From the Guidelines
Spinal cysts occur due to several underlying causes, with the most common being degenerative changes in the spine that happen with aging, as well as infections such as neurocysticercosis, which can cause cystic lesions in the spine 1. These cysts typically form when the facet joints or intervertebral discs deteriorate, causing fluid-filled sacs to develop.
- Synovial cysts arise from the lining of facet joints when these joints experience arthritic changes,
- while Tarlov cysts form around nerve roots, often due to increased cerebrospinal fluid pressure. Trauma to the spine can trigger cyst formation as part of the healing process. Some cysts develop congenitally, meaning people are born with them, particularly dermoid and epidermoid cysts that contain skin elements. Certain inflammatory conditions like rheumatoid arthritis can contribute to cyst formation through joint inflammation. Rarely, tumors or infections may present as cystic lesions in the spine. Most spinal cysts are benign and may not require treatment unless they cause symptoms like pain, numbness, or weakness by compressing nearby nerves or the spinal cord. Treatment options range from observation for asymptomatic cysts to surgical removal for those causing significant problems, with the specific approach depending on the type and location of the cyst, as well as the patient's overall health and symptoms 1. In cases of neurocysticercosis, treatment may involve antiparasitic medication, corticosteroids, and/or surgical intervention, depending on the severity and location of the infection 1. It is essential to note that the management of spinal cysts should prioritize minimizing morbidity, mortality, and improving quality of life, with treatment decisions made on a case-by-case basis, taking into account the latest clinical guidelines and evidence-based practices 1.
From the Research
Causes of Cysts in the Spine
- Cysts in the spine, also known as spinal synovial cysts, are a known cause of back pain and radiculopathy 2, 3.
- These cysts are thought to occur due to the disruption of the facet joints, often with accompanying instability, and can compromise both the cephalad and caudad nerve roots 3.
- The exact cause of spinal synovial cysts is not fully understood, but they are believed to be related to degenerative changes in the spine, such as facet joint degeneration 4.
- Spinal synovial cysts can occur in any region of the spine, but they are most commonly found in the lumbar region 5, 6.
Risk Factors
- Degenerative changes in the spine, such as facet joint degeneration, are thought to be a risk factor for the development of spinal synovial cysts 4.
- Instability of the spine, such as spondylolisthesis, may also contribute to the formation of spinal synovial cysts 2.
- Age may also be a risk factor, as spinal synovial cysts are more commonly found in older adults 6.
Pathophysiology
- Spinal synovial cysts are thought to occur when the synovial membrane of the facet joint becomes disrupted, allowing fluid to accumulate and form a cyst 3.
- The cyst can then compress nearby nerve roots, causing pain, numbness, and tingling 2, 3.
- The pathophysiology of spinal synovial cysts is complex and may involve a combination of mechanical and inflammatory factors 5.