What are spinal cysts?

Cysts are cavities that form in a tissue and are surrounded by a membrane or wall. A cyst can consist of one or more chambers. The inside is filled with tissue fluid, spinal fluid, blood or a pulpy content. Cysts can arise from different causes throughout the body and most of them are harmless. However, depending on the cause, the organ, how large they are, where they are positioned and how they behave, the structures can also cause problems. For example, when pressing the surrounding structures in the spinal canal they will cause pain. This creates the typical symptoms of the so-called root compression syndrome. Like a herniated disc, a cyst is an extra piece of tissue in the spinal canal. In the spinal canal, there are the nerve roots that can be pressed by cysts.

There are two major types of cysts on the spine called Tarlov-Cyst and Synovial Cysts (joint cyst, ganglion cyst, and pseudocyst). In most cases, they are joint cysts, also called ganglia. Often, at the same level of the ganglion cyst, other degenerative changes such as wear, spinal canal stenosis or spondylolisthesis can be seen.

Cysts have a long history, that is to say they were first recognized and described in 1885 by the British surgeon William Morrant Baker (1839-1896). In 1950, a facet joint cyst was first described as the cause of a nerve root compression.

How common are cysts in the spinal canal?

Cysts are less common than narrowing of the lumbar spine (spinal canal stenosis) or disc herniation, but are being diagnosed more and more often thanks to more refined MRIs (magnetic resonance imaging). Studies show that 1% synovial cysts are detectable in the MRI images of patients. The synovial cysts occur mainly in the lumbar spine - 90 %. Of this, in turn, account for the amount of 4/5. Lumbar vertebra 70%. The affected persons are predominantly between 58 and 67 years old, and they affect slightly more women than men.

Why do cysts develop?

Cysts can be innate and acquired. Congenital ones are formed as a consequence of defects in the development of embryonic tissue. The acquired cyst develops against the background of inflammatory and degenerative diseases of the spine, as well as injuries and strains. There are still many questions about the formation of joint cysts which means that their development is not fully understood. Science assumes that a worn-out vertebral joint favors cell proliferation of its joint capsule, which then bulges like a balloon – like a cyst - into the spinal canal and presses on nerve roots. Thus, the degeneration occurs in the foreground: Overloading and inflammation of the small joints can lead to a fracture of the joint capsule and thereby develop a cyst in the spinal canal. In case of syringomyelia, there would be a cystic in the central canal of the spinal cord.

Symptoms - radiating persistent pain

Ganglion cysts can spread in all directions within the spinal canal. Outward synovial cysts are mostly symptomless. It is quite different with the inward cysts that grow in the spinal canal. Already from a size of a few millimeters, joint cysts produce symptoms similar to a herniated disc. However, in contrast to classic spinal stenosis, most patients do not complain of back pain, but almost exclusively of radiating, tormenting, and persistent nerve pain, preferably in the leg (depending on which nerve root is pressed and compressed). In fact, the symptoms can be felt not only when moving, but also when resting. Partial symptoms include numbness or even muscle paralysis. Especially in older, partially calcified cysts, the symptoms begin gradually to increase their severity. Rarely, there is an improvement in the symptoms, so that in most cases an operation is inevitable.

Diagnosis of a cysts - anamnesis is always at first

The diagnosis always begins with the appointment with the doctor. Of course, pain comes and goes and sometimes you do not need to take it seriously. In most cases, the person concerned has a sense of whether it is necessary to consult a doctor. But there are mostly indications that clearly signal: to the doctor. The second step is the anamnesis interview in which you explain to the doctor the reasons for your visit and describe the complaints. Normally he then starts the diagnosis with instrumental methods that could help him to locate the cyst. One of these methods will certainly not be an X-ray examination because they cannot detect a cyst like the magnetic resonance imaging does. It shows the changes in the spine (narrow spinal canal, herniated disc, cysts, tumors, hemorrhages, inflammation) and provides accurate localization and expansion of the joint cysts. If you live with a pacemaker, the doctor will choose a computed tomography (CT) scanner because MRI is not feasible in pacemaker patients.

Treatment - how can the problem with the cyst be solved?

Whether and how a cyst must be treated, the doctor decides individually on a case-by-case basis. Of course it would be ideally if you could decide together. First of all, you should answer this question: Should only the symptoms be alleviated or should the problem be solved? To alleviate the symptoms, the doctor can prescribe painkiller and physiotherapy or you will receive targeted cortisone injections that may be free you from your complaints for a few weeks, but in this case the cause would not be solved. In some cases there may be spontaneous shrinkage of the synovial cyst, but this is extremely rare. Furthermore, an emptied cyst fills up with liquid again relatively quickly and then presses again on the surrounding structures, make the complaints reappear.

The treatment of choice for definitive solution is thus the microsurgical decompression. It leads to faster reduction or complete remedy of the complaints. By the microsurgery on lumbar spine a 3-centimeter long incision is made in the middle of the back and under the control of an operating microscope, the joint cyst is completely detached from the surrounding nerve roots (as adhesions are often found) and removed.
Targeted antibiotic therapy often helps in some cysts caused by parasites.

Prognosis - once the cyst is removed, you will finally be free of pain

Having a cyst is not like having a disease. Only when the cyst expands, make spaces within our bodies, causes pain and other health problems, it becomes a burden for the sufferer. But it is also a warning signal. The important thing is to take this signal seriously. So: go to a doctor (ideally neurosurgeon or orthopedist), when movements and even rest circumstances become an agony. If the joint cyst has been successfully surgically removed from your body, and cannot longer cause you pain, the prognosis for your everyday life is: PAINFREE!

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
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You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

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