Treatment Options for Synovial Cysts

There are three main non-surgical treatment options for synovial cysts in the lumbar spine:

• Observation and activity modifications
• General non-surgical treatments for pain relief
• Injections

Treatment for synovial cysts in the lumbar spine is usually the same as for other causes of lumbar spinal stenosis, with the exception that there is often accompanying spinal instability at the same joint that needs to be considered if surgery becomes necessary.

Observation and Activity Modification

If the synovial cyst is not creating a lot of dysfunction or pain in the patient’s daily life, no medical treatments may be necessary.

The cyst itself is benign (not malignant), and the symptoms and level of pain or discomfort may remain stable for many years.

For many people, the pain is usually caused by certain positions so changing these positions is a reasonable way to manage the pain.

Pain Relief for a Synovial Cyst

In conjunction with activity modification, patients will typically find pain relief with a range of possible nonsurgical remedies, including but not limited to:

• Application of ice and/or heat, which is especially effective for activity related pain and discomfort
• Pain medications, including non-steroidal anti-inflammatory medications (such as ibuprofen), acetaminophen, and/or prescription pain medications
• Rest, which is most effective for brief periods, such as a few hours or a day or two
• Physical therapy and exercise, which is similar in approach to exercise for spinal stenosis

For aerobic exercise, it may be preferable to try biking or stationary biking instead of walking, because in the seated position (leaning forward) the patient should be comfortable.  

Alternatively, if you prefer walking it may be a good idea to walk on a treadmill so you can lean forward and support yourself with the handrails. 

Generally, self-care options are the same as lumbar spinal stenosis self-care.

Injections for Synovial Cysts

There are two types of injections that can be helpful to alleviate the pain: facet injections or epidural injections.

Epidural steroid injection
One common injection technique is to inject around the cyst with an anti-inflammatory steroid in the epidural space, known as an epidural injection.

Watch Epidural Steroid Injections Video

It does not reduce the cyst, but it can reduce the pain. It works well about 50% of the time and not so well 50% of the time, and unfortunately, the pain relief tends to be temporary.

Facet injection
The facet joint can be entered with a small needle, and occasionally the cyst can be drained by aspirating it through the joint. Afterwards, the facet injection is done to inject the joint with an anti-inflammatory steroid.

Watch Facet Joint Injections Procedure Video

While injections are not all that reliable in the long run, it is reasonable to try since the only other alternative is surgery. Generally, no more than three injections within a year are recommended.

If injections don't provide sufficient pain relief or return to an acceptable level of function, then surgery may be considered.