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PubMed2004

Microsurgical approach to lumbar synovial cysts. Technical notes.

Intraspinal extradural synovial cysts are quite common in the lumbar spine. With respect to clinical presentation and surgical treatment, juxta-facet cysts (ganglion and synovial cysts) share identical characteristics and results. Nowadays, current treatment strategies of intraspinal juxta-facet cysts continue to inspire controversy regarding appropriate surgical approaches, and include many technical options. The purpose of this report is to illustrate the advantage of minimally invasive approaches in 3 cases of lumbar synovial cysts. We performed a small flavectomy in the 1st case, a transarticular partial facectomy, followed by etherologous bone graft fusion in the 2nd case, and a flavectomy and partial facectomy in the 3rd case. In our cases, a microsurgical approach to lumbar synovial cysts yielded to complete excision of the lesions and excellent pain relief, with early mobilization and hospital discharge of the patients. In our opinion, minimally invasive approaches and microsurgical excision of lumbar juxta-facet cysts are advantageous over conventional lumbar laminectomy because they reduce later development of segmental instability at the operative level, and therefore a less invasive strategy for intraspinal synovial cysts removal should be recommended.

Adult↗
PubMed1999

Multiple cutaneous metaplastic synovial cysts.

The cutaneous metaplastic synovial cyst is a recently described lesion that characteristically presents as a solitary, tender subcutaneous nodule. On histopathologic examination, the lesion is characterized by a cystic structure with villous-like projections and a lining resembling hyperlastic synovium. The cause of cutaneous metaplastic synovial cysts is unclear, but trauma is presumed to be a precipitating factor, as most reported cases have a history of antecedent cutaneous injury. Here we present a case of multiple, bilateral cutaneous metaplastic synovial cysts in a 72-year-old white man with rheumatoid arthritis. This is the first reported case of a patient with multiple lesions. The characteristic clinical and pathologic features of this lesion, along with proposed cause, are reviewed herein.

Aged↗
PubMed2004

An expanding cervical synovial cyst causing acute cervical radiculopathy.

Synovial cysts of the cervical spine occur infrequently in the spinal canal and are most often associated with degenerative facet joints. Despite the prevalence of degenerative spinal disease, symptomatic synovial cysts are extremely uncommon. We report a rare case that showed an exacerbation of a cervical radiculopathy due to an acute expansion of the synovial cyst. Magnetic resonance (MR) images originally revealed a small cystic extradural lesion when the patient presented with neck pain and slightly numbness in the right hand. The patient's complaints subsequently subsided after administration of pain killers. However, 2 weeks after this, the patient experienced a spontaneous, sudden, severe radiating pain into the right arm without any accompanying cervical injury. MR images showed that the cyst had become markedly increased in size in the intervening 4 weeks and compressed the spinal cord laterally. Because the arm pain was so severe and neurologic examinations revealed the paralysis of the C8 nerve root, the synovial cyst was excised surgically and a good clinical outcome achieved. Thus, even if symptoms are mild and the size of the synovial cyst is small, acute expansion of the cyst might be rarely observed and careful management, including surgical consideration, is needed.

Acute Disease↗
PubMed2005

Uncommon synovial cysts in children.

UNLABELLED: Popliteal synovial cysts (Baker's cysts) are a common occurrence in children and adults. Synovial cysts in other locations and/or with atypical extension are less common and may be confounded with tumors or other medical conditions. In this article we describe the underlying disease, clinical presentation and clinical course in six children with a sudden onset of paraarticular soft tissue masses or non-specific chronic pain. Ultrasound was the initial imaging method used in all cases; this was supplemented by MRI in three patients. Four children were diagnosed to be suffering from juvenile idiopathic arthritis (JIA), one child from Lyme Arthritis, whereas in one child no underlying disease was identified. Well-demarcated hypoechogenic lesions without signs of perfusion extending from the shoulder (two patients), elbow (one patient), hip (one patient), knee (1) or ankle (one patient) far into the adjacent musculature were detected on ultrasonography. A direct connection to the joint was demonstrated in all cases. All synovial cysts in the five arthritic patients resolved rapidly with medical treatment for arthritis, whereas the cyst persisted in the non-JIA patient. CONCLUSION: Uncommon synovial cysts occur in particular as a complication of arthritis. Ultrasonography is the initial and follow-up imaging method of choice, which can be supplemented by MRI in unusual cases. Apart from treatment for arthritis, no specific therapeutic interventions were required in the present cases.

Arthritis, Juvenile↗
PubMed2005

Proximal tibiofibular joint synovial cyst--one pathology with three different presentations.

