Telemed waiting room
Schedule an Appointment

Synovial Cysts

Spinal Synovial Cysts

Causes, Symptoms & Treatment Options

A synovial cyst is a fluid-filled sac located along the spine. Most synovial cysts occur in the lumbar spine (lower spine above the tailbone) but may occur in other spine regions, as well. Spinal synovial cysts usually affect patients over 50 years of age, and symptoms may include pain in the low back, legs, sciatica or neck. Patients may also experience leg cramps, numbness or tingling in the legs, and increased pain while standing.

Synovial cysts do not always cause symptoms, and they are not cancerous or deadly. In some cases, they put pressure on the spine, leading to spine conditions like stenosis (narrowing of the spinal canal).

What Are Synovial Joints?

Synovial joints are the most common joints in the body. They allow for full range of motion and are found in our wrists, elbows, shoulders, knees and spine. All human joints are covered with a capsule that helps hold the bones in place. The capsule is like an envelope that contains layered fibrous tissue and synovial fluid, which lubricates the joint and helps it move freely through its normal range of motion. As we perform everyday activities like bending our arms and legs or turning our head and neck, these tissues glide back and forth smoothly.

Think of the synovial joint process like a door hinge. As long as the metal on the hinge is smooth and well-oiled, it glides back and forth effortlessly. As you age, the joints are used repetitively, and the joint tissues degenerate over time. Synovial fluid also begins to dry up, and pollutants like alcohol and nicotine can accelerate the drying and degeneration processes. Eventually, a well-oiled door hinge becomes creaky, stiff and hard to use.

Development of Synovial Cysts in the Spine

The spine has 33 bones and the most joints in the body. These joints move back and forth against one another all day long, every day. Because of this, the spine is one of the most common places for synovial cysts to develop. As the supporting structures around a spinal joint degenerate or suffer trauma, the joint becomes loose. This excess movement leads to increased friction of the synovial tissue and accelerated synovial fluid production, both of which contribute to development of spinal synovial cysts.

Treatment Options for Spinal Synovial Cysts

Synovial cysts are benign (non-cancerous). If they remain small, they will not cause pain and do not require treatment. When a synovial cyst becomes larger, though, it may press against lumbar spinal nerves and cause severe pain that requires treatment.

Oral Pain Medication

Oral Pain Medication

One treatment approach is oral pain management. Potential pitfalls of this treatment include physical side effects and the potential for longer-term drug dependence, especially in patients with a history of chemical dependency.

Injections for Synovial Cysts

Pain management can also be achieved with various types of low-back injections, but unfortunately these treatments only provide temporary relief. Additional doses may be required over time.

Draining Synovial Cysts

Draining Synovial Cysts

Another method of treating spinal synovial cysts is to drain the cyst using a small needle. This reduces the cyst size and relieves nerve pressure, but the needle may damage nerves near the spinal canal. The needle puncture may also cause excessive scar tissue, which can complicate cyst surgery if it is required at some point.

The main issue with treating spinal synovial cysts with pain management and needle aspiration is that these interventions don’t solve the main problems:

  • Continued presence of the cyst in the joint
  • Likelihood of cyst reoccurrence
  • Spinal joint instability, which caused the cyst’s initial formation

The Most Effective Treatment of Spinal Synovial Cysts

According to experienced neurosurgeon Dr. Mark McLaughlin, MD, the best option for treating spinal synovial cysts is to remove them using minimally invasive or mini-open surgical techniques. These approaches have high success rates for relieving pain and permanently solving cyst problems.

Medical research supports Dr. McLaughlin’s point of view. A 2012 study published in Surgical Neurology International stated, “After a thorough review of the literature, it appears that the treatment with the best outcome for patients with synovial cysts is cyst removal utilizing surgical decompression.”1 This study also pointed out that the success rate for surgical cyst decompression is greater than 90 percent.

A study that appeared in Neurosurgery Focus in 2006 evaluated 19 patients who had spinal synovial cysts surgically removed. The study concluded, “Synovial cysts can be safely and effectively treated using minimally invasive surgical techniques.” Of the patients involved in this research, 95 percent reported either excellent or good results.2

Along with surgical removal of the cyst, it’s important for surgeons to assess abnormal synovial joint movement with x-rays and other diagnostics. In cases where there is clear joint instability demonstrated by abnormal motion or slippage of the spine, a spinal fusion procedure must be performed to stabilize the joint and prevent the scarring that causes reoccurring cysts.

Synovial Cyst Removal: Procedure & Advantages

To perform a minimally invasive cyst-removal procedure, the surgeon makes a small incision (about the size of a quarter) in the patient’s lower back. Inserting a thin, telescope-like instrument called a retractor, he or she then uses an endoscope or microscope to perform the operation. A tiny video camera attached to the tip of the endoscope or an operating microscope sends images from inside the body to a screen in the operating room. Specialized, precise surgical instruments are inserted through tiny tubes and used to remove the cyst.

Minimally invasive procedures have many advantages, including shorter operating times, less damage to soft tissue, less blood loss during surgery, shorter hospital stays, faster recovery with less pain, and much smaller surgical scars.

Synovial Cyst Treatment at Princeton Brain, Spine & Sports Medicine

Princeton Brain, Spine & Sports Medicine is an internationally known neurosurgical practice offering advanced, scientifically proven techniques. Our team of surgeons has performed hundreds of minimally invasive and mini-open procedures to remove spinal synovial cysts with successful outcomes. Our physicians are also highly trained in spinal instrumentation and fusion procedures for patients requiring supplemental stabilization for synovial cysts related to instability of the spine.

To request a consultation for synovial cysts or to inquire about insurance coverage, call 609.921.9001 in New Jersey or 215.741.3141 in Pennsylvania. With seven campuses throughout the region, PBSSM makes it convenient to schedule an appointment at the location nearest you. For more information about our NJ & PA campuses, click here.


  1. Epstein N, Baisden J. The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surgical Neurology International. 2012; 3(Suppl 3): S157-S166.
  2. Sehati N, Khoo L, Holly L. Treatment of Lumbar Synovial Cysts Using Minimally Invasive Surgical Techniques. Neurosurgery Focus. 2006; 20(3): E2.

Request an Appointment Submit an appointment request online today. Our patient advocates will be in touch promptly to meet your scheduling needs. Request An Appointment

New Patients Existing Patients