Intraspinal Lumbar Synovial Cysts I.
Overview of the Topic

Authors: M. Häckel;  P. Vaněk
Authors‘ workplace: Neurochirurgická klinika 1. LF UK a IPVZ, ÚVN Praha
Published in: Cesk Slov Neurol N 2009; 72/105(1): 18-23
Category: Review Article


The article provides an overview of literature on the history, epidemiology and progress in the diagnosis and treatment of intraspinal synovial cysts in the lumbar spine (ILSC). ILSC are pathological protrusions of synovial lining. From the pathophysiological point of view, it is necessary to distinguish between ILSC and atypical lumbar cysts classified under the term “discal cysts”. The diagnostic method used for the detection of ILSC is magnetic resonance imaging (MRI). Conservative methods, analgesic and physiatric treatment may have a positive effect in some patients and should precede surgical treatment in symptomatic cysts except for those ILSC which cause paretic neurological symptoms, generate pressure or endanger the CNS (the spinal cord). Mini invasive methods (corticoid injections, etc.) have a good effect in a large portion of patients. However, the effect is limited in time in a considerable percentage of patients who suffer from recurrent symptoms. Surgical treatment of the disease consists in the resection of the cysts and decompression, mostly by means of laminectomy. Discussion concerning the use of primary arthrodesis simultaneously with decompression continues and there are still no comparative valid studies available. The article is followed up by the article Intraspinal lumbar synovial cysts II. Own results.

Key words:
lumbar synovi al cysts – degenerative disease of the lumbal spine – radicular signs and symptoms – decompression of the spinal canal


1. Baker WM. Formation of abnormal synovial cysts in the leg in connection with the joints. St. Bartholomew Hosp Rep 1885; 21: 177–190.

2. Vossschulte K, Borger G. Anatomische and funktinonelle Untersuchugen über den Bandsheibenprolaps. Langenbecks Arch Klin Chir Ver Dtsch Z Chir 1950; 265(3–4): 329–355.

3. Schöllner D. Ganglion on a vertebral joint. Z Orthop Ihre Grenzgeb 1967, 102(4): 619–620.

4. Kao CC, Uihlein A, Bickel WH, Soule EH. Lumbar intraspinal extradural ganglion cyst. J Neurosurg 1968; 29(2):168–172.

5. Kao CC,Winkler SS, Turner JH. Synovial cyst of the spinal facet. J Neurosurg 1974; 41(3): 372–376.

6. Epstein NE. Lumbar laminectomy for resection of lumbar synovial cysts and coexisting lumbar spinal stenosis or degenerative spondylolisthesis: an outcome study. Spine 2004; 29(9): 1049–1056.

7. Doyle AJ, Merrilees M. Synovial cysts of the lumbar facet joints in a symptomatic population. Spine 2004; 29(8): 874–878.

8. Pendleton B, Carl B, Pollay M. Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery 1983; 13(3): 322–326.

9. Onofrio BM, Mih AD. Synovial cyst of the spine. Neurosurgery 1988; 22(4): 642–647.

10. Sabo RA, Tracy PT, Weinger JM. A series of 60 juxtafacet cysts: clinical presentation, the role of spinal instability, and treatment. J Neurosurg 1996; 85(4): 560–565.

11. Franck JI, King RB, Petro CB, Kanzer MD. A posttraumatic lumbar spinal synovial cyst. Case report. J Neurosurg 1987; 66(2): 293–296.

12. Awwad EE, Sundaram M, Bucholz RD. Post traumatic spinal synovial cyst with spondylolysis: CT features. J Comput Assist Tomogr 1989;13(2): 334–337.

13. Lunardi P, Acqui M, Ricci G, Agrillo A, Ferrante L. Cervical synovial cysts: case report and review of the literature. Eur Spine Journal 1999; 8(3): 232–237.

14. Fonoff ET, Dias MP, Tarico MA. Myelopathic presentation of cervical juxtafacet cyst: a case report. Spine 2004; 29(23): E538–E541.

15. Doherty PF, Sherman BA, Stein SC, White R. Bilateral synovial cyst sof the thoracic spine: a case report. Surg Neurol 1993; 39(4): 279–281.

