Lumbar intraspinal synovial cysts: conservative management and review of the world's literature.
Review
Overview
abstract
BACKGROUND CONTEXT: Lumbar intraspinal synovial cysts are an important cause of axial and radicular spine pain. Controversy about nonsurgical versus surgical treatment persists. PURPOSE: To evaluate the efficacy of nonsurgical management of symptomatic lumbar intraspinal synovial cysts (LISCs). STUDY DESIGN/SETTING: Retrospective review set in outpatient physiatry office. PATIENT SAMPLE: Ten patients (8 women, 2 men; average age, 60 years) with LISCs and average symptom duration of 7.9 months. OUTCOME MEASURES: Numerical pain rating scale (NRS-11), Roland-Morris disability outcome measure, patient satisfaction, and surgery. METHODS: Patients with LISCs were identified and their charts were reviewed. Those patients whose symptoms correlated with the level of LISC-induced extradural compression were eligible. All patients received conservative care and a fluoroscopic-guided lumbar spine injection. The primary author conducted telephone follow-up. RESULTS: All 10 patients had unilateral radicular pain. Seven had stable neurologic deficits. Magnetic resonance imaging and computed tomography/myelography, respectively, identified a LISC in 8 and 2 patients. Five patients had cyst aspiration followed by steroid instillation; 5 patients had cyst aspiration followed by a transforaminal epidural steroid injection. Average length of follow-up was 50.4 weeks. Only 1 patient had sustained benefit. One patient had no benefit and refused surgery. Eight patients underwent surgery and had a good result. CONCLUSION: In our opinion, nonsurgical management in patients with LISC-induced radicular pain does not appear to be as successful as surgery.
