Facet Cysts

Facet Cysts | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Facet Cysts Mustafa Emrah Kaya, Ali Maksut Aykut, Hanifi Bayaroğulları, Mahmut Cingöz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8346108/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Although they are uncommon in the spine, synovial cysts are common in the hands, feet, and knees. They are often seen in the lumbar area around L4-5. Synovial cysts are brought on by spinal instability and degeneration. These cysts are asymptomatic, but they cause cauda equina syndrome, myelopathy, radiculopathy, and back pain. Objective From 2011 to 2025, we looked on the clinical outcomes of individuals with spinal synovial cysts at our hospital. Methods A review of twenty-four individuals with spinal synovial cysts was conducted. We collected information on demographics, radiological findings, clinical symptoms, treatment approaches, and results. The McNab score was used to evaluate the success of the surgery. Results Six men and eighteen women, all fifty-eight years of age, took part. The most frequent complaint from patients was lumbar pain. Radiculopathy accounted for 62.5%. Ten patients had cystectomies and decompression. Since there was no recurrence or segmental instability in the surgical group, therapy was successful. Conclusion Spinal synovial cysts are uncommon but create serious symptoms that necessitate medical care. Some patients responded well to conservative care, but others needed surgery because their symptoms were severe or becoming worse. Following surgery, no instability or recurrence was discovered, indicating that it is beneficial for certain people. Spinal Synovial Cysts Lumbar Spine Synovial Cyst Excision Conservative Treatment Spinal Stenosis Surgery MRI 1. Introduction Synovial cysts, which are fluid-filled sacs seen in the knee, hand, and foot, are seldom found on the spine. W.M. In 1877, he was appointed librarian. This cyst was initially described by Becker. They are present in the knee of a patient with osteoarthritis. Von Gruhen found the first intraspinal synovial cyst during autopsy. Compared to spine cysts, limb cysts are more common. Usually, the lumbar spine is where they start. They are common in the L4-5 spine [ 28 ]. Although uncommon, synovial cysts of the cervical and thoracic spine have been documented. It's unclear what causes spinal synovial cysts. Facet joint development result from degenerative changes in the spine, namely in the facet joints [ 1 ]. Consequently, the synovial lining of the facet joint herniate and form cysts, which are linked to aging and spinal instability. Acute spinal column injuries or mechanical stress change the genesis of cysts. Numerous studies have shown that facet joint degeneration and spinal instability have a significant impact on the production of synovial cysts. Back discomfort, myelopathy, and radiculopathy result from compression of the spinal cord or nerve roots caused by a synovial cyst that narrows the spinal canal. Imaging generally detects asymptomatic synovial cysts. If they spread and make contact with tissues, they result in severe neurological disorders. Radicular and lumbosacral discomfort are often caused by the lumbar cyst [ 2 ]. Patients' symptoms vary on cyst size and location. Cauda equina syndrome, often known as myelopathy, is rare but fatal. Severe symptoms are experienced by some people with spinal synovial cysts. Unintentional imaging tests detect cysts, and the absence of symptoms delay diagnosis [ 26 ]. The primary method for identifying spinal synovial cysts is magnetic resonance imaging. MRI is great for cyst size, location, and features. Synovial cysts seldom have distinct boundaries. Signal intensity is affected by cyst components. T1-weighted MRIs show hypointense synovial cysts, whereas T2-weighted MRIs show hyperintense ones [ 3 ]. The cyst's gas aid in the diagnosis. Although CT also is used, MRI is the most effective method for identifying synovial cysts. This establishes the bone connection and cyst calcium. No guidelines exist for treating spinal synovial cysts, making treatment complicated. Many people, particularly those with small cysts or asymptomatic conditions, benefit from physical therapy, analgesics, and rest [ 27 ]. Surgery is required, if conservative treatment is insufficient or if symptoms are worsening over time. For segmental instability, spinal fusion, decompression, and cyst excision are used. Cyst aspiration and steroid injections are less invasive procedures. Medical trials for these methods were unsuccessful. While some cysts cure on their own, others that are symptomatic or growing often need surgery. Elderly individuals suffer from spinal synovial cysts. Surgery is determined by the size of the cyst, the severity of the symptoms, spinal instability, and nerve compression. Surgery increases function and lessens discomfort [ 4 ]. Infection, tissue deterioration, recurrence, and CSF leaking are possible outcomes of surgery. Despite these risks, surgery help most people live better lives. This study focuses on our fourteen-year clinical experience with spinal synovial cysts. Research will reveal the clinical manifestation, diagnosis, course of therapy, and adverse consequences of spinal synovial cysts. By comparing conservative and surgical approaches to treating spinal synovial cysts, we hope to gain more knowledge. Future clinical practices are what we want to suggest. 2. Patients and Methods 2.1 Study Design The Institution cohort study from 2011–2025 was a retrospective study. The ethics committee approved the study, and the researchers adhered to the Helsinki Declaration. The study examined the clinical experiences of individuals with spinal synovial cysts. The research looked at results, treatment outcomes, diagnostics, and patient demographics. Strict inclusion criteria were used to choose these individuals and radiological imaging and medical records were used to monitor their clinical progress. 2.2 Patient Selection Twenty-four individuals with spinal synovial cysts were analyzed. These people were chosen after synovial cysts were discovered on MRI or CT scans. The study comprised patients who were treated at our institution and had clinically significant symptoms of synovial cysts, such as low back pain, myelopathy, or radiculopathy. Age, gender, and coexisting disorders were examined in the patients' medical records. The length, symptoms, and clinical characteristics were noted. Prior to diagnosis, neurological abnormalities, pain, and weakness were assessed, as was the length of the symptoms [ 5 ]. Before and after the procedure, physical exams were recorded. This assessed function after treatment. Imaging assessed spinal anomalies such listhesis and stenosis as well as the size of the cyst. MRIs evaluated facet joint angle and identified Tarlov cysts [ 25 ]. During follow-up visits, the McNab score was utilized to evaluate the surgical outcome. 2.3 Diagnostic Imaging Synovial cysts and their impact on surrounding tissues were thoroughly investigated, as shown by both MRI and CT scans. Magnetic resonance imaging (MRI) is the most effective method for diagnosing spinal synovial cysts because it has a better soft tissue contrast and can precisely show the size, location, and contents of the cyst. Cysts that contain gas are pathognomonic [ 24 ]. On T1-MRIs, synovial cysts seem hypointense, but on T2-MRIs, they appear hyperintense [ 6 ]. The study used MRI to study spinal canal narrowing. This demonstrates the extent to which the cyst disrupts brain pathways. The link between the cyst and nearby bone structures was identified in this investigation using CT imaging. Imaging of the surrounding vertebrae and cyst calcification was good. MRI and CT data were used to properly evaluate the cyst's size, location, and risk of spinal stenosis or nerve root compression. Functional MAST used radiography to investigate segmental instability. During functional MRI scanning, active posture was maintained to detect any movement or instability of the synovial cyst. By identifying spinal instability, this imaging helps with therapy planning [ 7 ]. A test for spinal canal stenosis was developed by Schizas and associates. An estimate of an unobstructed channel is compared to the canal area, including the cyst. Use this method to determine the canal constriction percentage. For stenosis, the ratio was transformed into a percentage. 