Hello,

Thanks for posting your query.

The basic treatment options for symptomatic synovial cysts is pain killers, drainage of cysts, steroid injections to reduce inflammation and surgery when all conservative methods do not provide adequate quality of life.

Chiropractic distraction manipulation is done to reduce the radicular pain and reduction in cyst size on follow up MRIs have also been noted in some cases. It can be used as an initial conservative treatment although the success rate is not very high.

The treatment of synovial cysts has been described in homeopathy also but again the response rate is poor. Short term remission is seen with symptomatic improvement but the cyst size does not regress.

For your reference I have included the literature on treatment of synovial cysts.

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. Since the pain is usually caused by certain positions, changing positions is a reasonable way to deal with the pain as long as a patient can still function adequately.
For exercise, it may be preferable for the patient to try stationary biking instead of walking, because in the seated position the patient should be fairly comfortable.

Injections for Synovial Cysts

There are two types of injections that can be helpful to alleviate the pain: facet injections or epidural injections.
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 joint is then injected with steroid to decrease inflammation.

Epidural steroid injection. The more common injection technique is to inject around the cyst with steroid in the epidural space (an epidural injection). It does not reduce the cyst but can reduce the pain.

Although the mechanism of the pain reduction is not well understood it is thought to be due to a reduction in inflammation. 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.
Still, even though either injection is 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.

Spine Surgery for Synovial Cysts

The most common kinds of spine surgery for synovial cysts can be either a decompression alone or a decompression with a spine fusion.

Microdecompression Spine Surgery

If there is no associated instability with the cyst (e.g. no degenerative spondylolisthesis as seen on flexion/extension x-rays) then a microdecompression of the nerve root with removal of the cyst is reasonable. Basically, this is the same approach as would be used for a microdiscectomy, and is a minimally invasive surgery with a relatively quick recovery.

Decompression with Spine Fusion Surgery

The most reliable treatment method for a synovial cyst is to remove the cyst and then fuse the joint. Fusing the joint stops all the motion at that level, and without any motion the cyst should not regenerate.

This is the most reliable treatment, but it is also the most to go through. It changes the biomechanics in the back because one of the joints will no longer function. The L4-L5 level has the most motion, and fusing it creates more stress on the other non-fused levels of the lower spine. Also, the surgery is more to go through since this is an open procedure, and it takes about six to nine months or more for the fusion to heal.

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Hope this answers your query. I will be glad to answer the follow up queries that you have.

Wishing you good health.

Regards.

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