The facet joints are small joints that link the vertebrae of the spine. These joints provide stability and allow for the spine to move and bend in a normal manner. Each vertebra has two sets of facets joints, one pair facing upwards and one is facing downwards. The facet joints are like a hinge and are located at the backside of the spine.
What is a Synovial Facet Cyst?
A synovial cyst is a fluid-filled sac, that develops along the patient’s spinal cord. Often known as a synovial facet cyst, this condition is the result of the deterioration of the facet joint, at the intersection of the vertebrae. A synovial cyst is most common along the lower back or lumbar spine.
While this condition isn’t generally dangerous and may not even produce symptoms; it is known to cause the narrowing of the spinal canal known as spinal stenosis and in some instances, even press against a nerve causing nerve compression. The larger the cyst gets the more pressure it places on the surrounding tissue and nerves – causing more symptoms to progressively worsen.
Causes of a Synovial Facet Cyst
These cysts can develop for a variety of reasons – mainly a result of the degeneration of the facet joint. The facet joint can be damaged or deteriorate over time, as a byproduct of normal aging, or through some form of injury or trauma.
When the facet joint begins to degenerate, it produces excess fluid designed to provide lubrication to the joint, aiding in its movement, especially in its weakened state. However, this excess fluid will eventually build up and become trapped within the synovial lining of the joint – forming a cyst.
As the cyst grows larger and larger, it will put more and more pressure on the spine and its surrounding nerves.
Initially, a synovial facet cyst will not present many noticeable symptoms. However, as the cyst continues to grow larger over time, it will begin to interfere with parts of the spine, such as putting pressure on the spinal cord and nerves. This will cause spinal stenosis, the narrowing of the spinal canal, as well as nerve compression and pain. These issues will worsen when the patient is in a standing position. The main symptoms include:
- Moderate to Severe Pain – Most often from the lower back radiating down the buttocks and legs.
- Tingling or Burning Sensations – In the lower back, legs, and feet.
- Numbness or Loss of Feeling
- Chronic Leg Cramping
If detected early enough, the synovial cyst can be treated without having caused any issues or symptoms. In most cases, your doctor will be very passive in treatment – choosing to leave the cyst alone, and closely monitor its size. Often, these cysts can disappear or shrink, on their own – so it might be best to leave them alone, initially. However, once they grow large enough to cause issues with other areas of the spine, such as nerve compression.
Non-Surgical Options include:
- Physical Therapy – Facet cysts can develop due to improper movements causing injury to the facet joints. Lower body exercises and therapy can help these issues.
- Medication – Anti-Inflammatory drugs and pain relievers used in conjunction.
- Spinal Injections – Epidural steroid injections or corticosteroid injections.
- Drainage – Depending on where the cyst is, it can be drained, in order to remove the fluid. Once fluid is removed, a steroid injection is often administered to reduce inflammation and prevent more fluid from developing.
Surgery involves alleviating the compression caused by the cyst, and the damage it may due to the discs and other tissue around the spine. In addition, surgery may help to remove the cyst as well.
- Microdecompression or Microdiscectomy – This procedure is less invasive than most other spinal surgeries and does not require any fusion of the spine. This procedure will decompress the nerve root, by removing the disc material in the area. However, the cyst may regenerate later on.
- Decompression Surgery with Spinal Fusion – This is one of the most reliable surgical measures for the treatment of a facet synovial cyst. First the cyst is removed, and the joint is fused – preventing all future motion, and the cyst from regenerating.
For more information on synovial facet cysts, other spinal conditions, or to schedule a consultation, contact Dr. Arutyunyan today.