2.4 Treatment Approach We started our spinal synovial cyst investigation with conservative therapy. Physical therapy, analgesics, and rest were given for 6–8 weeks. In order to reduce symptoms and avoid surgery, conservative treatment focused on patients who reacted well to non-invasive techniques. Physicians evaluated the clinical state and symptom progression of their patients. Surgery was considered if conservative measures failed or if symptoms worsened. Cysts were decompressed and removed during the treatment. Cyst-induced spinal cord and nerve root pressure was reduced by decompression surgery. Surgery was performed to remove the cyst [ 23 ]. This got rid of the symptoms. Patients who showed signs of segmental instability on functional or clinical MAST radiography underwent cystectomy, decompression, fusion, and posterior instrumentation [ 8 ]. The objective was to stabilize the spine and stop deterioration. Eligibility for spinal fusion surgery was assessed by imaging data and clinical presentation. Spinal fusion surgery was indicated for deterioration of the facet joint and listhesis. This treatment reduced deformity and symptom recurrence while stabilizing the spine. 2.5 Outcome Evaluation The most used surgical effectiveness metric was McNab. The McNab score is often used to assess functional outcomes after spine surgery. Patient satisfaction, pain relief, and spinal range of motion are assessed [ 9 ]. Results are assessed as amazing, fantastic, fair, or dreadful. Depending on the patient's recovery. One month and one year after surgery, postoperative assessments were conducted. Using the McNab score, these follow-up sessions evaluated the patients' functional state and identified any recurrence or new symptoms. To find any new cysts or spinal instability, radiographs were used. Although the mean follow-up duration, examination of long-term effects was made possible by patient variability. To assess each approach, postoperative outcomes from conservative and surgical procedures were compared. Surgery patients were evaluated for symptom relief, treatment, and recurrence. 3. Results 3.1 Patient Demographics This study looked at 24 individuals with spinal synovial cysts. The six men and eighteen women in the group. With the youngest being nineteen and the oldest being ninety, their average age was fifty-eight. The average age of the patients was 59.8 years for males and 57.4 years for women. Spinal synovial cysts are more common in older people and girls. This broad tendency is consistent with population traits. 3.2 Clinical Findings The majority of study participants reported neurological issues despite a variety of clinical symptoms. 15 individuals, or 62.5% of the total, had paresthesia or radiculopathy. A number of symptoms appear when the size and location of the cyst squeeze the nerve root. The lower weakening rate (12.5% explained by more damage to the spinal cord or nerve roots [ 10 ]. Every research participant had lumbar, thoracic, and cervical pain. This ailment, which impacts everyday activities and quality of life, caused by spinal synovial cysts. Diagnosed after symptoms ranging from one month to eleven years. 44 months passed on average between symptoms and diagnosis. Before causing neurological problems, synovial cysts cause mild symptoms for years. This is seen by the prolonged duration of symptoms in the majority of people. Four patients, or 16.6% of this non-at-risk group, reported experiencing trauma. These people develop synovial cysts brought on by trauma. 3.3 Radiological Findings Lumbar spine findings were prevalent, as is customary in the literature. There are cysts on many levels of the spine: L4-5: 13 patients (54.16%) L3-4: 5 patients (20.83%) L5-S1: 3 patients (12.5%) C1-2: 1 patient (4.16%) C7-T1: 1 patient (4.16%) According to our findings, synovial cysts are common in the lumbar spine, particularly in the L4-5 region. Although less often, a significant portion of the population had altered L3-4 and L5-S1 levels. Spondylolisthesis, or spinal slippage, affected five people (20.83%). Two patients had grade 1 slippage, two had grade 2, and one had degree 3 slippage, based on Meyerding's classification of listhesis. For others, spondylolisthesis is a sign of synovial cysts brought on by spinal instability [ 11 ]. Cysts from joint capsule herniation and spinal dislocation occur in spondylolisthesis. Interestingly, spinal stenosis was seen in this group. Spinal stenosis affected 18 people, or 75% of the population. The categorization of stenosis: 9 patients (37.5%) had 25–50% stenosis 8 patients (33.3%) had 50–75% stenosis 1 patient (4.16%) had > 75% stenosis Surgery is necessary to treat spinal stenosis and neurological problems brought on by synovial cysts. These results imply that spinal stenosis is usually caused by these cysts. The average size of these synovial cysts was 6.6 by 6.0 millimeters. Remarkably, during follow-up, two (8.33%) developed cysts. Cyst reduction of 50% was achieved by only one patient (4.16%). Invasive therapy is necessary for synovial cysts that form or persist after spontaneous clearance. Spinal instability was suggested by their mean facet joint angle of 41.67 degrees. The mean facet joint angle was 43.4 degrees for surgical patients and 46.58 degrees for individuals who underwent cyst excision and decompression. Surgery is predicted by facet joint angle, according to statistics. More intensive therapy at acute angles is necessary for instability. 3.4 Treatment Outcomes After conservative physical treatment, analgesics, and rest for six to eight weeks [ 22 ], (58.3%) of the twenty-four patients showed improvement. These patients did not need surgery, suggesting that conservative measures are beneficial for small cysts or moderate symptoms. Ten patients (41.7%) required surgery because conservative treatment failed or their symptoms worsened. If segmental instability was detected, the cyst was decompressed and removed via posterior instrumentation and fusion. Surgical success was assessed using the McNab score, a functional outcome metric for spine surgery. Out of ten patients who had surgery, three (30%) had great results, seven (70%) had good results, and none had mediocre or disappointing results. Most patients who had surgery reported significant improvements in their symptoms and functionality [ 12 ]. Monitoring was made possible by the average patient follow-up of 27.5 months. During follow-up, there was no segmental instability or recurrence of synovial cysts. Following spinal instability surgery, patients had long-lasting symptom alleviation and spinal stabilization. Table: Clinical and Radiological Findings Parameter Findings Total number of patients 24 Male/Female ratio 6 males (25%), 18 females (75%) Mean age 58 years Most common symptoms Low back pain, radiculopathy Symptom duration (mean) 44 months Patients with trauma history 4 (16.6%) Cyst locations L4-5 (54.16%), L3-4 (20.83%), L5-S1 (12.5%) Listhesis 5 patients (20.83%) Spinal stenosis 75% of patients (18 patients) Facet joint angle (mean) 41.67 degrees Cyst size (mean) 6.6 x 6 mm Conservative treatment resolution 58.3% (14 patients) Surgical treatment required 10 patients (41.7%) McNab score Excellent (7 patients), Good (3 patients) Follow-up period (mean) 27.5 months This study assesses the clinical, radiological, surgical, and conservative therapy results for individuals with spinal synovial cysts. Most people respond well to conservative treatment, but severe symptoms or spinal instability need surgery. Long-term results were excellent, and there was no recurrence or instability over the follow-up period. This highlights the need of tailoring spinal synovial cyst treatment to radiological and clinical results. 4. Discussion Spinal diseases, especially in the lumbar region, are made worse by even uncommon spinal synovial cysts. Cysts form on the cervical or thoracic spine; however they usually appear between L4 and L5. According to research, degenerative changes and spinal instability is the reason why spinal synovial cysts are more prevalent in the lumbar region, particularly L4-5 [ 13 ]. Degenerative facets are the cause of these cysts. Listhesis or osteoarthritis both cause spinal instability. Cystsresult from this instability, making the illness worse. The instability allows the lining of the synovial membrane to protrude. Our findings show that Tarlov cysts are present in a wide range of medical conditions. Cysts were found in 62.5% of the participants [ 21 ]. Tarlov cysts are fluid-filled perineural cysts found in the sheaths surrounding the sacral nerve roots. The relationship between spinal synovial cysts and Tarlov cysts needs more research. These cysts indicate spinal instability or degeneration of the nerve roots and connective tissue [ 14 ]. To find out how these two cyst types interact and if their coexistence affects treatment or clinical results, further research is needed. During our study, spinal synovial cysts appeared out of the ordinary. While some cysts cause symptoms, the majorities are asymptomatic and discovered by mistake via imaging. You have significant myelopathy, cauda equina syndrome, radiculopathy, and back discomfort. The size, position, and pressure of the cyst on nearby tissues, such as the spinal cord or nerve roots, determine its clinical appearance. The most common symptoms were