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Bilateral lumbar synovial cysts 2005

General Spine

Peter x Kalina, MD

Excerpta

A 59-year-old female presented with a long history of progressing low back pain. It was made worse with prolonged standing and walking. The pain initially involved the back with radiation to the right groin. Lately, it was worse on the left with involvement of the posterior thigh and calf, greater on the left. It was worse with extension. Facet and sacroiliac injections had provided only short lasting relief.

MRI revealed large bilateral L4-5 synovial cysts resulting in significant central spinal canal stenosis.
The cysts were surgically excised and the patient’s symptoms significantly improved.

Synovial cysts of the spine are typically unilateral in the lower lumbar region (especially L4-5). They develop as a result of facet degenerative disease and excessive joint motion. The clinical differential diagnosis includes other etiologies producing symptoms and signs of nerve root/thecal sac compression, especially disk herniation. Surgical cyst resection is usually limited to patients who fail conservative measures including rest and intra-articular injections.

Bilateral lumbar synovial cysts are extremely rare with only a few reported cases in the literature.