Spontaneous Resolution Of Synovial Lumbar Cyst Presented With Severe Symptoms: A Case Report
Hassan, M., Salman, I., & Salman, I. (2024). Spontaneous resolution of synovial lumbar cyst presented with severe symptoms: a case report. Journal of medical case reports, 18(1), 432. https://doi.org/10.1186/s13256-024-04762-2
View Original Source →Abstract
INTRODUCTION: Spinal cysts have traditionally been treated with surgery since it was first described in 1950. However, there have been rare instances where these cysts have resolved on their own without the need for surgical intervention. Here, we discuss the 27th reported case of such spontaneous resolution in the medical literature and delve into the details of this unique case. CASE PRESENTATION: This report details a rare case of a 58-year-old Middle Eastern female who suffered from severe radicular and lumbar pain. Radiological study showed the presence of a cyst in the lumbar column. Noninvasive treatment was chosen after ensuring that there were no other symptoms requiring surgery. The patient showed gradual improvement over the course of 12 months, after which the pain completely disappeared. DISCUSSION: The surgical approach is currently the main treatment for spinal cysts, but spontaneous resolution, despite its rarity, may be worth considering as a preferred therapeutic approach in the future. This avenue has not been thoroughly explored or studied. Due to the etiology of these cysts and their location within mobile joints, a longer period of conservative management including rest and physical therapy may play a pivotal role in promoting natural resolution. CONCLUSION: Conservative treatment of cysts should continue for at least 8 months, using painkillers and physical therapy without lumbar bracing. Surgery remains the most effective means of treatment to date. Further research is needed to validate and establish standardized treatment protocols.
Case Details
Disease Location
L5-s1 spinal canal
Personal Characteristics
58-year-old middle eastern female. History of chronic right radicular lumbar pain treated with painkillers for 3 months in two occasions
Clinical Characteristics
Progressive left radicular pain extending to the hip and the lateral posterior side of the thigh and leg, reaching the lateral toes, and back pain in the lumbar region, scoring 10/10 on the numeric pain scale, that had been ongoing for 1 month. MRI showed an extradural cystic lesion in the l5–s1 spinal canal, adjacent to the left internal facet joint, with hypointensity in t1-weighted images and slightly hyperintensity in t2-weighted images, consistent with a synovial cyst
Remission Characteristics
A total of 9 months after the onset of symptoms, the patient reported a nearly complete absence of pain. A follow-up MRI performed 12 months later showed overgrowth of facets without canal steno- sis at l5–s1. The previously observed cyst was nearly no longer present.
Treatment & Mechanisms
Proposed Remission Mechanisms
Alleviated external pressures on joint surfaces and relieved spinal pressure, facilitated the gradual reabsorb- tion and reduction in cyst size over time.
Clinical Treatment
Painkillers
Non-Clinical Treatment
Physical therapy