Spontaneous Resolution of Symptomatic Synovial Cysts of the Lumbar Spine: A Comprehensive Review with Two Illustrative Cases.

Although lumbar synovial cysts (LSCs) are frequently described in the literature, they are a relatively uncommon cause of low back and radicular leg pain. Furthermore, their spontaneous resolution is an even rarer event. The standard treatment of the lumbar synovial cyst is surgical excision. Spontaneous resolution in the literature is a sporadic event. In our experience, we have had two cases where the lumbar synovial cyst disappeared spontaneously. To date, only nine cases of spontaneous resolution of synovial cysts have been documented in the literature. In this discussion, we highlight a pathology that typically suggests surgical intervention, yet conservative treatment can be a viable alternative. We present two cases of large synovial cysts that were initially scheduled for surgery but ultimately resolved spontaneously without any treatment. While the spontaneous resolution of lumbar synovial cysts is extremely rare, conservative strategies are an option that should not be overlooked. Our cases contribute to the growing body of evidence on the spontaneous regression of symptomatic LSC, potentially enhancing the understanding of the disease's natural progression in the future.

LUMBAR SPINE SYNOVIAL CYST: A CASE SERIES REPORT AND REVIEW OF SURGICAL STRATEGIES.

Lumbar spine synovial cysts are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy and neurological deficit. However, they are not well defined concerning their origin, cause and pathology, as well as available treatment strategies. The scope of different surgical procedures includes image-guided epidural steroid injection, direct cyst puncture by percutaneous epidural needle, spinal canal decompression and cyst resection, and spinal bone fusion with/without instrumentation. Hereby, we report institutional experience and discuss surgical strategies of lumbar spine synovial cyst treatment. Presenting symptoms, imaging findings and outcomes were retrospectively analyzed in 15 patients with lumbar spine synovial cyst, operated on during a one-year period. The leading presenting symptom was lumbar radicular pain, while the most commonly involved vertebral level was L5-S1. In a great majority of patients, a single-level interlaminectomy and cyst resection were performed. Most patients recovered without postoperative neurological and functional deficit, as well as surgery-related complications. No poor outcome was noticed in our series. Concerning our results and literature review, the optimal management for patients with symptomatic lumbar synovial cyst has to be highly personalized, which is essential to achieve a favorable outcome. Nonetheless, the best treatment strategy has yet to be affirmed.

Multiple extra-articular synovial cysts accompanied by rheumatoid arthritis in the bilateral elbow joints: A case report.

RATIONALE: Synovial cysts are well known in rheumatoid arthritis (RA), and most common in the popliteal fossa. They may produce lots of local symptoms and complaints, which may present initially as an unrelated clinical condition. Few studies have reported multiple extra-articular synovial cysts (MESCs) in the RA patients. Early diagnosis is crucial for patient treatment. PATIENT CONCERNS: A 50-year-old man without any special clinical histories found a soya bean size bump at the left elbow medially, then multiple lumps were found at bilateral elbows and gradually increasing. No pain, no activity, no redness, and swelling. Magnetic resonance imaging (MRI) showed multiple cystic lesions in the bursa and surrounding soft tissue of bilateral elbow joints. In addition, the elbow joint bursa was swollen and the synovial membrane was significantly thickened. DIAGNOSES: The man was diagnosed as RA with multiple extra-articular synovial cysts formation. INTERVENTIONS: The patient was performed tylectomy of the right elbow. Other lumps were punctured and injected with compound betamethasone injection. OUTCOMES: The bumps were reduced in size and the swelling relieved, and the patient was sent to the department of rheumatology and immunology for further treatment. LESSONS: In this case, it is difficult for the diagnosis of RA because of no relative histories and simultaneously multiple cystic lesions in multiple joints. Imaging examinations can show the characteristics of such kind of disease and be very helpful for the diagnosis and differentiate diagnosis.

Evaluation and Treatment of Lumbar Facet Cysts.

Lumbar facet cysts are a rare but increasingly common cause of symptomatic nerve root compression and can lead to radiculopathy, neurogenic claudication, and cauda equina syndrome. The cysts arise from the zygapophyseal joints of the lumbar spine and commonly demonstrate synovial herniation with mucinous degeneration of the facet joint capsule. Lumbar facet cysts are most common at the L4-L5 level and often are associated with spondylosis and degenerative spondylolisthesis. Advanced imaging studies have increased diagnosis of the cysts; however, optimal treatment of the cysts remains controversial. First-line treatment is nonsurgical management consisting of oral NSAIDs, physical therapy, bracing, epidural steroid injections, and/or cyst aspiration. Given the high rate of recurrence and the relatively low satisfaction with nonsurgical management, surgical options, including hemilaminectomy or laminotomy to excise the cyst and decompress the neural elements, are typically performed. Recent studies suggest that segmental fusion of the involved levels may decrease the risks of cyst recurrence and radiculopathy.

Atlantoaxial Synovial Cyst: Case Report and Literature Review.

BACKGROUND: Degenerative cystic lesions of atlantoaxial joints are rare and generally believed to be due to mechanical instability. There is currently no consensus on the management of such lesions in symptomatic and asymptomatic patients. Both conservative and surgical strategies have been described. Surgery may involve anterior or posterior approaches with and without decompression and instrumentation. METHODS: We present a case report of a 45-year-old man who presented with new onset weakness and ataxia. Physical examination revealed decreased motor function in all extremities as well as positive Hoffman sign and ankle clonus bilaterally. An MRI of cervical spine showed a large atlantoaxial, T-2 hyperintense cystic lesion with cord compression and cord signal changes. RESULTS: A C1 partial laminectomy was performed with resection of the cyst and C1-2 instrument fusion. Intra-operatively, the cystic lesion was found to be anatomically connected to the right C1-2 atlantoaxial joint with pathology showing fibroconnective tissue and chronic inflammatory changes. Post-operatively there were no complications and the patient was discharged to a rehabilitation facility. The patient was regaining gait and hand function by 3 months after surgery. CONCLUSIONS: Atlantoaxial synovial cysts are rare and the optimal surgical approach has not been determined. We further conducted a literature review and found a total of 70 other cases of atlantoaxial synovial cysts reported to date in the literature. We attempt to analyze available data and evaluate anterior versus posterior approaches and the need for decompression, amount of cyst resection, and instrumentation.

A ganglion cyst derived from a synovial cyst: A case report.

The synovial and ganglion cysts originating from the facet joint have been named under the name of the Juxtafacet cyst by the several researchers. They put forward that the synovial cyst originated from the synovial joint. But, they failed to clarify the pathophysiology of the formation of the ganglion cyst. In this case report, we reported a 67-year-old male patient was referred to the emergency from another center with the complaint of a left leg pain and weakness in the left foot and patient was treated with microchirurgical technique. His patological examination was evaluated a ganglion cyst. We have discussed and explained the pathophysiology of the formation of a ganglion cyst derivered from a synovial cyst. And separately, we have presented the spinal cysts by grouping them under a new classification called a cystic formation of the soft tissue attachments of the mobile spine as well as dividing them into sub-groups.

Immediate Reduction of a Retro-odontoid Synovial Cyst Following Lateral Atlantoaxial Joint Puncture and Arthrography: A Case Report.

STUDY DESIGN: Case report. OBJECTIVE: We report on a case with a retro-odontoid synovial cyst, and the immediate reduction of the cyst was confirmed after lateral atlantoaxial joint puncture and arthrography. SUMMARY OF BACKGROUND DATA: Retro-odontoid synovial cysts are rare diseases located posteriorly to a dense axis. Because most reports have focused on surgical treatment, only a few have examined nonsurgical treatment. However, several months are required after nonsurgical treatment until cyst regression. METHODS: A 52-year-old female presented with atlantoaxial instability. She complained of neck pain and numbness in her hands. Magnetic resonance imaging revealed a retro-odontoid synovial cyst. Lateral atlantoaxial joint puncture and arthrography were performed. RESULTS: Two days after treatment, the patient showed significant improvement in the numbness of her hands, and a follow-up magnetic resonance imaging revealed an immediate reduction in the cyst. During a 4.5-year follow-up period, no recurrence of the clinical symptoms occurred. CONCLUSION: Lateral atlantoaxial joint puncture may immediately reduce retro-odontoid synovial cysts, and the lateral atlantoaxial joint has a communication channel with the retro-odontoid synovial cyst via the atlantodental joint. Once disappearance of the cyst is confirmed, an acceptable long-term outcome can be achieved with nonsurgical treatment even in cases with atlantoaxial instability. LEVEL OF EVIDENCE: N/A.

Coexisting intraarticular disorders are unrelated to outcomes after arthroscopic resection of dorsal wrist ganglions.

