Abstract
Purpose of the study: To study clinical, radiological and pathological features of this rare condition and to observe the effect of surgery on the relief of presenting symptoms.
Materials, Methods and Results: between February 1989 to May 1999, more than 200 spinal operations were carried out at Oswestry, amongst which we found 11 patients with 13 symptomatic lumbar synovial cysts. Nine patients were female and 2 were male. Among the symptoms produced, sciatica was present in 10 out of 11 patients, neurologic claudication was present in 6 patients and only one patient had neurologic deficit. All the patients suffered with back pain, which was either of facetal origin or mechanical back pain.
Radiological investigations revealed that all patients had evidence of facet arthrosis. Seven patients had degenerative spondylolisthesis. Degenerative disc disease was also seen in 7 patients.
The contents of the cysts varied from serous fluid to chalky white material to gelatinous grey material. One cyst contained calcium pyrophosphate crystals. Another cyst contained hydroxyapatite crystals. Seven cysts which contained deposition of bone debris in the cyst wall also revealed an (giant cell and macrophage) inflammatory reaction to this bone debris. In all patients complete resolution of sciatica, neurologic claudication and neurologic deficit was observed after surgery. However, after a minimum follow up of two years the back pain persisted in all but one patient.
Conclusion: Lumbar synovial cyst is a rare condition, more common in females, elderly, and occurs most commonly in association with degenerative disease of the spine, although it can also be caused by other conditions like trauma, or rheumatoid arthritis. When they cause compression of the dura or nerve roots, they present with symptoms like sciatica and neurologic claudication, which resolve promptly after surgery. However, patients also have a long history of back pain from the associated degenerative spinal disease which usually does not resolve unless it is addressed separately and patients need to be warned regarding this.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at the Irish Orthopaedic Association, Secretariat, c/o Cappagh Orthopaedic Hospital, Finglas, Dublin