radiculopathy and low back discomfort [ 15 ]. The patient's functioning and quality of life is significantly impacted by these symptoms, prompt diagnosis and treatment are required. The most effective method for detecting spinal synovial cysts is magnetic resonance imaging (MRI), which has a 90% sensitivity and provides detailed images of soft tissue, including the location, size, and relationship of the cyst to adjacent structures. Synovial cysts are easily distinguished by MRI from ganglion, Tarlov, and other spinal neoplasms. T1 hypointensity and T2 hyperintensity are often seen in cysts. Cystic gas is often pathognomonic [ 16 ]. To make the diagnosis and describe the cyst, we used MRI, which had an impact on the course of therapy. Spinal synovial cysts are detected by MRI, although treatment is impacted by the cysts' size, location, severity, and spinal instability. Physical therapy, rest, and pain medication is helpful in moderate instances or cysts that do not compress the spinal cord or nerve roots. After 6–8 weeks, 58.3% of patients reported a reduction in symptoms after conservative therapy. Try conservative therapy initially since it has been utilized to treat non-surgical patients [ 17 ]. If symptoms worsen or spinal instability develops, many individuals with spinal synovial cysts need surgery right away. We looked at 41.7% of patients who had pressure alleviation and cyst excision. Patients with segmental instability underwent cyst ectomy and decompression. Patients underwent fusion and posterior instrumentation. Spinal fusion was selected using functional radiography. These radiographs were used to investigate spinal instability and listhesis. Serious instability increased the chance of spinal degeneration and recurrence. Stability was essential throughout the procedure. Following posterior fusion, decompression, and cyst ectomy, none of our patients had instability. There was no recurrence throughout the follow-up. The results show that these patients did well. By measuring pain reduction, functional improvement, and patient satisfaction, the McNab score evaluated the effectiveness of surgery. Thirty percent got acceptable results and no adverse effects, while seventy percent had great results. According to the evidence, if done properly, surgery enhances a patient's function and quality of life. Surgery for spinal synovial cysts is difficult and effective. Examples include CSF leakage, infection, and tissue degeneration associated with implants. Following surgery and subsequent care, we found no evidence of CSF leakage or infection. According to research, 3.3% CSF leakage and 0.9% infection result with cyst removal and decompression [ 18 ]. These challenges highlight the need for careful planning and the development of surgical skills in order to reduce hazards. After surgery, recurrent cysts or nearby deterioration develop. Although there was no spinal instability or synovial cyst recurrence during our assessment, the literature indicates that there is a 0% to 33% chance. Variability is caused by the surgical technique, spinal instability, and intervention duration [ 20 ]. We discovered that individuals with segmental instability benefit from posterior fusion, which stabilizes the spine. Our findings demonstrate that, despite their rarity, spinal synovial cysts contribute significantly to spinal disease by causing degenerative alterations and spinal instability. MRI is the most accurate way to diagnose cysts. When symptoms worsen or become unstable, surgery can be necessary. For many, conservative therapy is sufficient [ 19 ]. Patients with segmental instability benefit long-term from cyst therapy, posterior fusion, and decompression. During follow-up, there was no instability or recurrence. Future studies should look into the biology of synovial cysts, their interactions with other types of spinal cysts, and treatment plans in order to improve patient outcomes. 5. Conclusion Although they often don't cause any symptoms, swelling or pressure on nearby tissues cause pain. The majority of lumbar cysts are L4-L5. Degeneration and spinal instability ensue. To distinguish spinal synovial cysts from other diseases, MRI is required. Cyst removal and decompression is necessary for persistent or worsening symptoms. Some people benefit from conservative therapy. According to our research, choosing surgical candidates and using the right methods have long-term advantages. Patients with segmental instability were able to prevent instability and recurrence with decompression, cyst excision, and posterior fusion. The lives of people with spinal synovial cysts are improved by surgery. More research is required to better understand the pathophysiology of synovial cysts and enhance therapy. Abbreviations • MRI Magnetic Resonance Imaging • CT Computed Tomography • CSF Cerebrospinal Fluid Declarations Ethics approval and consent to participate This study was conducted as a retrospective analysis of anonymized patient data obtained from medical records at Mustafa Kemal University, Faculty of Medicine Hospital, Hatay, Turkey . Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding The authors received no specific funding for this study. Authors’ contributions MEK conceived and designed the study, supervised surgical procedures, and drafted the manuscript. AMA contributed to data acquisition, patient evaluation, and manuscript revision. Acknowledgements Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request. All patient data were anonymized prior to analysis. References Weerakkody Y, Walizai T, Yap J et al Ganglion cyst. Reference article, Radiopaedia.org 2025 Sep.12 https://doi.org/10.53347/rID-18707 Sandhu FA, Santiago P, Fessler RG, Palmer S (2004) Minimally invasive surgical treatment of lumbar synovial cysts. Neurosurgery. ;54(1):107 – 11; discussion 111-2. 10.1227/01.neu.0000097269.79994.2f . PMID: 14683546 Gunduz B, Ovalıoğlu TC, Atabey R, Karasu A, Dincer A (2003) Three Cases of Symptomatic Intraspinal Lumbar Synovial Cyst. Türk Nörosirürji Dergisi 13:180–183 Francavilla TL, Weiss MC, Umansky D, Songhurst S, Davis RJ (2022) Patient Outcomes After Minimally Invasive Excision of Lumbar Synovial Cysts, With and Without a Spondylolisthesis, in an Ambulatory Care Center Setting. Int J Spine Surg 16(4):690–696 Epub ahead of print. PMID: 35835576; PMCID: PMC9421275 Elgafy H, Peters N, Lea JE, Wetzel RM (2016) Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection: A case report and review of the literature. World J Orthop 7(7):452–457. 10.5312/wjo.v7.i7.452 PMID: 27458557; PMCID: PMC4945513 Lyons MK et al (2000) Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg 93(1):53–57. 10.3171/spi.2000.93.1.0053 Jabaz D (2022) Synovial cyst from degenerative facet joint disease. 10.53347/rID-158263 Freidberg SR, Fellows T, Thomas CB, Mancall AC (1994) Experience with symptomatic spinal epidural cysts. Neurosurgery. ;34(6):989 – 93; discussion 993. 10.1227/00006123-199406000-00006 . PMID: 8084409 Sherif R, Carter J, McCarthy MJH (2024) Lumbar Facet Joint Cysts: Evaluating Clinical Trends and Treatment Outcomes in a Single-Centre Retrospective Case Series. Int J Spine Res. ; 6(1):001–007. Available from: https://dx.doi.org/10.17352/ijsr.000025 Peng T-C, Liu P-C, Chang C-C, Chang H-K, Ko C-C, Tu T-H, Fay L-Y, Wu J-C Wen-Cheng Huang, Chao-Hung Kuo,An Updated Review on Treatment of Cervical Synovial Cyst. World Neurosurg Volume 193,2025,35–45 doi.org/10.1016/j.wneu.2024.09.135 Kao CC, Stefan S, Winkler and J. Harvey Turner. Synovial cyst of spinal facet: case report. J Neurosurg 41.3 (1974): 372–376 van Dijke M, Janssen SJ, Cha TD, Wood KB, Borges LF, Harris MB, Bono CM, Schwab JH (2017) Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts. Clin Spine Surg. ;30(10):E1399-E1404. 10.1097/BSD.0000000000000449 . PMID: 27753698 Wun K, Hashmi SZ, Maslak J, Schneider AD, Katchko KM, Singh G, Patel AA, Hsu WK (2019) The Variability of Lumbar Facet Joint Synovial Cyst Recurrence Requiring Revision Surgery After Decompression-only and Decompression/Fusion.Clin Spine Surg Volume 32, Number 10, December Yarde WL, Arnold PM, Kepes JJ, O'Boynick PL, Wilkinson SB, Batnitzky S (1995) Synovial cysts of the lumbar spine: diagnosis, surgical management, and pathogenesis. Report of eight cases. Surg Neurol. ;43(5):459 – 64; discussion 465. 10.1016/0090-3019(95)80090-4 . PMID: 7660284 Hsu KY et al (1995) Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment. Spine 201:80–89. 10.1097/00007632-199501000-00015 Sut N (2009) Synovial cysts of the lumbar facet joints: A retrospective magnetic resonance imaging study investigating their relation with degenerative spondylolisthesis. Prague Med Rep 110:301–309 Sarac ME, Boga ZA (2025) Comparative Evaluation of Surgical Techniques Applied in Lumbar Synovial Cysts in Accordance with the Literature. Diagnostics 15:1767. https://doi.org/10.3390/diagnostics15141767 Lyons MK, Atkinson JL, Wharen RE, Deen HG, Zimmerman RS, Lemens SM (2000) Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg. ;93(1 Suppl):53 – 7. doi: 10.3171/spi.2000.93.1.0053. PMID: 10879758 Khan AM, Girardi F (2006) Spinal lumbar synovial cysts. Diagnosis and management challenge. Eur Spine J 15(8):1176–1182. 