There are a number of different surgeries that may be advised for synovial cysts in the spine, including many microdecompression techniques using endoscopic surgery methods. The shorter recovery time is advantageous in these minimally invasive procedures but there is a risk of the synovial cyst recurring as the underlying cause remains unaddressed. In open back surgery it may be possible to remove the cyst and fuse the degenerated joints together to reduce the likelihood of the cyst recurring. The more invasive procedures do carry higher risks of complications and have a longer recovery time however and so patients should discuss their options for back surgery for spinal cysts carefully with their physician.
Back Surgery as a Cause of Spinal Cysts
In some cases it may be that previous back surgery has created the instability in the spine, particularly where open back surgery procedures involved the severance of back muscles, removal of a portion of the lamina, or discectomy across a number of levels. A second, or third, back surgery may then be warranted to remove the synovial cyst, excise any osteophytes that have also formed in an attempt by the body to stabilize the spine, and to fuse the facet joints to prevent the unstable movement that triggered the synovial fluid build-up. Fusing the facet joints stops the natural movement of the spine at that level and, as intraspinal cysts are most common at the most mobile section of the spine, L4/5, the development of adjacent segment syndrome after back surgery involving fusion is more likely. Recovery from open back surgery with fusion for spinal cysts is usually six to nine months or more and patients will have to undergo physical therapy and activity modification during this time to help with the healing process.
Choosing Spinal Cyst Surgery
Younger patients with active lifestyles and little joint degeneration are more likely to be considered for a minimally invasive decompressive back surgery for an intraspinal cyst, without spinal fusion. An invasive spinal fusion procedure in a young and relatively active patient could mean a lifetime of problems from adjacent segment syndrome as the natural movement of the spine has been disturbed. Older patients who are less active may wish to consider a single procedure involving both decompression and spinal fusion as this means only one back surgery, rather than an initial endoscopic procedure followed by open back surgery, and the risk of joint degeneration from adjacent segment syndrome is lessened due to the patients’ relative inactivity.
Decompression Back Surgery and Fusion for Cysts
Decompression surgery may simply not be enough in some cases and it can be more beneficial in the long-term to have a decompression-fusion procedure all at once rather than two separate back surgeries with double the associated risks. In most cases however, back surgery to remove the spinal cyst is effective with or without fusion of the lumbar spine and cysts rarely recur. Determining the level of spinal instability is paramount therefore in deciding which kind of surgery is likely to offer most benefit to patients. Exploratory back surgery leading to hemi-laminectomy, flavectomy (removal of the ligamentum flavum), and minimal facet joint removal is sometimes used in cases of synovial cysts. Where the cyst is adherent to the dura covering the spinal cord it is often difficult to successfully aspirate an intraspinal cyst or remove the synovial cyst with back surgery without considerable risk.