16. Stoodley MA, Jones NR, Scott G. Cervical and thoracic juxtafacet cysts causing neurologic deficits. Spine 2000; 25(8): 970–973.

17. Hemminghytt S, Daniels DL, Williams AL, Haughton VM. Intraspinal synovial cysts. Natural history and diagnosis by CT. Radiology 1982; 145(2): 375–376.

18. Howington JU, Connolly ES, Voorhies RM. Intraspinal synovial cysts: 10-year experience at the Ochsner Clinic. J Neurosurg 1999; 91 (Suppl 2): 193–199.

19. Hsu KY, Zucherman JF, Shea WJ, Jeffrey RA. Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment. Spine 1995; 20(1): 80–89.

20. Yarde WL, Arnold PM, Kepes JJ, O‘Boynick PL, Wilkinson SB, Batnitzky S. Synovial cysts of the lumbar spine: diagnosis, surgical management, and pathogenesis. Report of eight cases. Surg Neurol 1995; 43(5): 459–464.

21. Kjerulf TD, Terry DW jr, Boubelik RJ. Lumbar synovial or ganglion cysts. Neurosurgery 1986; 19(3): 415–420.

22. Abdullah AF, Chambers TW, Daut DP. Lumbar nerve root copression by synovial cyst of the ligamentum flavum. Report of four cases. J Neurosurg 1984; 60(3): 617–620.

23. Baba H, Furusawa N, Maezawa Y, Uchida K, Kokubo Y, Imura S et al. Ganglion cyst of the posterior longitudinal ligament causing radiculopathy: case report. Spinal Cord 1997; 35(9): 632–635.

24. Barea H, Teschner D, Chouc P, Jeandel P, Brigant JF. Cyst of the lumbar posterior longitudinal ligament. An unusual case of non discal sciatica. J Radiol 1996; 77(8): 579–581.

25. Feldman F, Singson RD, Staron RB. Magnetic resonance imaging of paraarticular and ectopic ganglia. Skeletal Radiol 1989; 18(5): 353–358.

26. Oertel MF, Ryang YM, Gilsbach JM, Rohde V. Lumbar foraminal and far lateral juxtafacet cyst of intraspinal origin. Surg Neurol 2006; 66(2): 197–199.

27. Komberg M. Nerve root compression by a ganglion cyst of the lumbar annulus fibrosus. A case report. Spine 1995; 20: 1633–1635.

28. Grabel JC, Davis R, Zappulla R. Intervertebral disc space cyst simulating a recurrent herniated nukleus pulposus. Case report. J Neurosurg 1988; 69(1): 137–139.

29. Kono K, Nakamura H, Inoue Y, Okamura T, Shakudo M,Yamada R. Intraspinal extradural cysts communicating with adjacent herniated disk: Imaging characteristics and possible pathogenesis. AJNR Am J Neuroradiol 1999; 20(7): 1373–1377.

30. Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Nishizawa T. Intraspinal cysts communicating with the intervertebral disc in the lumbar spine. Spine 2001; 26(19): 2112–2118.

31. Marshman LA, Benjamin JC, David KM, King A, Chawda SJ. „Disc cysts“ and „posterior longitudinal ligament ganglion cysts“: synonymous entities? Report of three cases and literature review. Neurosurgery 2005; 57(4): E818.

32. Okada K, Saito H, Nishida J, Miyakoshi N, Takahashi S, Nagasawa H et al. Discal cyst associated with myxoid change and apoptosis of herniated disc materials: a case report. Ups J Med Sci 2007; 112(1): 39–47.

33. Kurz LT, Garfin SR, Unger AS, Thorne RP, Rothman RH. Intraspinal synovial cyst causing sciatica. J Bone Joint Surg Am 1985; 67(6): 865–871.

34. Bjorkengren AG, Kurz LT, Resnick D, Sartoris DJ, Garfin SR. Symptomatic intraspinal synovial cysts: opacification and treatment by percutaneous injection. AJR Am J Roentgenol 1987; 149(1): 105–107.