10.1007/s00586-005-0009-4 Epub 2006 Jan 27. PMID: 16440202; PMCID: PMC3233964 Chebib I, Chang C, Schwab J, Kerr, Darcy, Deshpande, Vikram, Nielsen G (2018) Histopathology of Synovial Cysts of the Spine. Histopathology 72. 10.1111/his.13465 Boviatsis E, Stavrinou L, Kouyialis A, Gavra M, Stavrinou P, Themistokleous, Marios, Selviaridis, Panayiotis, Sakas D (2008) Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. Eur Spine J 17:838–838. 10.1007/s00586-008-0673-2 Cambron SC, McIntyre JJ, Guerin SJ, Li Z, Pastel DA (2013) Lumbar facet joint synovial cysts: does T2 signal intensity predict outcomes after percutaneous rupture? AJNR Am J Neuroradiol 34(8):1661–1664. 10.3174/ajnr.A3441 Epub 2013 Feb 28. PMID: 23449657; PMCID: PMC3801423 Garg K, Manish K (2021) Kasliwal. Outcomes and complications following minimally invasive excision of synovial cysts of the lumbar spine: a systematic review and meta-analysis. Clin Neurol Neurosurg 206:106667 Sarac M, Emre, Boga Z (2025) A comparative evaluation of surgical techniques applied in lumbar synovial cysts in accordance with the literature. Diagnostics 15, no. 14 : 1767 Lalanne L, Beaulieu RL, Carmona, Juan I, Cirillo Totera (2022) Facundo Alvarez Lemos, José Tomás Muñoz Wilson, and Andre M. Beaulieu Montoya. Surgically managed symptomatic intraspinal lumbar facet synovial cyst outcome of surgical treatment with resection and instrumented posterolateral fusion, a case series. BMC Surg 22(1):277 Morishita Y, Taniguchi R, Kawano O, Takeshi Maeda (2021) Synovial facet joint cysts after lumbar posterior decompression surgery. J Neurosurgery: Spine 35(6):704–709 Chen Y, Yu P, Xu H, Li S, Wang Q, Wu C, Wang J, Ji F (2023) Qiang Huang, and Qing Lan. Efficacy of minimally invasive tubular approaches for management of the lumbar spinal synovial cysts: a meta-analysis. Eur J Med Res 28(1):494 Ji L-Z, Guo M-Z, Li S-P, Hao-Xuan Zhang (2025) Surgical treatment of special type of adjacent segment disease–lumbar intraspinal synovial cysts in patients with osteoporosis: A case report. Int J Surg Case Rep : 111690 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8346108","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":559413240,"identity":"b4bbcb21-8a36-4f4c-89cf-4e59709276d4","order_by":0,"name":"Mustafa Emrah Kaya","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-4118-8129","institution":"Mustafa Kemal University","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"Emrah","lastName":"Kaya","suffix":""},{"id":559413369,"identity":"f1d489e3-9a95-4602-897b-cf62091ae4be","order_by":1,"name":"Ali Maksut Aykut","email":"","orcid":"https://orcid.org/0000-0002-7651-7132","institution":"Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Maksut","lastName":"Aykut","suffix":""},{"id":559413756,"identity":"87628277-a6c1-4ec7-9f58-e569b7099276","order_by":2,"name":"Hanifi Bayaroğulları","email":"","orcid":"https://orcid.org/0000-0001-6147-5876","institution":"Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Hanifi","middleName":"","lastName":"Bayaroğulları","suffix":""},{"id":559413757,"identity":"8beb4669-86ad-4b5b-bd1a-898c3e51aef2","order_by":3,"name":"Mahmut Cingöz","email":"","orcid":"https://orcid.org/0009-0001-6543-9466","institution":"Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Mahmut","middleName":"","lastName":"Cingöz","suffix":""}],"badges":[],"createdAt":"2025-12-12 13:11:41","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-8346108/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8346108/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99770130,"identity":"b05ad34d-4975-4eac-8449-327bbaea1fa6","added_by":"auto","created_at":"2026-01-08 08:41:17","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":36689,"visible":true,"origin":"","legend":"","description":"","filename":"FacetCysts111.docx","url":"https://assets-eu.researchsquare.com/files/rs-8346108/v1/54e9c46443032ce34ab4ba94.docx"},{"id":99770131,"identity":"22e752a2-5470-4e27-b22d-a6ebd999d5e3","added_by":"auto","created_at":"2026-01-08 08:41:17","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":342,"visible":true,"origin":"","legend":"","description":"","filename":"rs8346108.json","url":"https://assets-eu.researchsquare.com/files/rs-8346108/v1/a1179a06b06718c05cba5ce3.json"},{"id":99770129,"identity":"f8f124a6-ba22-48ce-9202-576beda49231","added_by":"auto","created_at":"2026-01-08 08:41:17","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77564,"visible":true,"origin":"","legend":"","description":"","filename":"rs83461080enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8346108/v1/3f5e1f8568e9461e45c31271.xml"},{"id":99770132,"identity":"23716696-3d15-401a-a8cd-8d33234cb05b","added_by":"auto","created_at":"2026-01-08 08:41:18","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":75512,"visible":true,"origin":"","legend":"","description":"","filename":"rs83461080structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8346108/v1/5f0c5c301818e84141bb86f2.xml"},{"id":99770114,"identity":"3ba76ce7-b12c-4d85-88e2-c0212ebacbff","added_by":"auto","created_at":"2026-01-08 08:41:15","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85030,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8346108/v1/7ce24bf8115745a433fdf717.html"},{"id":99798474,"identity":"85a733a2-f04c-47a3-bf27-187b144c910f","added_by":"auto","created_at":"2026-01-08 13:48:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":740382,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8346108/v1/07fad2be-0384-4420-85b4-74cd005d8845.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eFacet Cysts\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSynovial cysts, which are fluid-filled sacs seen in the knee, hand, and foot, are seldom found on the spine. W.M. In 1877, he was appointed librarian. This cyst was initially described by Becker. They are present in the knee of a patient with osteoarthritis. Von Gruhen found the first intraspinal synovial cyst during autopsy. Compared to spine cysts, limb cysts are more common. Usually, the lumbar spine is where they start. They are common in the L4-5 spine [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Although uncommon, synovial cysts of the cervical and thoracic spine have been documented.\u003c/p\u003e \u003cp\u003eIt's unclear what causes spinal synovial cysts. Facet joint development result from degenerative changes in the spine, namely in the facet joints [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Consequently, the synovial lining of the facet joint herniate and form cysts, which are linked to aging and spinal instability. Acute spinal column injuries or mechanical stress change the genesis of cysts. Numerous studies have shown that facet joint degeneration and spinal instability have a significant impact on the production of synovial cysts. Back discomfort, myelopathy, and radiculopathy result from compression of the spinal cord or nerve roots caused by a synovial cyst that narrows the spinal canal.\u003c/p\u003e \u003cp\u003eImaging generally detects asymptomatic synovial cysts. If they spread and make contact with tissues, they result in severe neurological disorders. Radicular and lumbosacral discomfort are often caused by the lumbar cyst [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Patients' symptoms vary on cyst size and location. Cauda equina syndrome, often known as myelopathy, is rare but fatal. Severe symptoms are experienced by some people with spinal synovial cysts. Unintentional imaging tests detect cysts, and the absence of symptoms delay diagnosis [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe primary method for identifying spinal synovial cysts is magnetic resonance imaging. MRI is great for cyst size, location, and features. Synovial cysts seldom have distinct boundaries. Signal intensity is affected by cyst components. T1-weighted MRIs show hypointense synovial cysts, whereas T2-weighted MRIs show hyperintense ones [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The cyst's gas aid in the diagnosis. Although CT also is used, MRI is the most effective method for identifying synovial cysts. This establishes the bone connection and cyst calcium.