title: Synovial cysts of the lumbar spine: surgery-related results and outcome.
abstract: OBJECTIVE
  The authors conducted a study to determine the surgery-related results and outcomes in patients with synovial cysts of the lumbar spine. They emphasize several specific characteristics useful in clinical management.
  
  
  METHODS
  Forty-six consecutive patients with 54 lumbar synovial cysts underwent surgery between 1990 and 2001. A retrospective analysis of the clinical presentation and follow-up data, radiological findings, and surgical techniques was performed. Clinical presentation was dominated by acute or subacute sciatic pain. No specific symptom allowed differentiation of synovial cyst from a lumbar disc herniation. Computerized tomography scanning aided in establishing the correct diagnosis in 19 of 30 cases and magnetic resonance (MR) imaging did so in all cases. Three of the 46 patients presented with bilateral lumbar synovial cysts. The L4-5 level was affected in 61%, and radiological signs of disc degeneration/spondylosis were observed in 54% of the patients. Immediate symptom relief without local recurrence was obtained by complete microsurgical excision in which bipolar coagulation was used to remove the synovial membrane and in which the interapophysial joint was preserved. During the 1st postoperative year, a newly formed symptomatic synovial cyst developed on the contralateral side or at a superior vertebral level in five patients. They underwent surgery; results were good and there was no recurrence.
  
  
  CONCLUSIONS
  The findings in this series suggest that synovial cysts can occur at multiple lumbar sites within a short period of time and could be predisposed to developing in certain individuals, predominantly in women older than 40 years of age. Postoperative follow up is recommended and MR imaging mandatory in cases of recurrent sciatica.
authors.affiliation: Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. bpirotte@ulb.ac.be
authors.forename: Benoit
authors.initials: B
authors.lastname: Pirotte
authors.forename: Nicolay
authors.initials: N
authors.lastname: Gabrovsky
authors.forename: Nicolas
authors.initials: N
authors.lastname: Massager
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.forename: Philippe
authors.initials: P
authors.lastname: David
authors.forename: Jacques
authors.initials: J
authors.lastname: Brotchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D012585:Sciatica / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013581:Synovial Cyst / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome