Facet Joint Synovial Cyst
Facet joint synovial cysts are fluid-filled sacs in the joint of the spine, called facet joints. They are benign growths.
Signs and symptoms
Symptoms and their severity depend on the size of the facet joint synovial cyst. Some might not cause any symptoms. Common symptoms include:
- Back and leg pain, often that is better with sitting and worse with standing or walking
- Spinal stenosis
- Numbness, tingling or weakness in ca one or both of the legs
- Cramping or heaviness of the legs, especially from standing or walking
- Cauda equina syndrome
There are several treatment options depending on the severity of your symptoms:
- Observation. Often, these cysts do not cause any symptoms and would not require treatment. If the cyst grows and begins to cause issues, other treatment options can be revisited.
- Pain medication
- Exercise and stretching modifications
- Facet joint injections. This is an interventional pain procedure used to diagnose and treat arthritic pain originating from the joints in the spine. A small needle is advanced with the help of a fluoroscopy or x-ray machine. Brief x-rays are taken to help direct the needle to the correct location. A small amount of local anesthetic and possibly steroid is slowly injected in the appropriate location.
- Epidural steroid injections. This is a procedure where a steroid and a local anesthetic are injected into the space around your spine to help decrease inflammation and swelling, typically leading to improvement in pain in your neck, arms, back and legs. This procedure is performed in either the office or surgery center setting and typically takes just a few minutes. Most procedures involve a needle that is advanced to the target area under fluoroscopic (x-ray) guidance. A small amount of x-ray contrast will be injected to confirm accurate placement. Once the needle has been properly placed, a combination of a local anesthetic and/or injectable steroid will be placed into the targeted area.
- Posterior lumbar decompression and fusion surgery. This procedure is performed to remove the cyst, take pressure off of the nerves in the lower back and treat or prevent instability of the lower spine. The surgery is performed through an incision in the middle of the lower back. Your surgeon will remove a window of bone—a process called a laminectomy—as well as ligament and parts of the joints of the spine to take the pressure off of the nerves. The cyst is removed. The fusion portion of the procedure involves using screws and rods to connect bones of the spine together, along with placing bone graft material that will grow over time, typically 6 – 12 months, and “fuse” the bones of the spine together.
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