\u003c/p\u003e \u003cp\u003e No guidelines exist for treating spinal synovial cysts, making treatment complicated. Many people, particularly those with small cysts or asymptomatic conditions, benefit from physical therapy, analgesics, and rest [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Surgery is required, if conservative treatment is insufficient or if symptoms are worsening over time. For segmental instability, spinal fusion, decompression, and cyst excision are used. Cyst aspiration and steroid injections are less invasive procedures. Medical trials for these methods were unsuccessful. While some cysts cure on their own, others that are symptomatic or growing often need surgery. Elderly individuals suffer from spinal synovial cysts. Surgery is determined by the size of the cyst, the severity of the symptoms, spinal instability, and nerve compression. Surgery increases function and lessens discomfort [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Infection, tissue deterioration, recurrence, and CSF leaking are possible outcomes of surgery. Despite these risks, surgery help most people live better lives.\u003c/p\u003e \u003cp\u003eThis study focuses on our fourteen-year clinical experience with spinal synovial cysts. Research will reveal the clinical manifestation, diagnosis, course of therapy, and adverse consequences of spinal synovial cysts. By comparing conservative and surgical approaches to treating spinal synovial cysts, we hope to gain more knowledge. Future clinical practices are what we want to suggest.\u003c/p\u003e"},{"header":"2. Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003eThe Institution cohort study from 2011\u0026ndash;2025 was a retrospective study. The ethics committee approved the study, and the researchers adhered to the Helsinki Declaration. The study examined the clinical experiences of individuals with spinal synovial cysts. The research looked at results, treatment outcomes, diagnostics, and patient demographics. Strict inclusion criteria were used to choose these individuals and radiological imaging and medical records were used to monitor their clinical progress.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Patient Selection\u003c/h2\u003e \u003cp\u003eTwenty-four individuals with spinal synovial cysts were analyzed. These people were chosen after synovial cysts were discovered on MRI or CT scans. The study comprised patients who were treated at our institution and had clinically significant symptoms of synovial cysts, such as low back pain, myelopathy, or radiculopathy.\u003c/p\u003e \u003cp\u003eAge, gender, and coexisting disorders were examined in the patients' medical records. The length, symptoms, and clinical characteristics were noted. Prior to diagnosis, neurological abnormalities, pain, and weakness were assessed, as was the length of the symptoms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Before and after the procedure, physical exams were recorded. This assessed function after treatment. Imaging assessed spinal anomalies such listhesis and stenosis as well as the size of the cyst. MRIs evaluated facet joint angle and identified Tarlov cysts [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. During follow-up visits, the McNab score was utilized to evaluate the surgical outcome.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Diagnostic Imaging\u003c/h2\u003e \u003cp\u003eSynovial cysts and their impact on surrounding tissues were thoroughly investigated, as shown by both MRI and CT scans. Magnetic resonance imaging (MRI) is the most effective method for diagnosing spinal synovial cysts because it has a better soft tissue contrast and can precisely show the size, location, and contents of the cyst. Cysts that contain gas are pathognomonic [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. On T1-MRIs, synovial cysts seem hypointense, but on T2-MRIs, they appear hyperintense [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The study used MRI to study spinal canal narrowing. This demonstrates the extent to which the cyst disrupts brain pathways.\u003c/p\u003e \u003cp\u003eThe link between the cyst and nearby bone structures was identified in this investigation using CT imaging. Imaging of the surrounding vertebrae and cyst calcification was good. MRI and CT data were used to properly evaluate the cyst's size, location, and risk of spinal stenosis or nerve root compression.\u003c/p\u003e \u003cp\u003eFunctional MAST used radiography to investigate segmental instability. During functional MRI scanning, active posture was maintained to detect any movement or instability of the synovial cyst. By identifying spinal instability, this imaging helps with therapy planning [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A test for spinal canal stenosis was developed by Schizas and associates. An estimate of an unobstructed channel is compared to the canal area, including the cyst. Use this method to determine the canal constriction percentage. For stenosis, the ratio was transformed into a percentage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Treatment Approach\u003c/h2\u003e \u003cp\u003eWe started our spinal synovial cyst investigation with conservative therapy. Physical therapy, analgesics, and rest were given for 6\u0026ndash;8 weeks. In order to reduce symptoms and avoid surgery, conservative treatment focused on patients who reacted well to non-invasive techniques. Physicians evaluated the clinical state and symptom progression of their patients. Surgery was considered if conservative measures failed or if symptoms worsened.\u003c/p\u003e \u003cp\u003eCysts were decompressed and removed during the treatment. Cyst-induced spinal cord and nerve root pressure was reduced by decompression surgery. Surgery was performed to remove the cyst [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This got rid of the symptoms. Patients who showed signs of segmental instability on functional or clinical MAST radiography underwent cystectomy, decompression, fusion, and posterior instrumentation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The objective was to stabilize the spine and stop deterioration.\u003c/p\u003e \u003cp\u003eEligibility for spinal fusion surgery was assessed by imaging data and clinical presentation. Spinal fusion surgery was indicated for deterioration of the facet joint and listhesis. This treatment reduced deformity and symptom recurrence while stabilizing the spine.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Outcome Evaluation\u003c/h2\u003e \u003cp\u003eThe most used surgical effectiveness metric was McNab. The McNab score is often used to assess functional outcomes after spine surgery. Patient satisfaction, pain relief, and spinal range of motion are assessed [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Results are assessed as amazing, fantastic, fair, or dreadful. Depending on the patient's recovery.\u003c/p\u003e \u003cp\u003eOne month and one year after surgery, postoperative assessments were conducted. Using the McNab score, these follow-up sessions evaluated the patients' functional state and identified any recurrence or new symptoms. To find any new cysts or spinal instability, radiographs were used. Although the mean follow-up duration, examination of long-term effects was made possible by patient variability.\u003c/p\u003e \u003cp\u003eTo assess each approach, postoperative outcomes from conservative and surgical procedures were compared. Surgery patients were evaluated for symptom relief, treatment, and recurrence.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Patient Demographics\u003c/h2\u003e \u003cp\u003eThis study looked at 24 individuals with spinal synovial cysts. The six men and eighteen women in the group. With the youngest being nineteen and the oldest being ninety, their average age was fifty-eight. The average age of the patients was 59.8 years for males and 57.4 years for women. Spinal synovial cysts are more common in older people and girls. This broad tendency is consistent with population traits.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Clinical Findings\u003c/h2\u003e \u003cp\u003eThe majority of study participants reported neurological issues despite a variety of clinical symptoms. 15 individuals, or 62.5% of the total, had paresthesia or radiculopathy. A number of symptoms appear when the size and location of the cyst squeeze the nerve root. The lower weakening rate (12.5% explained by more damage to the spinal cord or nerve roots [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvery research participant had lumbar, thoracic, and cervical pain. This ailment, which impacts everyday activities and quality of life, caused by spinal synovial cysts.\u003c/p\u003e \u003cp\u003eDiagnosed after symptoms ranging from one month to eleven years. 44 months passed on average between symptoms and diagnosis. Before causing neurological problems, synovial cysts cause mild symptoms for years. This is seen by the prolonged duration of symptoms in the majority of people. Four patients, or 16.6% of this non-at-risk group, reported experiencing trauma. These people develop synovial cysts brought on by trauma.