What is a Synovial Cyst?

Synovial cysts are abnormal sacs filled with fluid that usually occur due to age-related spine degeneration. 

As Columbia University’s Irving Medical Center notes, “Synovial = having to do with a type of joint that is lubricated by synovial fluid”. Meanwhile, “Cyst = an abnormal, fluid-filled sac”. Therefore synovial cysts are [abnormal] cysts between joints in the spine.

Because synovial cysts occur most often due to age-related spinal deterioration, they’re uncommon in adults under the age of 45, and are most common in adults over the age of 65. 

Are Synovial Cysts Dangerous?

They’re not normally dangerous. They’re also benign. But they may put pressure on the spinal nerves – causing spinal stenosis which would lead to an increased amount of lower extremity pain. What’s more, they usually are observed “in the lumbar spine…almost always most common at the L4-5 level

Symptoms of Synovial Cysts

Recognizable symptoms of synovial cysts on your spine, per Columbia University’s Irving Medical Center, include:

• No symptoms (Asymptomatic)
• Back and leg pain that’s worse when standing & walking rather than sitting or lying down
• Numbness, tinging, or weakness in one or both legs due to spinal-stenosis caused by synovial cysts

Diagnostic Approaches for Synovial Cysts of the Spine

Diagnosis of synovial cysts is generally dependent upon these methods:

• Magnetic Resonance Imaging (MRI): Uses large magnets, radiofrequencies, and a computer concurrently to create detailed pictures of both soft tissue and bones.
• Computed Tomography (CT) Scan: Uses X-rays along with a computer to produce images of soft tissue and bones.

Treatment Options and Management of Synovial Cysts

Synovial cysts that are symptomatic and lead to spinal stenosis can be treated or managed either conservatively or aggressively in some of the following ways.

Conservative Treatments

Conservative treatments for synovial cysts may include:

• Medication: NSAIDs like Advil (Ibuprofen) 
• Injections (corticosteroids) carefully administered and monitored by a physician
• Physical and occupational therapy (including heat, cold, and electrotherapy)

A combination of conservative treatment methods (such as physical therapy and administration of NSAIDs) often proves most effective. However, if they prove to be ineffective, it may be time to consult a spine surgeon.

Non-Conservative Treatments

Non-conservative treatments for synovial cysts may include aspiration and cyst removal (surgery). As Johns Hopkins Medicine pointedly notes, “Surgery may be recommended for persistent cysts that cause pain and impaired movement.” 

We consistently advocate for conservative treatment as the initial approach. However, should you discover that conservative therapy proves ineffective, it might be prudent to seek guidance from a spine specialist to explore alternative options.

What Are the Risks of Spine Surgery for Synovial Cysts?

If surgery is recommended, you should know the risks. Most synovial cysts can be removed via spinal decompression, or decompression and spinal fusion.

Like any surgery, there are associated risks leading to:

• Infection
• Blood clots
• Dural tear
• Leakage of cerebrospinal fluid
• Nerve injury & paralysis

Do I Need Spine Surgery for Synovial Cysts?

Larger synovial cysts that put a lot of pressure on the spine and cause spinal stenosis are often the type that must be removed surgically. But what is considered a large synovial cyst, and what exactly is the average size of a synovial cyst that doesn’t need surgical removal? Only a spine specialist with the knowledge of how to appropriately diagnose a synovial cyst can answer this tough question. 

If you still have questions about whether you can treat your spinal cysts via conservative treatment or you might require surgery, we invite you to reach out to our expert team of spine doctors at Desert Spine and Scoliosis Center.