35. Abrahams JJ, Wood GW, Eames FA, Hicks RW. CT-guided needle aspiration biopsy of an intraspinal synovial cyst (ganglion): case report and review of the literature. AJNR Am J Neuroradiol 1988; 9(2): 398–400.

36. Parlier-Cuau C, Wybier M, Nizard R, Champsaur P, Le Hir P, Laredo JD. Symptomatic lumbar facet joint synovial cysts: clinical assessment of facet joint steroid injection after 1 and 6 months and long term follow up in 30 patients. Radiology 1999; 210(2): 509–513.

37. Shah RV, Lutz GE. Lumbar intraspinal synovial cysts:conservative management and review of the world‘s literature. Spine J 2003; 3(6): 479–488.

38. Baum JA, Hanley EN jr. Intraspinal synovial cyst simulating spinal stenosis. A case report. Spine 1986; 11(5): 487–489.

39. Bozzao A, Floris R, Fraioli C, Ticca L, Simonetti G. „Relapsing-remitting“ bilateral synovial cysts of the lumbar spine. A case report. Neuroradiology 2001; 43(12): 1076–1078.

40. Pendleton B, Carl B, Pollay M. Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery 1983; 13(3): 322–326.

41. Shaw M, Birch N. Facet joint cysts causing cauda equina compression. J Spinal Disord Tech 2004; 17(5): 442–445.

42. Summers RM, Quint DJ. Case report 712: Hemorrhagic synovial cyst arising from right L2-3 facet point. Skeletal Radiol 1992; 21(1): 72–75.

43. Tatter SB, Cosgrove GR. Hemorrhage into a lumbar synovial cyst causing an acute cauda equina syndrome. Case report. J Neurosurg 1994; 81(3): 449–452.

44. Howling SJ, Kessel D. Case report: acute radiculopathy due to a hemorrhagic lumbar synovial cyst. Clin Radiol 1997; 52: 73–74.

45. Kaneko K, Inoue Y. Hemorrhagic lumbar synovial cyst. A cause of acute radiculopathy. J Bone Joint Surg Br 2000; 82(4): 583–584.

46. Wait SD, Jones FD, Lonser RR, Lee KS. Symptomatic epidural hematoma caused by lumbar synovial cyst rupture: report of two cases and review of the literature. Neurosurgery 2005; 56(5): E1157.

47. Reust P, Wendling D, Lagier R, Pageaut G, Reverdin A,Jacquet G et al. Degenerative spondylolisthesis, synovial cyst of the zygapophyseal joints, and sciatic syndrome: report of two cases and a review of the literature. Arthritis Rheum 1988; 31(2): 288–294.

48. Nelson DA. Intraspinal therapy using methylprednisolone acetate: twenty-three years of clinical controversy. Spine 1993; 18(2): 278–286.

49. Nelson DA. Dangers from methylprednisolone acetate therapy by intraspinal injection. Arch Neurol 1988; 45(7): 804–806.

50. Plumb VJ, Dismukes WE. Chemical meningitis related to intrathecal corticosteroid therapy. South Med J 1977; 70(10): 1241–1243.

51. Demaerel P, Eerens I, Goffin J, Wilms G. Spontaneous regression of an intraspinal disc cyst. Eur Radiol 2001; 11(11): 2317–2318.

52. Vallée C, Chevrot A, Benhamouda M, Gires F, Wybier M, Sellier N et al. Aspects tomodensitométriques des kystes synoviaux articulaires lombaires à développement intrarachidien. J Radiol 1987; 68(8–9): 519–526.

53. Wang AM, Haykal HA, Lin JC, Lee JH. Synovial cyst sof the lumbar spine: CT evaluation. Comput Radiol 1987; 11(5–6): 253–257.

54. Conrad MR, Pitkethly DT. Bilateral synovial cysts creating spinal stenosis: CT diagnosis. J Comput Assist Tomogr 1987; 11(1): 196–197.

55. Sampson MA, Warren SJ. Acute extradural compression due to an intraspinal synovial cyst: CT and myelogram appearances. Clin Radiol 1990; 41(6): 433–434.

56. Awwad EE, Martin DS, Smith KR jr, Bucholz RD. MR imaging of lumbar juxtaarticular cysts. J Comput Assist Tomogr 1990; 14(3): 415–417.