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Radiological Findings\u003c/h2\u003e \u003cp\u003eLumbar spine findings were prevalent, as is customary in the literature. There are cysts on many levels of the spine:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eL4-5: 13 patients (54.16%)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eL3-4: 5 patients (20.83%)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eL5-S1: 3 patients (12.5%)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eC1-2: 1 patient (4.16%)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eC7-T1: 1 patient (4.16%)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAccording to our findings, synovial cysts are common in the lumbar spine, particularly in the L4-5 region. Although less often, a significant portion of the population had altered L3-4 and L5-S1 levels.\u003c/p\u003e \u003cp\u003eSpondylolisthesis, or spinal slippage, affected five people (20.83%). Two patients had grade 1 slippage, two had grade 2, and one had degree 3 slippage, based on Meyerding's classification of listhesis. For others, spondylolisthesis is a sign of synovial cysts brought on by spinal instability [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Cysts from joint capsule herniation and spinal dislocation occur in spondylolisthesis.\u003c/p\u003e \u003cp\u003eInterestingly, spinal stenosis was seen in this group. Spinal stenosis affected 18 people, or 75% of the population. The categorization of stenosis:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e9 patients (37.5%) had 25\u0026ndash;50% stenosis\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e8 patients (33.3%) had 50\u0026ndash;75% stenosis\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e1 patient (4.16%) had\u0026thinsp;\u0026gt;\u0026thinsp;75% stenosis\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eSurgery is necessary to treat spinal stenosis and neurological problems brought on by synovial cysts. These results imply that spinal stenosis is usually caused by these cysts.\u003c/p\u003e \u003cp\u003eThe average size of these synovial cysts was 6.6 by 6.0 millimeters. Remarkably, during follow-up, two (8.33%) developed cysts. Cyst reduction of 50% was achieved by only one patient (4.16%). Invasive therapy is necessary for synovial cysts that form or persist after spontaneous clearance.\u003c/p\u003e \u003cp\u003eSpinal instability was suggested by their mean facet joint angle of 41.67 degrees. The mean facet joint angle was 43.4 degrees for surgical patients and 46.58 degrees for individuals who underwent cyst excision and decompression. Surgery is predicted by facet joint angle, according to statistics. More intensive therapy at acute angles is necessary for instability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Treatment Outcomes\u003c/h2\u003e \u003cp\u003eAfter conservative physical treatment, analgesics, and rest for six to eight weeks [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], (58.3%) of the twenty-four patients showed improvement. These patients did not need surgery, suggesting that conservative measures are beneficial for small cysts or moderate symptoms.\u003c/p\u003e \u003cp\u003eTen patients (41.7%) required surgery because conservative treatment failed or their symptoms worsened. If segmental instability was detected, the cyst was decompressed and removed via posterior instrumentation and fusion.\u003c/p\u003e \u003cp\u003eSurgical success was assessed using the McNab score, a functional outcome metric for spine surgery. Out of ten patients who had surgery, three (30%) had great results, seven (70%) had good results, and none had mediocre or disappointing results. Most patients who had surgery reported significant improvements in their symptoms and functionality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMonitoring was made possible by the average patient follow-up of 27.5 months. During follow-up, there was no segmental instability or recurrence of synovial cysts. Following spinal instability surgery, patients had long-lasting symptom alleviation and spinal stabilization.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable: Clinical and Radiological Findings\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFindings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal number of patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale/Female ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 males (25%), 18 females (75%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMost common symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow back pain, radiculopathy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptom duration (mean)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatients with trauma history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCyst locations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eL4-5 (54.16%), L3-4 (20.83%), L5-S1 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eListhesis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 patients (20.83%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpinal stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75% of patients (18 patients)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFacet joint angle (mean)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.67 degrees\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCyst size (mean)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.6 x 6 mm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConservative treatment resolution\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.3% (14 patients)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical treatment required\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 patients (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMcNab score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent (7 patients), Good (3 patients)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up period (mean)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.5 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis study assesses the clinical, radiological, surgical, and conservative therapy results for individuals with spinal synovial cysts. Most people respond well to conservative treatment, but severe symptoms or spinal instability need surgery. Long-term results were excellent, and there was no recurrence or instability over the follow-up period. This highlights the need of tailoring spinal synovial cyst treatment to radiological and clinical results.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eSpinal diseases, especially in the lumbar region, are made worse by even uncommon spinal synovial cysts. Cysts form on the cervical or thoracic spine; however they usually appear between L4 and L5. According to research, degenerative changes and spinal instability is the reason why spinal synovial cysts are more prevalent in the lumbar region, particularly L4-5 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Degenerative facets are the cause of these cysts. Listhesis or osteoarthritis both cause spinal instability. Cystsresult from this instability, making the illness worse. The instability allows the lining of the synovial membrane to protrude.\u003c/p\u003e \u003cp\u003eOur findings show that Tarlov cysts are present in a wide range of medical conditions. Cysts were found in 62.5% of the participants [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Tarlov cysts are fluid-filled perineural cysts found in the sheaths surrounding the sacral nerve roots. The relationship between spinal synovial cysts and Tarlov cysts needs more research. These cysts indicate spinal instability or degeneration of the nerve roots and connective tissue [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. To find out how these two cyst types interact and if their coexistence affects treatment or clinical results, further research is needed.\u003c/p\u003e \u003cp\u003eDuring our study, spinal synovial cysts appeared out of the ordinary. While some cysts cause symptoms, the majorities are asymptomatic and discovered by mistake via imaging. You have significant myelopathy, cauda equina syndrome, radiculopathy, and back discomfort. The size, position, and pressure of the cyst on nearby tissues, such as the spinal cord or nerve roots, determine its clinical appearance. The most common symptoms were radiculopathy and low back discomfort [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The patient's functioning and quality of life is significantly impacted by these symptoms, prompt diagnosis and treatment are required.\u003c/p\u003e \u003cp\u003eThe most effective method for detecting spinal synovial cysts is magnetic resonance imaging (MRI), which has a 90% sensitivity and provides detailed images of soft tissue, including the location, size, and relationship of the cyst to adjacent structures. Synovial cysts are easily distinguished by MRI from ganglion, Tarlov, and other spinal neoplasms. T1 hypointensity and T2 hyperintensity are often seen in cysts. Cystic gas is often pathognomonic [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. To make the diagnosis and describe the cyst, we used MRI, which had an impact on the course of therapy.