhies
Keyword(s):  
Facet Joint ◽  
Signs And Symptoms ◽  
Cord Compression ◽  
Radicular Pain ◽  
Neurogenic Claudication ◽  
Content Type ◽  
Synovial Cysts ◽  
Operative Findings ◽  
Radiological Studies ◽  
Fine Print

Object. Although synovial cysts commonly involve the joints of the extremities, they are also found in the spinal canal. When symptomatic, they produce signs and symptoms consistent with nerve root and spinal cord compression. In this report the authors review the clinical presentations, radiological studies, and operative findings in 28 patients with intraspinal synovial cysts treated surgically at the Ochsner Clinic between 1988 and 1998. Methods. The medical records and radiological studies obtained in 28 patients (31 intraspinal synovial cysts) were analyzed. Twenty-nine (94%) of the cysts were located in the lumbar, one in the thoracic (T8–9), and one in the cervicothoracic (C7—T1) spine. Sixteen (57%) of the 28 patients presented with radicular pain. The remaining patients presented either with neurogenic claudication (25%) or with radicular pain and an associated neurological deficit (18%). Each cyst was located adjacent to a facet joint in which there was evidence of degenerative disease. Conclusions. Intraspinal synovial cysts are uncommon lesions most often found in the lumbar spine at the L4–5 level. They are invariably associated with facet degeneration and respond very well to surgical therapy.

Factors Associated With Recurrent Back Pain and Cyst Recurrence After Surgical Resection of One Hundred Ninety-Five Spinal Synovial Cysts

Spine ◽  
2010 ◽  
Vol 35 (10) ◽  
pp. 1044-1053 ◽  
Author(s):  
Risheng Xu ◽  
Matthew J. McGirt ◽  
Scott L. Parker ◽  
Mohamed Bydon ◽  
Alessandro Olivi ◽  
...  
Keyword(s):  
Back Pain ◽  
Surgical Resection ◽  
Factors Associated ◽  
Synovial Cysts ◽  
Cyst Recurrence

scholarly journals The Interspinous Spacer: A New Posterior Dynamic Stabilization Concept for Prevention of Adjacent Segment Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Antoine Nachanakian ◽  
Antonios El Helou ◽  
Moussa Alaywan
Keyword(s):  
Lumbar Spine ◽  
Preventive Measure ◽  
Radicular Pain ◽  
Dynamic Stabilization ◽  
Adjacent Segment Disease ◽  
Neurogenic Claudication ◽  
Adjacent Segment ◽  
Disability Score ◽  
Interspinous Spacer ◽  
Posterior Dynamic Stabilization

Introduction. Posterior Dynamic stabilization using the interspinous spacer device is a known to be used as an alternative to rigid fusion in neurogenic claudication patients in the absence of macro instability. Actually, it plays an important in the management of adjacent segment disease in previously fused lumbar spine.Materials and Method. We report our experience with posterior dynamic stabilization using an interspinous spacer. 134 cases performed in our institution between September 2008 and August 2012 with different lumbar spine pathologies. The ages of our patients were between 40 and 72 years, with a mean age of 57 years. After almost 4 years of follow up in our patient and comparing their outcome to our previous serious we found that in some case the interspinous distracter has an important role not only in the treatment of adjacent segment disease but also in its prevention.Results and Discussion. Clinical improvement was noted in ISD-treated patients, with high satisfaction rate. At first, radicular pain improves with more than 3/10 reduction of the mean score on visual analog scale (VAS). In addition, disability score as well as disc height and lordotic angle showed major improvement at 3 to 6 months post operatively. And, no adjacent segment disease was reported in the patient operated with interspinous spacer.Conclusion. The interspinous spacer is safe and efficient modality to be used not only as a treatment of adjacent segment disease but also as a preventive measure in patients necessitating rigid fusion.

scholarly journals CT Guided Aspiration of a Cervical Synovial Cyst

2007 ◽  
Vol 13 (3) ◽  
pp. 295-298 ◽  
Author(s):  
V.J. Kostanian ◽  
M.S. Mathews
Keyword(s):  
Cervical Spine ◽  
Nerve Root ◽  
Symptomatic Relief ◽  
Epidural Injection ◽  
Synovial Cyst ◽  
Joint Space ◽  
Complete Relief ◽  
Ct Guided ◽  
Image Guided ◽  
Synovial Cysts

Synovial cysts are cystic dilations of synovial sheaths with or without anatomical continuity within a joint space that occasionally involve the lumbar spine. Image-guided aspiration has been used successfully in the management of lumbar synovial cysts. Synovial cysts of the cervical spine are rare, tend to present with myelopathic symptoms, and are classically treated using operative intervention. We report a novel approach for cervical synovial cyst aspiration under CT guidance. A 66-year-old woman presented to the clinic complaining of severe pain, tingling, and dysesthesia in her right upper extremity in the C5, C6 and C7 nerve root distribution. MR imaging of her cervical spine showed a synovial cyst within the right C6-C7 neural foramen with significant compression and obliteration of the C7 nerve root. The patient underwent CT-guided aspiration of the cyst using a double needle technique, where one needle was used to open up the epidural space while another aspirated the cyst. This was followed by epidural injection of local anesthetic and steroids. Immediately after injection, the patient experienced complete relief of her right forearm pain, tingling, and dysesthesias. The patient tolerated the procedure well and there were no postprocedure complications. At four year follow-up the patient is free of any symptoms. Image-guided aspiration of cervical synovial cysts is feasible using CT fluoroscopy. Aspiration of these cysts combined with epidural steroid injection can provide long-lasting symptomatic relief in some patients.

scholarly journals Giant Synovial Cyst of Thigh: A Rare Entity

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Kushagra Sinha ◽  
Rajesh Maheshwari ◽  
Atul Agrawal
Keyword(s):  
Knee Joint ◽  
Surgical Excision ◽  
Inflammatory Cells ◽  
Synovial Cyst ◽  
Rare Entity ◽  
The Past ◽  
Inflammatory Conditions ◽  
Precise Diagnosis ◽  
Synovial Cysts ◽  
Laboratory Investigations

Synovial cyst occurs secondary to traumatic, degenerative, or inflammatory conditions. Synovial cysts represent abnormal distension of bursae, which communicate with the joint. Giant synovial cysts are typically due to rheumatoid arthritis, other causes being trauma and synovial pseudoarthrosis. A 33-year-old male presented to an outpatient clinic with a massive swelling on his posterolateral aspect of right thigh extending from upper one-third to the knee joint which had been increasing in size over the past six months. This was associated with dull aching pain. All laboratory investigations were within normal parameters. Even FNAC was inconclusive. With time, swelling was increasing in size. Ultrasound revealed the cystic nature of swelling. MRI showed large cystic lesion 24 × 10 × 12 cm in posterolateral aspect of thigh extending up to knee joint. Following the MRI, an excision was planned. After excision, histological examination confirmed the synovial nature of the cyst, which had a collagenous wall and dense chronic inflammatory cells. As the disease is extremely rare and asymptomatic, precise diagnosis is difficult and often delayed. We consider that open surgical excision should be reserved for cases of large synovial cysts because it can provide a complete resection of the lesion and minimize the risk of recurrence.

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