gms | German Medical Science

Objective: Lumbar synovial cysts are frequently associated with segmental degenerative changes. Radiculopathy is the leading clinical presentation. However signs of instability are frequently present or arise after surgical decompression. We evaluate a series of patients with lumbar synovial cysts to elucidate if all patients need spinal fusion as primary treatment or if decompression is sufficient for a subset of patients.

Methods: Retrospective data of 40 patients treated during January 2004 to August 2009 were analysed (26 males, 24 females). All patients underwent a complete microsurgical resection of the synovial cyst by an interlaminar approach and a partial facetectomy. Fourteen patients showed additional degenerative spinal spondylolistesis requiring instrumentation in eight cases. The pre- and postoperative symptoms and imaging studies were reviewed.

Results: Most of the synovial cysts were at level L4/5. We found a strong correlation between degenerative spinal spondylolistesis and occurrence of synovial cysts. All patients presented with radiculopathy and local back pain, with 25% having neurological deficits. Postoperatively in thirty-four patients radiculopathy resolved, whereas back pain persisted in over 80%. These patients required secondary spinal fusion, reporting then about a marked remission of local back pain.

Conclusions: According to the literature the aetiology of synovial cysts is still unclear. However there seems to be a strong association for the development of a synovial cyst and spinal segmental instability. We can provide evidence that primary spinal fusion after resection of synovial cysts provides a better outcome.