57. Jackson DE jr, Atlas SW, Mani JR, Norman D. Intraspinal synovial cysts: MR imaging. Radiology 1989; 170(2): 527–530.

58. Davis R, Illiya A, Roque C, Pampati M. The advantage of magnetic resonance imaging in diagnosis of a lumbar synovial cysts. Spine 1990; 15(3): 244–246.

59. Liu SS, Williams KD, Drayer BP, Spetzler RF, Sonntag VK. Synovial cysts of the lumbosacral spine: diagnosis by MR imaging. AJR Am J Roentgenol 1990; 154(1): 163–166.

60. Silbergleit R, Gebarski SS, Brunberg JA, McGillicudy J, Blaivas M. Lumbar synovial cysts: correlation of myelographic, CT, MR, and pathologic findings. AJNR Am J Neuroradiol 1990; 11(4): 777–779.

61. Hanley EN jr, Howard BH, Brigham CD, Chapman TM, Guilford WB, Coumas JM. Lumbar epidural varix as a cause of radiculopathy. Spine 1994; 19(18): 2122–2126.

62. Casselman ES. Radiologic recognition of symptomatic spinal synovial cysts. AJNR Am J Neuroradiol 1985; 6(6): 971–973.

63. Koga H, Yone K, Yamamoto T, Komiya S. Percutaneous CT-guided puncture and steroid injection for the treatment of lumbar discal cyst: a case report. Spine 2003; 28(11): E212–E216.

64. Bureau NJ, Kaplan PA, Dussault RG. Lumbar facet joint synovial cyst: percutaneous treatment with steroid injection and distention: clinical and imaging follow up in 12 patients. Radiology 2001; 221(1): 179–185.

65. Vaněk P, Häckel M. Intraspinální lumbální synoviální cysty II – chirurgická léčba 13 nemocných. Cesk Slov Neurol N 2009; 72/105(1): 61–64.

66. Sova M, Smrčka M, Hušek K. Synoviální cysty bederní páteře – vzácná příčina lumboischialgií. Cesk Slov Neurol N 2000; 63/96(5): 297–299.

67. Artico M, Cervoni L, Carloia S, Stevanato G, Mastantuono M, Nucci F. Synovial cysts: clinical and neuroradiological aspects. Acta Neurochir (Wien) 1997; 139(3): 176–181.

68. Lyons MK, Atkinson JL, Wharen RE, Dean HD, Zimmerman RS, Lemens SM. Surgical evaluation and management of lumbar synovial cysts: Mayo Clinic experience. J Neurosurg. 2000; 93 (1 Suppl): 53–57.

69. Trummer M, Flaschka F, Tillich M, Homann CN, Unger F, Eustacchio S. Diagnosis and surgical management of intraspinal synovial cysts. J Neurol Neurosurg Psychiatry 2001; 70(1): 74–77.

70. Khan AM, Synnot K, Cammissa FP, Girardi FP. Lumbar synovial cysts of the spine: and evaluation of surgical outcome. J Spinal Disord Tech 2005; 18(2): 127–131.

71. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta analysis of the literature. Spine 1992; 17(1): 1–8.

72. Silvers HR, Lewis PJ, Asch HL. Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg 1993; 78(5): 695–701.

73. Herron L, Turner JA, Ersek M, Weiner P. Does the Million Behavioral Health Inventory (MBHI) predict lumbar laminectomy outcome? A comparison with the Minnesota Multiphasic Personality Inventory (MMPI). J Spinal Disord 1992; 5(2): 188–192.

74. Fischgrund JS, Mackay M, Herkowitz HN, Brower R,Montgomery DM, Kurz LT. 1997 Volvo Award Winner in Clinical Studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 1997; 22(24): 2807–2812.

75. Airaksinen O, Herno A, Turunen V, Saari T, Suomlainen O. Surgical outcomes of 438 patients treated surgically for lumbar spinal stenosis. Spine 1997; 22(19): 2278–2282.

76. Herno A, Airaksinen O, Saari T. Long term results of surgical treatment of lumbar spinal stenosis. Spine 1993; 18(11): 1471–1474.

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