\u003c/p\u003e \u003cp\u003eSpinal synovial cysts are detected by MRI, although treatment is impacted by the cysts' size, location, severity, and spinal instability. Physical therapy, rest, and pain medication is helpful in moderate instances or cysts that do not compress the spinal cord or nerve roots. After 6\u0026ndash;8 weeks, 58.3% of patients reported a reduction in symptoms after conservative therapy. Try conservative therapy initially since it has been utilized to treat non-surgical patients [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIf symptoms worsen or spinal instability develops, many individuals with spinal synovial cysts need surgery right away. We looked at 41.7% of patients who had pressure alleviation and cyst excision. Patients with segmental instability underwent cyst ectomy and decompression. Patients underwent fusion and posterior instrumentation. Spinal fusion was selected using functional radiography. These radiographs were used to investigate spinal instability and listhesis. Serious instability increased the chance of spinal degeneration and recurrence. Stability was essential throughout the procedure.\u003c/p\u003e \u003cp\u003eFollowing posterior fusion, decompression, and cyst ectomy, none of our patients had instability. There was no recurrence throughout the follow-up. The results show that these patients did well. By measuring pain reduction, functional improvement, and patient satisfaction, the McNab score evaluated the effectiveness of surgery. Thirty percent got acceptable results and no adverse effects, while seventy percent had great results. According to the evidence, if done properly, surgery enhances a patient's function and quality of life.\u003c/p\u003e \u003cp\u003eSurgery for spinal synovial cysts is difficult and effective. Examples include CSF leakage, infection, and tissue degeneration associated with implants. Following surgery and subsequent care, we found no evidence of CSF leakage or infection. According to research, 3.3% CSF leakage and 0.9% infection result with cyst removal and decompression [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These challenges highlight the need for careful planning and the development of surgical skills in order to reduce hazards.\u003c/p\u003e \u003cp\u003eAfter surgery, recurrent cysts or nearby deterioration develop. Although there was no spinal instability or synovial cyst recurrence during our assessment, the literature indicates that there is a 0% to 33% chance. Variability is caused by the surgical technique, spinal instability, and intervention duration [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. We discovered that individuals with segmental instability benefit from posterior fusion, which stabilizes the spine.\u003c/p\u003e \u003cp\u003eOur findings demonstrate that, despite their rarity, spinal synovial cysts contribute significantly to spinal disease by causing degenerative alterations and spinal instability. MRI is the most accurate way to diagnose cysts. When symptoms worsen or become unstable, surgery can be necessary. For many, conservative therapy is sufficient [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Patients with segmental instability benefit long-term from cyst therapy, posterior fusion, and decompression. During follow-up, there was no instability or recurrence. Future studies should look into the biology of synovial cysts, their interactions with other types of spinal cysts, and treatment plans in order to improve patient outcomes.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eAlthough they often don't cause any symptoms, swelling or pressure on nearby tissues cause pain. The majority of lumbar cysts are L4-L5. Degeneration and spinal instability ensue. To distinguish spinal synovial cysts from other diseases, MRI is required. Cyst removal and decompression is necessary for persistent or worsening symptoms. Some people benefit from conservative therapy.\u003c/p\u003e \u003cp\u003eAccording to our research, choosing surgical candidates and using the right methods have long-term advantages. Patients with segmental instability were able to prevent instability and recurrence with decompression, cyst excision, and posterior fusion. The lives of people with spinal synovial cysts are improved by surgery. More research is required to better understand the pathophysiology of synovial cysts and enhance therapy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; MRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; CT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; CSF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCerebrospinal Fluid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eThis study was conducted as a \u003cb\u003eretrospective analysis of anonymized patient data\u003c/b\u003e obtained from medical records at \u003cb\u003eMustafa Kemal University, Faculty of Medicine Hospital, Hatay, Turkey\u003c/b\u003e.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no specific funding for this study.\u003c/p\u003e\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e \u003cp\u003eMEK conceived and designed the study, supervised surgical procedures, and drafted the manuscript. AMA contributed to data acquisition, patient evaluation, and manuscript revision.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request. All patient data were anonymized prior to analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWeerakkody Y, Walizai T, Yap J et al Ganglion cyst. Reference article, Radiopaedia.org 2025 Sep.12 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.53347/rID-18707\u003c/span\u003e\u003cspan address=\"10.53347/rID-18707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandhu FA, Santiago P, Fessler RG, Palmer S (2004) Minimally invasive surgical treatment of lumbar synovial cysts. Neurosurgery. ;54(1):107\u0026thinsp;\u0026ndash;\u0026thinsp;11; discussion 111-2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1227/01.neu.0000097269.79994.2f\u003c/span\u003e\u003cspan address=\"10.1227/01.neu.0000097269.79994.2f\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 14683546\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGunduz B, Ovalıoğlu TC, Atabey R, Karasu A, Dincer A (2003) Three Cases of Symptomatic Intraspinal Lumbar Synovial Cyst. T\u0026uuml;rk N\u0026ouml;rosir\u0026uuml;rji Dergisi 13:180\u0026ndash;183\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrancavilla TL, Weiss MC, Umansky D, Songhurst S, Davis RJ (2022) Patient Outcomes After Minimally Invasive Excision of Lumbar Synovial Cysts, With and Without a Spondylolisthesis, in an Ambulatory Care Center Setting. Int J Spine Surg 16(4):690\u0026ndash;696 Epub ahead of print. PMID: 35835576; PMCID: PMC9421275\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElgafy H, Peters N, Lea JE, Wetzel RM (2016) Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection: A case report and review of the literature. World J Orthop 7(7):452\u0026ndash;457. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5312/wjo.v7.i7.452\u003c/span\u003e\u003cspan address=\"10.5312/wjo.v7.i7.452\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 27458557; PMCID: PMC4945513\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons MK et al (2000) Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg 93(1):53\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3171/spi.2000.93.1.0053\u003c/span\u003e\u003cspan address=\"10.3171/spi.2000.93.1.0053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJabaz D (2022) Synovial cyst from degenerative facet joint disease. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.53347/rID-158263\u003c/span\u003e\u003cspan address=\"10.53347/rID-158263\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreidberg SR, Fellows T, Thomas CB, Mancall AC (1994) Experience with symptomatic spinal epidural cysts. Neurosurgery. ;34(6):989\u0026thinsp;\u0026ndash;\u0026thinsp;93; discussion 993. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1227/00006123-199406000-00006\u003c/span\u003e\u003cspan address=\"10.1227/00006123-199406000-00006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 8084409\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherif R, Carter J, McCarthy MJH (2024) Lumbar Facet Joint Cysts: Evaluating Clinical Trends and Treatment Outcomes in a Single-Centre Retrospective Case Series. Int J Spine Res. ; 6(1):001\u0026ndash;007. