Individuals that have gone through a back injury may develop a synovial spinal cyst as a way to protect the spine that could cause pain symptoms and sensations. Can knowing the signs help healthcare providers develop a thorough treatment plan to relieve pain, prevent worsening of the condition and other spinal conditions?
Spinal Synovial Cysts
Spinal synovial cysts are benign fluid-filled sacs that develop in the spine’s joints. They form because of spinal degeneration or injury. The cysts can form anywhere in the spine, but most occur in the lumbar region/lower back. They typically develop in the facet joints or junctions that keep the vertebrae/spinal bones interlocked.
Symptoms
In most cases, synovial cysts don’t cause symptoms. However, the doctor or specialist will want to monitor for signs of degenerative disc disease, spinal stenosis, or cauda equina syndrome. When symptoms do present, they typically cause radiculopathy or nerve compression, which can cause back pain, weakness, numbness, and radiating pain caused by the irritation. The severity of symptoms depends on the size and location of the cyst. Synovial cysts can affect one side of the spine or both and can form at one spinal segment or at multiple levels.
Effects Can Include
Radiculopathy symptoms can develop if the cyst or inflammation caused by the cyst comes into contact with a spinal nerve root. This can cause sciatica, weakness, numbness, or difficulty controlling certain muscles.
Neurogenic claudication/impingement and inflammation of spinal nerves can cause cramping, pain, and/or tingling in the lower back, legs, hips, and buttocks. (Martin J. Wilby et al., 2009)
If the spinal cord is involved, it may cause myelopathy/severe spinal cord compression that can cause numbness, weakness, and balance problems. (Dong Shin Kim et al., 2014)
Symptoms related to cauda equina, including bowel and/or bladder problems, leg weakness, and saddle anesthesia/loss of sensation in the thighs, buttocks, and perineum, can present but are rare, as are synovial cysts in the middle back and neck. If thoracic and cervical synovial cysts develop, they can cause symptoms like numbness, tingling, pain, or weakness in the affected area.
Causes
Spinal synovial cysts are generally caused by degenerative changes like osteoarthritis that develop in a joint over time. With regular wear and tear, facet joint cartilage/the material in a joint that provides protection, a smooth surface, friction reduction, and shock absorption begins to waste away. As the process continues, the synovium can form a cyst.
Traumas, large and small, have inflammatory and degenerative effects on joints that can result in the formation of a cyst.
Around a third of individuals who have a spinal synovial cyst also have spondylolisthesis.
This condition is when a vertebrae slips out of place or out of alignment onto the vertebra underneath.
It is a sign of spinal instability.
Instability can occur in any spine area, but L4-5 are the most common levels.
This segment of the spine takes most of the upper body weight.
Epidural corticosteroid injections can reduce inflammation and could be an option to relieve pain.
Patients are recommended to receive no more than three injections per year.
Surgical Options
For severe or persistent cases, a doctor may recommend decompression surgery to remove the cyst and surrounding bone to relieve pressure on the nerve root. Surgical options range from minimally invasive endoscopic procedures to larger, open surgeries. The best surgical option varies based on the severity of the situation and whether associated disorders are present. Surgical options include:
Laminectomy – Removal of the bony structure that protects and covers the spinal canal/lamina.
Hemilaminectomy – A modified laminectomy where a smaller portion of the lamina is removed.
Facetectomy – The removal of part of the affected facet joint where the synovial cyst is located, usually following a laminectomy or hemilaminectomy.
Fusionof the facet joints and vertebra – Decreases vertebral mobility in the injured area.
Most individuals experience immediate pain relief following a laminectomy or hemilaminectomy.
Fusion can take six to nine months to heal completely.
If surgery is performed without fusion where the cyst originated, the pain could return, and another cyst could form within two years.
Surgery Complications include infection, bleeding, and injury to the spinal cord or nerve root.
