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Medical Edge Newspaper Column from Mayo Clinic
SYNOVIAL CYST RECURRENCE MAY REQUIRE MORE SURGERY
DEAR MAYO CLINIC: I had two synovial cysts removed from lumbar four and five in my lower back. They have since grown back and more are forming. What are my treatment options? — Tucson, Ariz.
ANSWER: Synovium is the name of the soft tissue that lines and surrounds the joint spaces between adjacent bones. Synovium helps produce and contain synovial fluid, which lubricates our joints. Synovial cysts occur when synovial fluid collects in a sac outside of the joint space.
A synovial cyst can arise from any joint in the body. In the spine, such cysts are especially likely to arise at the lumbar level, where they are associated with the facet joints — paired joints in back of and on both sides of the spinal column.
Medical scientists do not fully understand why these cysts form, but a common theory suggests that degeneration of the facet joint contributes to synovial cyst formation due to excessive wear and tear. Although the cysts can occur at other levels of the spine, they are thought to be more common in the lumbar spine because of significantly greater weight-bearing stresses at this level.
If you develop one synovial cyst in your spine, you are at increased risk of developing more. Synovial cysts in the spine act like benign tumors and can cause pressure on the nerves in the lower back, which results in pain in the spine and often in one or both lower limbs as well, sometimes with accompanying numbness and weakness. Diagnosis is the key. Synovial cysts are best visualized by {MRI imaging since I in MRI stands for imaging, should we say MR imaging or just MRI of the spine?}of the spine, but they can also be seen with plain CT scans or myelography followed by CT scanning. (Myelography involves the instillation of fluid into the spine that will show up on X-rays and CT scans.)
If the cysts are small and the symptoms are minimal, no treatment may be needed. Sometimes the cysts spontaneously go away. If the synovial cyst is large enough to produce symptoms, it usually requires intervention.
While larger symptomatic cysts can occasionally be drained by a needle, the fluid is quite thick and often the cyst redevelops. Therefore, most large cysts require surgical removal via a standard laminectomy, in which a portion of the bony vertebral arch, the lamina (which is behind the spinal column), is removed in order to allow access to the cyst. In general, part or the entire facet joint is removed, making recurrence at the same joint very rare. As in your case, adjacent joints may form new cysts requiring additional surgery.
The success rate of surgery on synovial cysts in relieving nerve root origin pain is high. There is a slightly higher complication rate because the cysts tend to adhere to adjacent bony and neural structures. Surgery should be performed only by surgeons who are experienced in dealing with this problem.
— John L. D. Atkinson, M.D., Neurosurgery, Mayo Clinic, Rochester, Minn.
Additional Resources:
Synovial Cysts
Appointment Information
READERS: Magnetic shoe insoles did not effectively relieve foot pain among patients in a study, researchers report in Mayo Clinic Proceedings. And the results indicate that patients who strongly believed in magnets had pain relief even if they were given false magnets to wear.
“This study provides convincing evidence that use of these static magnets was not effective in relieving symptoms of nonspecific foot pain in the workplace,” says Mark Winemiller, M.D., the lead author of the study and a Mayo Clinic physician.
Dr. Winemiller said adults with foot pain are likely to initiate self-treatment with magnets based on personal recommendations or belief systems, often without a specific diagnosis or prescription. That population was targeted in this study, he says, with the goal of determining whether magnetic insoles work in the way they are typically used. He says the randomized, double-blind nature of this study was chosen to minimize bias and maximize the validity of results, and he is confident that this was accomplished.
In the past decade, the use of magnets for pain relief has increased substantially. Despite little scientific evidence (and lack of Food and Drug Administration approval for pain relief), many people have used magnets to relieve their pain, spending approximately $5 billion worldwide — an estimated $500 million in the United States annually — on magnetic pain-relieving devices.
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