{"id":"af55ebd2-d117-49eb-a019-fcdc4395b4d9","slug":"diagnosis-and-safe-excision-of-lumbar-synovial-cysts-and-accompanying-pathology-a-perspective","title":"Diagnosis and Safe Excision of Lumbar Synovial Cysts and Accompanying Pathology: A Perspective","authors":["Nancy E. Epstein"],"abstract":"Background: Lumbar synovial cysts are often not sufficiently diagnosed prior to spine surgery. Utilizing both MR and CT studies is critical for recognizing the full extent/severity of these lesions. Methods: In patients with chronic, acute, or subacute lumbar disease, obtaining both MR and CT studies is critical to correctly diagnose; disc disease, hypertrophy/ossification of the yellow ligament (OYL), stenosis, with/without degenerative spondylolisthesis, and/or synovial cysts (SC). Results: MR T2 weighted images directly demonstrate hyperintensity within a SC. They initially cause lateral recess/caudad nerve root and/foraminal compromise, with larger extrusions causing significant lateral thecal sac, and far lateral/superior cephalad root compromise. CT 2 mm cuts often better demonstrate mid-vertebral level compression of cephalad nerve roots with/without SC calcification, along with the extent of mid-vertebral stenosis, hypertrophy/OYL, and DS. When CT studies directly document SC calcification, it alerts the surgeon to the increased potential risk of creating a cerebrospinal fluid fistula with full SC excision, and should prompt the adoption of alternative measures such as decompression/partial removal. Most critically, surgery for synovial cysts often warrants a 2-level laminectomy for fuller visualization of the cephalad and caudad nerve roots, and clearer differentiation of neural tissues from the large fibrotic SC capsule, to effect safer removal. Conclusions: Preoperatively, establishing the full cephalad and cauda extent of lumbar synovial cysts with both MR and CT studies is critical. Anticipation and better visualization of the foraminal/far lateral and superior extent of these lesions often warrants more extensive multilevel laminectomies for thecal sac and both cephalad and caudad root decompression.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/af55ebd2-d117-49eb-a019-fcdc4395b4d9/featured/hero-1781563589817.png","publishDate":"2020-02-28T00:00:00.000Z","doi":"10.25259/SNI_54_2020","categories":["Spine","Review Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2020/02/9881/SNI-11-33.pdf"}