Intraspinal synovial cysts: 10-year experience at the Ochsner Clinic

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Object. Although synovial cysts commonly involve the joints of the extremities, they are also found in the spinal canal. When symptomatic, they produce signs and symptoms consistent with nerve root and spinal cord compression. In this report the authors review the clinical presentations, radiological studies, and operative findings in 28 patients with intraspinal synovial cysts treated surgically at the Ochsner Clinic between 1988 and 1998.

Methods. The medical records and radiological studies obtained in 28 patients (31 intraspinal synovial cysts) were analyzed. Twenty-nine (94%) of the cysts were located in the lumbar, one in the thoracic (T8–9), and one in the cervicothoracic (C7—T1) spine. Sixteen (57%) of the 28 patients presented with radicular pain. The remaining patients presented either with neurogenic claudication (25%) or with radicular pain and an associated neurological deficit (18%). Each cyst was located adjacent to a facet joint in which there was evidence of degenerative disease.

Conclusions. Intraspinal synovial cysts are uncommon lesions most often found in the lumbar spine at the L4–5 level. They are invariably associated with facet degeneration and respond very well to surgical therapy.

Article Information

Address correspondence to: Edward S. Connolly, M.D., Department of Neurosurgery, Ochsner Clinic, 1514 Jefferson Highway, Jefferson, Louisiana 70121.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Lateral lumbar spine myelogram obtained in a 75-year-old woman, revealing degenerative spondylolisthesis with a doming defect anteriorly at L4–5 that was caused by the uncovered disc and a large posterior extradural defect at the same level representing a synovial cyst. Right: Oblique lumbar spine myelogram obtained in a 60-yearold man, demonstrating a large right-sided posterolateral defect caused by a synovial cyst.

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    Left: Postmyelography CT scan obtained in the patient in Fig. 1 left, demonstrating degenerative disease of the facets, hypertrophied ligamentum flavum, gas in the disc space, and posterolateral compression of the thecal sac that was caused by a synovial cyst adjacent to the facet joint. Right: Postmyelography CT scan obtained in the patient shown in Fig. 1 right, also revealing degenerative disease of the facets and a posterolateral compression of the thecal sac caused by a synovial cyst that is contiguous with the right facet joint.

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    Left: Postcontrast sagittal T1-weighted MR image revealing a thin rim of enhancement around an epidural mass that displays an intermediate signal intensity between that of disc and that of CSF. Center: Postcontrast axial T1-weighted MR image obtained in the same patient, demonstrating the cyst and its capsule as evidenced by the rim of enhancement. Right: A T2-weighted gradient axial image obtained in the same patient, demonstrating an increased signal within the mass and its close association with the degenerated facet joint on the right.

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    Imaging studies obtained in a 52-year-old woman. Axial T1-weighted (upper left) and T2-weighted (upper right) MR images revealing an epidural mass with a signal intensity equal to that of CSF on both sequences that appears to arise from the right L5–S1 facet joint. Anteroposterior myelogram (lower left) and postmyelography CT scan (lower right) demonstrating the presence of a Tarlov's cyst at that level as well as the level above.

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