Synovial cysts arising from the intraspinal facet joint can directly cause thecal sac or nerve root compression. They are increasingly cited as a major source of spinal instability and mechanical back pain. In this case, we report a 51-year-old woman who has been treated conservatively for a unilateral synovial cyst for 15 months. She then presented with an acute exacerbation of lower back pain, neurogenic claudication and lower extremity weakness. Her magnetic resonance (MR) studies showed new onset of spondylolisthesis at the same level of the previously found synovial cyst. She underwent bilateral decompression laminectomy and instrumented fusion which resulted in significant pain relief and neurological improvement.
Key words: spondylolisthesis, …show more content…
They herniate from the degenerative intervertebral facet joint capsule, most commonly in the lower lumbar spine at L4-L5 level (2). A synovial cyst that extends to the spinal canal can result in intractable back pain, radiculopathy and cauda equina. These symptoms largely depend on the size and location of the cyst (3). Although non-operative therapy and spontaneous regression of synovial cysts have been reported in the literature (4, 5), complete cyst excision remains the mainstay treatment in the presence of continues symptoms or neurological deficits (6, 7). Surgical removal consists of decompression with or without a concomitant fusion (8). Synovial cysts commonly present in association with other degenerative spine changes such as facet arthropathy, degenerative disc disease and spondylolisthesis. In this report, we highlight this association and document the natural history of synovial cyst. We represent a case of degenerative spondylolisthesis at L4-L5 level that has developed on the ground of unilateral synovial cyst. The spondylolisthesis, measuring 9 mm, had developed within almost a 1-year period in the absence of any traumatic events, a pars defect or surgical intervention. The patient was successfully treated surgically using laminectomy and instrumented …show more content…
Intraoperatively, we performed a complete laminectomy of L4 and L5 with a high-speed drill and Kerrison rongeurs, as well as a complete facetectomy bilaterally of L4-L5. This allowed us to confirm the significant compression of both L5 nerve roots, especially at the right side. Although the synovial cyst was not observed on preoperative MR studies, we were able to identify it intraoperatively. It was located cranially and compressing the L4 nerve root. No evidence of pars defect was noted at the slipped level. Once the decompression was complete, reduction of listhesis and stabilization was then performed using transpedicular screws and lordotic rods from L4 through L5 bilaterally. Arthrodesis was performed across the joints of L4-L5 bilaterally, followed by placement of demineralized bone matrix and local
Key words: spondylolisthesis, …show more content…
They herniate from the degenerative intervertebral facet joint capsule, most commonly in the lower lumbar spine at L4-L5 level (2). A synovial cyst that extends to the spinal canal can result in intractable back pain, radiculopathy and cauda equina. These symptoms largely depend on the size and location of the cyst (3). Although non-operative therapy and spontaneous regression of synovial cysts have been reported in the literature (4, 5), complete cyst excision remains the mainstay treatment in the presence of continues symptoms or neurological deficits (6, 7). Surgical removal consists of decompression with or without a concomitant fusion (8). Synovial cysts commonly present in association with other degenerative spine changes such as facet arthropathy, degenerative disc disease and spondylolisthesis. In this report, we highlight this association and document the natural history of synovial cyst. We represent a case of degenerative spondylolisthesis at L4-L5 level that has developed on the ground of unilateral synovial cyst. The spondylolisthesis, measuring 9 mm, had developed within almost a 1-year period in the absence of any traumatic events, a pars defect or surgical intervention. The patient was successfully treated surgically using laminectomy and instrumented …show more content…
Intraoperatively, we performed a complete laminectomy of L4 and L5 with a high-speed drill and Kerrison rongeurs, as well as a complete facetectomy bilaterally of L4-L5. This allowed us to confirm the significant compression of both L5 nerve roots, especially at the right side. Although the synovial cyst was not observed on preoperative MR studies, we were able to identify it intraoperatively. It was located cranially and compressing the L4 nerve root. No evidence of pars defect was noted at the slipped level. Once the decompression was complete, reduction of listhesis and stabilization was then performed using transpedicular screws and lordotic rods from L4 through L5 bilaterally. Arthrodesis was performed across the joints of L4-L5 bilaterally, followed by placement of demineralized bone matrix and local