Lumbar intraspinal synovial cysts: conservative management and review of the world's literature.
BACKGROUND
Lumbar intraspinal synovial cysts are an important cause of axial and radicular spine pain. Controversy about nonsurgical versus surgical treatment persists.


OBJECTIVE
To evaluate the efficacy of nonsurgical management of symptomatic lumbar intraspinal synovial cysts (LISCs).


METHODS
Retrospective review set in outpatient physiatry office.


METHODS
Ten patients (8 women, 2 men; average age, 60 years) with LISCs and average symptom duration of 7.9 months.


METHODS
Numerical pain rating scale (NRS-11), Roland-Morris disability outcome measure, patient satisfaction, and surgery.


METHODS
Patients with LISCs were identified and their charts were reviewed. Those patients whose symptoms correlated with the level of LISC-induced extradural compression were eligible. All patients received conservative care and a fluoroscopic-guided lumbar spine injection. The primary author conducted telephone follow-up.


RESULTS
All 10 patients had unilateral radicular pain. Seven had stable neurologic deficits. Magnetic resonance imaging and computed tomography/myelography, respectively, identified a LISC in 8 and 2 patients. Five patients had cyst aspiration followed by steroid instillation; 5 patients had cyst aspiration followed by a transforaminal epidural steroid injection. Average length of follow-up was 50.4 weeks. Only 1 patient had sustained benefit. One patient had no benefit and refused surgery. Eight patients underwent surgery and had a good result.


CONCLUSIONS
In our opinion, nonsurgical management in patients with LISC-induced radicular pain does not appear to be as successful as surgery.
Shah
Rinoo V
RV
Physiatry Service, The Hospital for Special Surgery, New York, NY 10021, USA. drinoo@yahoo.com
Lutz
Gregory E
GE
D000368:Aged; D001175:Arthrography; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000628:therapy*; D013396:Suction / Q000379:methods*; D013581:Synovial Cyst / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome