Concomitant Spontaneous Resolution and Appearance of a New Contralateral Lumbar Synovial Cyst: Case Report

Background: Intraspinal synovial cysts are an uncommon cause of radicular pain, but are reported with increasing frequency. In most instances they develop secondary either to degenerated facet joints or trauma. Surgery is the effective in case of failure of the conservative management. Spontaneous resolution of synovial cyst has been rarely described.

Aim: We report a case of spontaneous resolution of L4/5 synovial cyst concomitant with appearance of a new contralateral cyst.

Results: We report the case of a 48-year-old woman with a lumbar right facet joint synovial cyst at L4/5 diagnosed with magnetic resonance imaging (MRI) and manifested with significant right-sided radicular pain with L5 distribution. The surgical treatment of the cyst was initially deemed indicated, but as patient’s symptoms significantly improved, she continued being conservatively managed. She presented 8 months later with resolution of the right-sided radicular pain and new left-sided sciatic pain; a repeated MRI of the lumbar spine showed evidence of a new right-sided facet joint cyst at L4/5 and complete resolution of the right facet joint synovial cyst.

Conclusion: Our case is unique in relation to the fact that following the spontaneous resolution of the facet joint synovial cyst on one side, a contralateral cyst was diagnosed. This clearly demonstrates that facet joint synovial cysts are a dynamic entity and their formation and resolution should be considered as result of dynamic inflammatory and mechanical events. The management of facet joint synovial cysts is still controversial and surgical treatment should be reserved in case of failure of the conservative management.

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