Synovial Cyst
Synovial cysts are cystic structures that occur around the nerve root. These are the pathologies that can mimic a herniated disc and should be kept in mind in the differential diagnosis of patients presenting with sudden radicular symptoms. Synovial cysts are periarticular cysts of the synovial membrane and contain mostly light to yellow mucinous fluid or gas. Lumbar intraspinal synovial cysts are most common in the 60s; It is more common in women than in men. Facet arthrosis usually plays a role in its pathophysiology. Lumbar synovial cysts are most common in the L4-5 level, where lumbar movement is greatest.
Synovial Cyst Symptoms
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Backache
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Leg pain
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Paralysis
Synovial Cyst Diagnosis
It can also be diagnosed incidentally in asymptomatic cases. Schwannoma, meningioma and metastases should be kept in mind in the differential diagnosis. Degenerative changes at a rate of 60% and spondylolisthesis , albeit at a much lesser rate, can be observed in direct radiography. Magnetic resonance (MR) imaging is the best diagnostic method. Typical observation of gas in MRI is diagnostic. In addition, hemorrhage and debris can be observed in the cyst. Computed tomography (CT) enables calcification in the cyst wall adjacent to the facet joint.
Synovial Cyst Treatment
Conservative or surgical methods can be used in the treatment. Conservative treatment includes rest, analgesic, corset application, and cyst aspiration and / or steroid injection. Conservative treatment can be tried in patients without obvious neurological deficits, and surgical treatment should be preferred in patients with radicular symptoms.
Although the natural history of lumbar intraspinal synovial cysts is not fully known, their spontaneous regression is extremely rare, unlike lumbar disc hernias. Surgical treatment is the most preferred treatment method. Indications for surgical treatment are symptomatic radiculopathy, myelopathy, progressive neurological deficit, and persistent pain. Good results can be obtained in most patients with surgical treatment. Cyst excision and simple decompression are sufficient in surgical treatment. In cases with degenerative spinal stenosis , in addition to simple cyst excision, laminectomy and decompression should be performed when necessary.
