Synovial Cyst Of The Spine - Everything You Need To Know - Dr. Nabil Ebraheim 

Dr. Ebraheim’s educational animated video describes synovial cyst of the spine.
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Synovial Spinal Cyst
Synovial cyst of the spine is an interesting topic. Basically, you need to recognize that it is a synovial cyst, and you need to recognize the treatment is probably removal by some sort of decompression and you may need fusion if there is instability. It occurs due to arthritis of the facets. It occurs mostly in patients 60 years or older. It usually affects the level of L4-L5. This is one of the most active levels. There will be bulging of the lining of the covering of the facet joint. The synovial cyst is a cyst or a fluid filled cavity. When the fluid escapes from the arthritic facet joint, because it is under pressure, it dilates the capsule of the facet joint and creates a cyst. The connection between the synovial cyst and the facet joint becomes obvious. The synovial cyst is walled off from the spinal canal. The synovial cyst causes pressure on the nerve root as it tries to exit the foramen. Compare both sides. The synovial cyst acts like a herniated disc. The patient will have low back pain, numbness, and radiation of the pain down the leg. The synovial cyst is best diagnosed by an MRI. The MRI can also diagnose the compression on the nerve root by the cyst. The synovial cyst is bright in T2 MRI because it is a fluid filled mass (it’s not like an intervertebral disc) and the cyst is contiguous with the hypertrophied facet joint, which also has a high signal intensity. The synovial cyst indicates a facet pathology. The patient will be initially treated conservatively. There is a high recurrence rate with nonsurgical treatment, and if there is no improvement, then you will need to do surgery. If the patient has radiculopathy alone, do decompression. If the patient has significant low back pain due to spinal instability, you will do decompression and fusion. To check for instability, look at the MRI or the x-rays. Get flexion/extension x-rays before you decide on surgical intervention. Basically, because you have the synovial cyst and when you go in and remove the cyst, you have hypertrophy of the facets and the ligamentum flavum, so you will do a hemilaminotomy and partial facetectomy with direct decompression of the neural elements. Do fusion if there is instability.