A cyst is a closed sac having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. Synovial cysts develop in the facet joints of the lumbar spine as a result of degeneration. If large enough, these sacs can cause spinal stenosis. Which is a narrowing of the spinal canal that places pressure on spinal nerves and causes a dull, aching pain in the lower back when standing or walking, radicular symptoms with pain, numbness, and weakness extending into the legs, and if severe, loss of coordination and bowel and bladder incontinence.
The synovium is a thin film of tissue that produces fluid to help lubricate the joints. When facet joints in the lumbar spine begin to degenerate, this fluid may build up in an attempt to protect the joint. In some patients, small amounts of the fluid escape from the joint capsule but remain within the synovium, creating a sac-like protrusion.
Many older patients have synovial cysts in their lumbar spines but have no symptoms. Occasionally, however, these cysts can cause pain in the lower back that travels down the legs. The pain is relieved when sitting as this position widens the spinal canal and relieves pressure on the nerves. A synovial cyst can be seen on an MRI.
- Steroidal anti-inflammatory medications (NSAIDs) include common over-the-counter drugs such as aspirin or ibuprofen.
- Epidural steroid injections which are often combined with an anesthetic and injected into the area around the irritated spinal nerves that are causing the pain. This area is called the epidural space, and it surrounds the sheath-like protective membrane, or dura, that covers the spinal nerves and nerve roots. Steroids reduce nerve irritation by inhibiting production of the proteins that cause inflammation. The anesthetic blocks nerve conduction in the area where it’s applied, numbing the sensation of pain.
- In severe cases, synovial cysts can be removed using the METRx system, which is an innovative series of dilators and tubes designed to be used during minimally invasive surgery in conjunction with an endoscope or microscope. Removal of these cysts using minimally invasive techniques minimizes soft-tissue trauma and blood loss and will also result in a smaller incision. If the synovial cysts are associated with spondylolisthesis this technique can minimize the risk of progressive instability and the need for fusion.
A spinal tumor is the name for a swelling or lesion formed by an abnormal growth of cells in or surrounding the spinal cord. A tumor is not synonymous with cancer. A tumor can be benign, pre-malignant, or malignant, whereas cancer is by definition malignant. Any type of tumor may occur in the spine, including leukemia, lymphoma, and myeloma.
A small number of spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other gliomas. Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metastasize) are called secondary spinal tumors. Tumors may spread to the spine from the breast, prostate, lung, and other areas. The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with certain inherited gene mutations.
Spinal tumors can occur:
- Inside the spinal cord (intramedullary)
- In the membranes (meninges) covering the spinal cord (extramedullary – intradural)
- Between the meninges and bones of the spine (extradural)
- tumors may extend from other locations. Most spinal tumors are extradural
As it grows, the tumor can affect the blood vessels, bones of the spine, meninges, nerve roots, and spinal cord cells. Tumors in the spinal cord usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord may grow for a long time before causing nerve damage.
Symptoms may include:
- Abnormal sensations or loss of sensation, especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg)
- Back pain that gets worse over time, is often in the middle or lower back, is usually severe and not relieved by pain medicine, gets worse when lying down or straining (such as during a cough or sneeze), and may extend to the hips or legs
- Cold sensation of the legs, cool fingers or hands, or coolness of other areas
- Fecal incontinence
- Inability to keep from leaking urine (urinary incontinence)
- Muscle contractions, twitches, or spasms
- Muscle function loss
- Muscle weakness (decreased muscle strength) in the legs that causes falls, makes walking difficult, and may get worse (progressive)
A nervous system (neurological) examination may help pinpoint the location of the tumor. The health care provider may also find the following during an exam:
- Abnormal reflexes
- Increased muscle tone
- Loss of pain and temperature sensation
- Muscle weakness
- Tenderness in the spine
These tests may confirm spinal tumor:
- Cerebrospinal fluid (CSF) examination
- Cytology (cell studies) of CSF
- Spinal CT
- Spine MRI
- Spine x-ray
The goal of treatment is to reduce or prevent nerve damage caused by pressure on compression of the spinal cord. Treatment should be given quickly. The more quickly symptoms develop; the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be thoroughly investigated. Treatments include:
- Corticosteroids (dexamethasone) may be given to reduce inflammation and swelling around the spinal cord.
- Emergency surgery may be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, part of the tumor may be removed to relieve pressure on the spinal cord.
- Radiation therapy may be used with, or instead of, surgery.
- Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended in some cases, depending on the type of tumor.
- Physical therapy may be needed to improve muscle strength and the ability to function independently.
If you have an issues with cysts or tumors contact Dr. Kushwaha. He is a board certified Orthopedic Surgeon specializing in Spine Surgery. To learn more about his procedures or to schedule an appointment please call us at (713) 587-6263.