Synovial cysts of the proximal tibiofibular joint are less common than synovial cysts of the knee joint but may present in a similar fashion and may be difficult to diagnose clinically. We report three cases of such synovial cysts: (1) the synovial cyst presented as an asymptomatic lump distal to lateral joint line of the knee; (2) the synovial cyst presented as a mass fluctuating in size with intermittent symptoms; (3) a man with a large mass in proximal anterior leg and drop foot. The patients were operated. The first and the third patients were treated successfully without recurrence, and complete recovery of the proneal nerve in third case ensued. The synovial cyst recurred in the second case; however, the patient refused a second operation. Age distribution and clinical manifestation of extraneural proximal tibiofibular joint synovial cyst is discussed in the light of relevant literature.

Adult↗
PubMed1997

[Lumbar vertebral synovial cyst].

Intraspinal facet synovial cyst is an uncommon cause of low back pain and sciatica that should be recognised in patients who are symptomatic, in particular in the presence of degenerated facet joints. CT and MRI are diagnostic imaging modalities of choice. Arthrography remains an important procedure to confirm the diagnostic, as avoiding surgery is particularly valuable in older patients.

Aged↗
PubMed1989

Intraspinal synovial cysts: MR imaging.

Juxtaarticular intraspinal synovial cysts are unusual lesions of the spine associated with facet arthropathy. These lesions can cause radicular symptoms and may masquerade clinically as other, more common entities. Synovial cysts have been detected at myelography and have been well characterized at computed tomography as posterolateral epidural masses, typically at L4-5. Six synovial cysts of the lumbar spine were demonstrated on magnetic resonance (MR) images. The signal-intensity patterns of these lesions are variable. MR imaging can be used to document the presence of hemorrhage within the cyst, which may relate to the exacerbation of symptoms. Air-filled synovial cysts may be difficult to detect and distinguish from facet arthropathy.

Adult↗
PubMed1991

Radiologic case study. Intraspinal lumbar synovial cyst.

In conclusion, intraspinal lumbar synovial cysts are uncommon causes of sciatic pain. Intraspinal synovial cysts are associated with degenerative arthritis of the lumbar spine. The radiographic findings on myelography are non-specific, but CT and MRI are helpful in establishing the diagnosis and in differentiating synovial cysts from other extradural lesions.

Adult↗
PubMed1988

Metaplastic synovial cyst after partial excision of nevus sebaceus.

The metaplastic synovial cyst (synovial metaplasia of the skin) is a recently described intradermal cyst lined by a membrane that resembles hyperplastic synovium. All of the reported cases thus far have occurred in adults after surgical incision. A case of metaplastic synovial cyst after partial excision of nevus sebaceus in a 7-year-old girl is herein reported. Pathogenesis and light-microscopic and immunohistochemical features of this case are discussed.

Child↗
PubMed2005

Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome.

BACKGROUND: Synovial cysts represent an uncommon and probably underestimated pathological entity of the degenerative lumbar spine. The authors report a retrospective analysis of the clinical presentation, radiological studies and operative findings in 77 patients surgically treated for symptomatic lumbar synovial cysts at their institution. MATERIALS AND METHOD: Between January 1992 and June 1998, a total of 77 patients presenting with symptomatic lumbar synovial cysts were operated on in the author's department. Operative procedure, complications, results and pathological findings were correlated with preoperative assessment. There were 41 men and 36 women with an average age of 63 years (range 44-90 years). RESULTS: On the basis of their symptom complex on presentation, two populations were identified: patients who presented with a single radicular pain (group I = 51 patients), and patients who presented with bilateral neurogenic claudication (group II = 26 patients). Neurological examination on presentation demonstrated motor deficit (12%), sensory loss (26%) and reflex changes (35%). Degenerative disc disease and facet joint osteoarthritis was a frequent finding in patients with pre-operative MRI. Facet joint orientation was >45 degrees in 76.6% of patients. Preoperative spondylolisthesis was found in 48% on radiological studies. All the patients were treated surgically with resection of the cyst. No fusion was performed as a first line procedure. However subsequent fusion was necessary in one patient who developed symptomatic spondylolisthesis. Mean follow-up period was of 45 months ranging from 18 to 105 months. Only one recurrence occurred during the follow-up period. An excellent or good functional outcome was seen in 97.4% of cases, and 89% of the patients with motor deficit recovered. CONCLUSIONS: Surgical resection of lumbar synovial cysts is an effective treatment associated with very low morbidity. Synovial cysts are associated with increased grade and frequency of facet joint asteoarthritis but not with increased grade or frequency of degenerative disc disease compared with patients without cysts. In the author's opinion, at the present time, there is no reliable criterion which allows the development of a symptomatic spinal instability to be predicted in patients with a preoperative spondylolisthesis and therefore fusion as a first line procedure is still debatable.

