Faculty Collaboration Database

Synovial excrescences and cysts of the spine: clinicopathological features and contributions to spinal stenosis. Clin Neuropathol 2004;23(2):80-90

Date

04/13/2004

Pubmed ID

15074582

Scopus ID

2-s2.0-1642329723 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

Synovial cysts occur throughout the body and are generally benign lesions with limited clinical consequences. Juxtafacet cysts of the spine, in contrast, often press on a nerve root as it exits in the foramen, causing radiculopathy. Synovial tissue that emanates from the facet joint but extends medially, is an additional important cause of spinal stenosis. Over the past 5 years, neurosurgeons at our institution have operated on a large number of patients with back pain, with removal of abnormal synovial tissues. Histological examination of these tissues distinguishes the different types of pathologic processes responsible for producing symptoms. Juxtafacet cysts may be either mucin-filled ganglion cysts devoid of cyst lining or true synovial cysts with watery content and lined by synovial cells. Ganglion cysts arise in degenerated ligament at the facet joint, and occasionally within synovial stroma. Synovial cysts arise within synovium and, unlike synovial cysts in the extremities, have a thick wall containing granulation tissue, numerous histiocytes and giant cells. This hyperplastic, irritated synovium of the spine, which we term "synovial excrescences", is voluminous and this reactive part overshadows the cystic portion of the lesion in most instances. Iron pigment deposition and inflammation are mild to absent, making synovial excrescences different from pigmented villonodular synovitis. Synovial excrescences of the spine are an important cause of spinal stenosis, predominantly in elderly patients. Surgical removal of excrescences protruding into the spinal canal provides prompt and durable relief of symptoms, usually without the need for extensive bony laminectomy or spinal fusion. Several patients in our study had both spinal ganglion cysts and synovial excrescences, suggesting common risk factors for both lesions.

Author List

Sze CI, Kindt G, Huffer WB, Chang M, Wang M, Kleinschmidt-DeMasters BK

Author

Marjorie Wang MD Clinical Transformation Officer, Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Back Pain
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Spinal Stenosis
Spine
Synovial Cyst
Synovial Membrane