BACKGROUND: Dorsal wrist ganglions are one of the most frequently encountered problems of the wrist and often are associated with intraarticular disorders. However, it is unclear whether coexisting intraarticular disorders influence persistent pain or recurrence after arthroscopic resection of dorsal wrist ganglions. QUESTIONS/PURPOSES: We investigated (1) which intraarticular disorders coexist with dorsal wrist ganglions and (2) whether they influenced pain, function, and recurrence after arthroscopic ganglion resection. METHODS: We retrospectively reviewed 41 patients with primary dorsal wrist ganglions who underwent arthroscopic resection. We also obtained VAS pain scores and the Mayo Wrist Scores (MWS) preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter postoperatively. Minimum followup was 24 months (mean, 38.9 months; range, 24-60 months). RESULTS: Twenty-one patients had other coexisting intraarticular disorders: 18 triangular fibrocartilage complex tears and nine intrinsic ligament tears. All coexisting disorders were treated simultaneously. Two years after surgery, the mean VAS pain score decreased from 2.4 to 0.6, and mean grip strength increased from 28 to 36 kg of force. The mean active flexion-extension showed no change. The mean MWS improved from 74 to 91. Three ganglions recurred. There was no difference in mean VAS pain score and MWS preoperatively and at 2 years after surgery or recurrence of ganglions between patients with or without coexisting lesions. CONCLUSIONS: Intraarticular disorders commonly coexist with ganglions but we found they were unrelated to pain, function, and recurrence after arthroscopic resection of the ganglion when the intraarticular disorders were treated simultaneously. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Greater strength increase with cyst decompression and SLAP repair than SLAP repair alone.

BACKGROUND: Treatment of symptomatic spinoglenoid cysts has been controversial with options ranging from observation, to open excision, to arthroscopic decompression with or without labral repair. It has recently been suggested that isolated repair of SLAP lesions without cyst decompression can restore function in patients with spinoglenoid cysts and SLAP lesions. QUESTIONS/PURPOSES: We examined gains in external rotation strength after isolated SLAP repair versus SLAP repair and cyst decompression to ascertain if gains in external rotation strength are attributable to SLAP repair or cyst decompression. METHODS: We retrospectively reviewed external rotation strength of 12 patients: six with spinoglenoid cysts and Type II SLAP lesions who underwent arthroscopic SLAP repair and spinoglenoid cyst decompression and six with isolated SLAP lesions who underwent repair of the lesions. Preoperative and postoperative external rotation strength was evaluated using a digitally calibrated dynamometer on the operative and nonoperative sides. The minimum followup was 12 months (mean, 15.2 months; range, 12-27 months). RESULTS: All of the patients in both cohorts had preoperative external rotation weakness on physical examination and dynamometer testing. The average increase in external rotation strength in the group of patients with SLAP lesions and paralabral cysts was 40% of the contralateral side versus 10% for the cohort with isolated SLAP repairs. CONCLUSIONS: Decompression of paralabral cysts and SLAP repair in patients with preoperative external rotation weakness resulted in greater strength improvement than in patients with isolated SLAP repairs without complications of suprascapular neuropathy. This suggests that gains in external rotation strength are likely mostly attributable to cyst decompression, questioning isolated SLAP repair in the treatment of patients who have primarily weakness with spinoglenoid cysts. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cervical synovial cyst: case report and review of literature.

Synovial cysts, typically observed in the lumbar spine eventually associated with degenerative changes of the facet joints, only rarely present in the cervical spine. Up to now, only 28 symptomatic cases are described in literature. Typically, the treatment of these cases is a decompressive laminectomy followed by complete surgical removal of the lesion. The authors present the case of an 84-year-old man with a symptomatic synovial cyst involving the space between C7 and T1.

Treatment of a little finger synovial cyst by repair of an opening in the wrist capsule: case report.

As synovial fluid from the wrist may leak into the ulnar bursa and from there into the flexor synovial sheath in the little finger, the origin of a synovial cyst of the pulp of the little finger may be in the wrist. Here we present the surgical treatment of a patient with a synovial cyst of the pulp of the little finger by surgery of the wrist and palm of the hand after failed conservative treatment.

[Pathomechanisms of spinal canal stenosis - upright MRI image gallery]. / Pathomechanismen der spinalen Enge - Upright-MRT-Bildergalerie.

AIM: Lumbar spinal canal stenosis is a common disease of the elderly patient, with a high prevalence and clinical importance. MRI is the established method of choice for the imaging of spinal canal stenosis. However, there is often a discrepancy between the clinical symptoms and the spinal canal stenosis as shown using MRI in a supine position. In such cases preoperative functional imaging is often warranted. METHODS: In an image gallery three cases of a functional spinal canal stenosis of the lumbar spine are shown. In all three patients a dynamic, positional MRI (upright MRI) was performed. RESULTS: The pathomechanisms of the spinal canal stenosis could be shown in all three cases. CONCLUSION: Using upright MRI a functional spinal canal stenosis can be shown. The pathomechanisms of the spinal canal stenosis are discussed. The possibilities and limitations of this new imaging modality are presented and analysed.

Lumbar hemorrhagic synovial cysts: diagnosis, pathogenesis, and treatment. Report of 3 cases.