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dx.doi.org/10.17352/ijsr.000025\u003c/span\u003e\u003cspan address=\"10.17352/ijsr.000025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng T-C, Liu P-C, Chang C-C, Chang H-K, Ko C-C, Tu T-H, Fay L-Y, Wu J-C Wen-Cheng Huang, Chao-Hung Kuo,An Updated Review on Treatment of Cervical Synovial Cyst. World Neurosurg Volume 193,2025,35\u0026ndash;45\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi.org/10.1016/j.wneu.2024.09.135\u003c/span\u003e\u003cspan address=\"10.1016/j.wneu.2024.09.135\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKao CC, Stefan S, Winkler and J. Harvey Turner. Synovial cyst of spinal facet: case report. J Neurosurg 41.3 (1974): 372\u0026ndash;376\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Dijke M, Janssen SJ, Cha TD, Wood KB, Borges LF, Harris MB, Bono CM, Schwab JH (2017) Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts. Clin Spine Surg. ;30(10):E1399-E1404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/BSD.0000000000000449\u003c/span\u003e\u003cspan address=\"10.1097/BSD.0000000000000449\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 27753698\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWun K, Hashmi SZ, Maslak J, Schneider AD, Katchko KM, Singh G, Patel AA, Hsu WK (2019) The Variability of Lumbar Facet Joint Synovial Cyst Recurrence Requiring Revision Surgery After Decompression-only and Decompression/Fusion.Clin Spine Surg Volume 32, Number 10, December\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYarde WL, Arnold PM, Kepes JJ, O'Boynick PL, Wilkinson SB, Batnitzky S (1995) Synovial cysts of the lumbar spine: diagnosis, surgical management, and pathogenesis. Report of eight cases. Surg Neurol. ;43(5):459\u0026thinsp;\u0026ndash;\u0026thinsp;64; discussion 465. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0090-3019(95)80090-4\u003c/span\u003e\u003cspan address=\"10.1016/0090-3019(95)80090-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 7660284\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsu KY et al (1995) Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment. Spine 201:80\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00007632-199501000-00015\u003c/span\u003e\u003cspan address=\"10.1097/00007632-199501000-00015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSut N (2009) Synovial cysts of the lumbar facet joints: A retrospective magnetic resonance imaging study investigating their relation with degenerative spondylolisthesis. Prague Med Rep 110:301\u0026ndash;309\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarac ME, Boga ZA (2025) Comparative Evaluation of Surgical Techniques Applied in Lumbar Synovial Cysts in Accordance with the Literature. Diagnostics 15:1767. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/diagnostics15141767\u003c/span\u003e\u003cspan address=\"10.3390/diagnostics15141767\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons MK, Atkinson JL, Wharen RE, Deen HG, Zimmerman RS, Lemens SM (2000) Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg. ;93(1 Suppl):53\u0026thinsp;\u0026ndash;\u0026thinsp;7. doi: 10.3171/spi.2000.93.1.0053. PMID: 10879758\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan AM, Girardi F (2006) Spinal lumbar synovial cysts. Diagnosis and management challenge. Eur Spine J 15(8):1176\u0026ndash;1182. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00586-005-0009-4\u003c/span\u003e\u003cspan address=\"10.1007/s00586-005-0009-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2006 Jan 27. PMID: 16440202; PMCID: PMC3233964\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChebib I, Chang C, Schwab J, Kerr, Darcy, Deshpande, Vikram, Nielsen G (2018) Histopathology of Synovial Cysts of the Spine. Histopathology 72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/his.13465\u003c/span\u003e\u003cspan address=\"10.1111/his.13465\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoviatsis E, Stavrinou L, Kouyialis A, Gavra M, Stavrinou P, Themistokleous, Marios, Selviaridis, Panayiotis, Sakas D (2008) Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. Eur Spine J 17:838\u0026ndash;838. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00586-008-0673-2\u003c/span\u003e\u003cspan address=\"10.1007/s00586-008-0673-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCambron SC, McIntyre JJ, Guerin SJ, Li Z, Pastel DA (2013) Lumbar facet joint synovial cysts: does T2 signal intensity predict outcomes after percutaneous rupture? AJNR Am J Neuroradiol 34(8):1661\u0026ndash;1664. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3174/ajnr.A3441\u003c/span\u003e\u003cspan address=\"10.3174/ajnr.A3441\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2013 Feb 28. PMID: 23449657; PMCID: PMC3801423\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarg K, Manish K (2021) Kasliwal. Outcomes and complications following minimally invasive excision of synovial cysts of the lumbar spine: a systematic review and meta-analysis. Clin Neurol Neurosurg 206:106667\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarac M, Emre, Boga Z (2025) A comparative evaluation of surgical techniques applied in lumbar synovial cysts in accordance with the literature. \u003cem\u003eDiagnostics\u003c/em\u003e 15, no. 14 : 1767\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLalanne L, Beaulieu RL, Carmona, Juan I, Cirillo Totera (2022) Facundo Alvarez Lemos, Jos\u0026eacute; Tom\u0026aacute;s Mu\u0026ntilde;oz Wilson, and Andre M. Beaulieu Montoya. Surgically managed symptomatic intraspinal lumbar facet synovial cyst outcome of surgical treatment with resection and instrumented posterolateral fusion, a case series. BMC Surg 22(1):277\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorishita Y, Taniguchi R, Kawano O, Takeshi Maeda (2021) Synovial facet joint cysts after lumbar posterior decompression surgery. J Neurosurgery: Spine 35(6):704\u0026ndash;709\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Y, Yu P, Xu H, Li S, Wang Q, Wu C, Wang J, Ji F (2023) Qiang Huang, and Qing Lan. Efficacy of minimally invasive tubular approaches for management of the lumbar spinal synovial cysts: a meta-analysis. Eur J Med Res 28(1):494\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJi L-Z, Guo M-Z, Li S-P, Hao-Xuan Zhang (2025) Surgical treatment of special type of adjacent segment disease\u0026ndash;lumbar intraspinal synovial cysts in patients with osteoporosis: A case report. Int J Surg Case Rep : 111690\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":true,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Mustafa Kemal University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Spinal Synovial Cysts, Lumbar Spine, Synovial Cyst Excision, Conservative Treatment, Spinal Stenosis, Surgery, MRI","lastPublishedDoi":"10.21203/rs.3.rs-8346108/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8346108/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAlthough they are uncommon in the spine, synovial cysts are common in the hands, feet, and knees. They are often seen in the lumbar area around L4-5. Synovial cysts are brought on by spinal instability and degeneration. These cysts are asymptomatic, but they cause cauda equina syndrome, myelopathy, radiculopathy, and back pain.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eFrom 2011 to 2025, we looked on the clinical outcomes of individuals with spinal synovial cysts at our hospital.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA review of twenty-four individuals with spinal synovial cysts was conducted. We collected information on demographics, radiological findings, clinical symptoms, treatment approaches, and results. The McNab score was used to evaluate the success of the surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSix men and eighteen women, all fifty-eight years of age, took part. The most frequent complaint from patients was lumbar pain. Radiculopathy accounted for 62.5%. Ten patients had cystectomies and decompression. Since there was no recurrence or segmental instability in the surgical group, therapy was successful.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSpinal synovial cysts are uncommon but create serious symptoms that necessitate medical care. Some patients responded well to conservative care, but others needed surgery because their symptoms were severe or becoming worse. Following surgery, no instability or recurrence was discovered, indicating that it is beneficial for certain people.\u003c/p\u003e","manuscriptTitle":"Facet Cysts","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-08 08:41:05","doi":"10.21203/rs.3.rs-8346108/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"34e08462-b251-4c7d-8a39-8577bf3fae27","owner":[],"postedDate":"January 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-08T08:41:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-08 08:41:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8346108","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8346108","identity":"rs-8346108","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}