Adult↗
PubMed1988

Giant synovial cyst of the hip joint.

Synovial cysts are known to occur in patients with rheumatoid arthritis. Their presentation in the hip joint, however, continues to be a diagnostic challenge. A case is presented involving a patient with a large synovial cyst of the hip, emphasizing the need for the orthopaedic surgeon to include synovial cyst in the differential diagnosis of a painless groin mass, particularly in patients with rheumatoid arthritis.

Aged↗
PubMed2000

[Synovial cyst of cervical spine].

The synovial cyst is a rare cause of cervical medullar compression. We report on one case of a 74-year-old man hospitalized for electric discharge in the limbs at neck extension. The MRI and CT-scan revealed a posterior extradural cystic lesion at the level of C5-C6. The surgical excision of the lesion resulted in completed recovery. The histological examination confirmed the diagnosis of a synovial cyst. Through this case and the review of the 9 reported cases in the literature, we discuss the etiopathogenesis, diagnosis and treatment of the lower cervical synovial cyst.

Aged↗
PubMed2001

Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases.

OBJECTIVE: Synovial cysts of the vertebral facet joints are a source of nerve root compression. Different surgical procedures are in use, but no consensus has been formed so far as to which method should be used in synovial cysts. To clarify the role of surgical management, the efficacy of operative procedures and factors influencing the outcome in our own series of 19 patients treated between 1994 and 1998 were analysed. METHODS: Nineteen patients with a mean age of 65 years underwent surgery for medically intractable radicular pain or neurological deficits caused by synovial cysts. The patients' records were retrospectively analysed for neurological deficits, cysts diameter, operative approach, segmental hypermobility, and clinical outcome; CT and MRI were analysed for additional degenerative changes. RESULTS: In 17 patients an excellent result and in two patients a good postoperative result was achieved. Twelve patients were found to have hypermobility of the facet joints and six had spondylolisthesis. There was no correlation between cyst diameter, operative approach, and outcome. No intraoperative or postoperative complications occurred. CONCLUSIONS: Age and hypermobility may play a part in the aetiology of facet joint synovial cysts. As all operative strategies showed equally good clinical outcome, total excision via a small flavectomy as the least invasive approach should be considered therapy of choice in patients with cysts causing neurological deficits.

Aged↗
PubMedDate not supplied

Epidural hematoma secondary to a rupture of a synovial cyst.

BACKGROUND CONTENT: With modern advances in imaging studies, synovial cysts are becoming more evident as a common component of erosive lumbar degenerative disc disease causing spinal stenosis and radiculopathy. Whereas hemorrhage can occur inside the cyst and is reported, rupture causing epidural hematoma is a rare complication and finding of this disorder. PURPOSE: To report a rare clinical presentation of a synovial cyst and spinal stenosis, where rupture of the cyst leads to an early cauda equina syndrome. STUDY DESIGN: Case report with a review of literature. METHODS: Clinical history, physical findings, and magnetic resonance imaging studies of a patient with an intraspinal synovial cyst at L4-5 1 week before a sudden worsening of symptoms are reported. RESULTS: A case report is presented of a male with a known synovial cyst at L4-5, presenting initially with neurogenic claudication. This patient developed sudden worsening of symptoms with bilateral lower extremity pain, weakness, and radiculopathy with difficult voiding. The patient had developed an epidural hematoma, secondary to rupture of a synovial cyst, documented at surgical decompression. CONCLUSIONS: Although synovial cyst associated with erosive facet and erosive degenerative disc disease are common, rupture of the cyst is not. A case report of a ruptured synovial cyst leading to an early cauda equina syndrome is presented. This case illustrates the spectrum of clinical features and presentations possible with spinal stenosis complicated by lumbar synovial cyst formation.

Aged↗
PubMed1993

Synovial cyst of the cervical spine.

Synovial cyst herniations, typically observed in the lumbar region in conjunction with degenerative changes of the facet joints, only rarely present as space occupying lesions in the cervical spine. The case of a 47-year-old white man with a C7-T1 synovial cyst impinging on the spinal cord and right C8 nerve root is presented.

Cervical Vertebrae↗
PubMed2003

Spontaneous regression of symptomatic lumbar synovial cysts. Report of three cases.

Synovial cysts emanating from the lumbar facet joints may compromise the spinal canal and produce symptoms of radiculopathy or stenosis. Good results have been reported after excision of the symptomatic lesions. There are limited data, however, on the natural history involving nonoperative management and little information to suggest that these lesions ever regress spontaneously. The authors report on three patients in whom symptomatic lumbar synovial cysts spontaneously resolved and review the relevant literature.

Female↗