title: Treatment of spinal synovial cysts.
abstract: BACKGROUND
  Spinal synovial cysts are a known cause of back pain and radiculopathy. With the advent of high-resolution imaging techniques, synovial cysts are increasingly diagnosed. There are a variety of treatment options for these lesions.
  
  
  METHODS
  A systematic literature review of published articles reporting outcomes after nonsurgical and surgical management of spinal synovial cysts was performed.
  
  
  RESULTS
  There were 51 published studies regarding the treatment of synovial cysts identified. Treatment modalities include observation, steroid injections, percutaneous cyst aspiration, hemilaminectomy or bilateral laminectomy with and without instrumented fusion, and minimally invasive cyst excision.
  
  
  CONCLUSIONS
  Based on review of the treatment modalities and outcomes, recommendations for the management of patients with synovial cysts are proposed. Observation can be considered in cases where there is no intractable pain. High-risk surgical patients with intractable pain may consider corticosteroid injection or percutaneous cyst aspiration; however, the failure rate of such a procedure approaches 50%. Patients with intractable pain are candidates for surgical resection of the symptomatic cyst. In cases of significant neurologic deficit, motor weakness, back pain, multiple synovial cysts, or spondylolisthesis, bilateral laminectomy and instrumented fusion may offer the best long-term outcome.
authors.affiliation: Department of Neurological Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA. abydon1@jhmi.edu
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Papadimitriou
authors.forename: Timothy
authors.initials: T
authors.lastname: Witham
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Daniel
authors.initials: D
authors.lastname: Sciubba
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gokaslan
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
mesh_terms: D006801:Humans; D007796:Laminectomy; D013122:Spinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013123:Spinal Fusion; D013581:Synovial Cyst / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*