11. Synovial Cyst

A facet joint synovial cyst is a benign lesion associated with outpouching of the joint capsule and accumulation of synovial fluid. As it extends into the spinal canal, the cyst may compress neural structures and cause low back pain and radicular pain in the lower limb. It may cause central or lateral recess stenosis. With longstanding cysts, the wall may become calcified or ossified.

In persistent, clinically significant symptoms caused by neural compression and failure of previous treatment, we consider surgical decompression and cyst removal. In my practice, I prefer a biportal endoscopic approach (BESS/UBE) when the anatomical and clinical conditions are appropriate.

References

1. Onofrio BM, Mih AD. Synovial cysts of the spine. Neurosurgery. 1988;22(4):642-647. doi:10.1227/00006123-198804000-00004.

2. Heo DH, Kim JS, Park CW, Quillo-Olvera J, Park CK. Contralateral sublaminar endoscopic approach for removal of lumbar juxtafacet cysts using percutaneous biportal endoscopic surgery: technical report and preliminary results. World Neurosurg. 2019;122:474-479. doi:10.1016/j.wneu.2018.11.072.

3. Giordan E, Gallinaro P, Stafa A, Canova G, Zanata R, Marton E, et al. A systematic review and meta-analysis of outcomes and adverse events for juxtafacet cysts treatment. Int J Spine Surg. 2022;16(1):124-138. doi:10.14444/8181.

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