BACKGROUND: To define the etiologic, clinical, histological, and surgical features of lumbar hemorrhagic synovial cysts (LHSCs). Three personal cases are reported together with a review of the pertinent literature. METHODS: We identified 3 cases of LHSC treated in our departments and 20 cases culled from the literature. RESULTS: A total of 23 cases of LHSC were selected. All the patients underwent surgical treatment because of untreatable radicular pain and/or neurological deficits. The amount of bleeding, either massive or minor but repeated, influenced the timing of surgery. In our cases, the histological examinations showed an inflammatory reaction within the cyst and the consequent formation of neoangiogenic vessels. CONCLUSIONS: Hemorrhagic synovial cyst of the spine is rare and its most common localization is lumbar. Bleeding within the cyst leads to an increase of its volume, accompanied by neurological deficits and/or painful symptoms that are violent and generally intractable. In this event, surgical excision is the treatment of choice and, in some cases, emergency surgery is necessary. Hemorrhages are probably caused by the rupture of fragile neoangiogenic vessels.

[Arthroscopic treatment of dorsal wrist ganglia]. / Traitement arthroscopique des kystes synoviaux dorsaux du poignet.

Incidentally discovered in 1987, arthroscopic treatment of dorsal wrist ganglia is based on our knowledge of their physiopathology which in turn benefits from the arthroscopic wrist evaluation. Dorsal wrist ganglia arise in the radiocarpal space from the dorsal part of the scapholunate ligament and migrate along the dorsal wrist capsule. According to their position above or under the dorsal intercarpal ligament, their cutaneous projection may vary. The basis of the arthroscopic treatment of wrist ganglia is, as with open surgery, the capsular resection in front of their origin. Arthroscopic resection is made either from dorsal radio-carpal or midcarpal approaches with little morbidity. Scars are unnoticeable, wrist mobility and strength close to normal by three months, which is the delay for dorsal wrist pain, always very limited, to disappear. The recurrence rate is however still debatable. Close to zero in some series, we had almost 20% recurrence rate in our series, with half of patients who reccur after two years follow-up. This variability in the recurrence rate also exists with open techniques. The only prospective and randomized study available to date found no differences between the two techniques, according to the recurrence rate.

Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-year follow-up period.

PURPOSE: The purpose of this report is to review the results of arthroscopic resection of dorsal wrist ganglions. METHODS: Forty-one patients with dorsal wrist ganglions had arthroscopic resection: 24 women and 17 men. The average patient age was 29.8 years. All of the patients had some or all of the following: pain, localized swelling, and limited range of motion. Along with clinical examination, 19 wrists had ultrasound or magnetic resonance imaging to confirm diagnosis. Twelve patients had previous injections with recurrence. The average follow-up time to date is 47.8 months (range, 28-97 months). RESULTS: Overall postoperative motion improved compared with preoperative values. No cases of scapholunate instability were noted. The average postoperative grip strength improved significantly. Only 2 ganglions recurred and required 2 attempts at open resection for successful eradication the ganglion. No major intraoperative or postoperative complications occurred. CONCLUSION: Arthroscopic ganglionectomy is a safe and reliable alternative to open resection.

Ganglion of the distal interphalangeal joint (myxoid cyst): therapy by identification and repair of the leak of joint fluid.

BACKGROUND: Digital myxoid cysts are a relatively common pathology in the skin, representing a ganglion of the adjacent distal interphalangeal joint. Success of treatment is largely proportional to the destructiveness of the therapy and postoperative morbidity. We studied an effective, minimally traumatic surgical treatment in which tissue is not removed and morbidity is low. DESIGN: Open, nonrandomized trial of therapy. Methylene blue dye was injected into the distal interphalangeal joint. A skin flap was designed around the cyst and raised to identify the dye-filled communication between joint and cyst. The communication was sutured and the flap was replaced with no tissue excision. SETTING: Two university dermatology departments. PATIENTS: Fifty-four subjects with 47 cysts involving fingers or thumbs and 7 involving toes. Previous therapies in 37 patients had resulted in relapse. MAIN OUTCOME MEASURES: Clinical assessment at 2 and 8 months. RESULTS: We treated 34 women and 20 men (mean age, 60.4 years; range, 45-83 years). Communication between cyst and joint was identified by means of methylene blue injection in 48 patients (89%). At 8 months, 48 patients remained cured with no visible scarring. Of these, nail dystrophy associated with the cyst preoperatively (n = 35) resolved in all but 1 patient (97%). Six patients had relapses (5 within 4 months). Of these, 3 were on the toes. Cure rate on toes was 4 of 7 (57%) and on fingers, 44 of 47 (94%). In 2 patients, pain persisted for 4 months and then resolved. Limitation of joint mobility resolved after 2 months in 1 subject. CONCLUSIONS: Ligature of myxoid cyst origin at the joint capsule is an effective treatment and does not require excision. Myxoid cysts on toes are more likely to relapse than those on fingers.