How I Gained My Mobility Back With Chiropractic
References
Wilby, M. J., Fraser, R. D., Vernon-Roberts, B., & Moore, R. J. (2009). The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine, 34(23), 2518–2524. https://doi.org/10.1097/BRS.0b013e3181b22bd0
Kim, D. S., Yang, J. S., Cho, Y. J., & Kang, S. H. (2014). Acute myelopathy caused by a cervical synovial cyst. Journal of Korean Neurosurgical Society, 56(1), 55–57. https://doi.org/10.3340/jkns.2014.56.1.55
Epstein, N. E., & Baisden, J. (2012). The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surgical neurology international, 3(Suppl 3), S157–S166. https://doi.org/10.4103/2152-7806.98576
A spinal tumor is an uncommon cause of back pain. They rarely occur and can be either benign or malignant. Some tumors can metastasize or spread out to other parts of the body. This is done through the arteries, veins, the lymphatic system, and directly depending on the location.
A tumor of the breast, prostate, lung, and kidney can metastasize into the spine increasing the risk of spinal compression. This could lead to neurologic dysfunction and paralysis. Many individuals present with back pain as the key symptom. The pain can worsen at night and have no relation to certain activities. Other symptoms include:
Aneurysmal bone cysts or ABCs usually cause pain and swelling. They can be large and typically affect children and adolescents.
Eosinophilic Granuloma
This type of spinal tumor usually develops in the vertebral bodies of children and adolescents. If the tumor is systemic it is called histiocytosis X. However, these tumors rarely lead to vertebral collapse and paraparesis. And also rarely but on occasion, they can heal spontaneously on their own.
Giant Cell Tumor
This type of spinal tumor affects children, adolescents, and young adults. They can be found around the cervical, thoracic, or lumbar segments of the spine, but are more common in the sacrum region.
Hemangioma
Hemangiomas develop most often in the thoracic or middle back. These affect adults and are known to be vascular masses that are progressive and can cause vertebral collapse and slight paralysis.
Osteoblastoma
These tumors can be large, aggressive, and painful. They affect children and adolescents. They can sometimes cause spinal deformity and paralysis.
Osteochondroma
This a slow-growing spinal tumor that comes from cartilage and usually affects adolescents. It is uncommon and typically found in the posterior or rear of the spine.
Osteoid Osteoma
A very small bone tumor that is less than 2 cm. It typically affects adolescents. It is known to cause night pain and can result in spinal deformity.
Malignant – Cancerous
Chordoma
This is typically seen in adults. About 50% involves the sacrum, but it can affect other regions of the spine. These tumors usually require aggressive treatment.
Chondrosarcoma
This tumor affects the spinal cartilage in middle-aged adults. It grows slowly but can be dangerous. Aggressive medical treatment is required.
Ewing/Ewing’s Sarcoma
An aggressive spinal tumor that affects adolescents and young adults. In certain cases, it can metastasize.
Lymphoma
Lymphoma can present in one or more vertebral bodies. It affects middle-aged and older adults. The lymphatic system can sometimes be involved.
Osteosarcoma
This is a bone cancer that develops in adolescents and middle-aged adults. It can metastasize and require aggressive medical treatment.
Plasmacytoma
Plasmacytoma typically presents in middle-aged and older adults. They usually present in the pedicle and vertebral body and can cause paraparesis.
Back pain does not always mean that there is a tumor present. But if back pain does not resolve or if neurologic symptom/s are experienced, early medical intervention/treatment is definitely warranted. A primary spinal tumor or those that originate in the spine are uncommon. However, metastatic spinal tumors are.
Spinal tumors are not a common cause of back pain, but if there is pain whose cause cannot be identified and continues with no change, it could be an indicator of something more going on. Persistent pain, specifically if it is not brought on with activity or if it worsens at night, could be a potential red flag needing further examination by x-ray, CT, or MRI. Metastatic tumors, that spread from another area such as the lung, breast, colon, and prostate are a more common type of spinal tumor. Individuals with a family history of cancer that develop back pain out of nowhere should be examined to exclude a spinal tumor.
Neck and Low Back Pain Treatment
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Osteoid osteoma refers to a benign tumor/s that can grow on the spine as well as other areas of the body. They are not cancerous, but they can cause pain and abnormal curvature of the spine. It can begin as a small benign spinal tumor that can cause pain, especially at night. They do respond well to over-the-counter pain relievers and can go away on its own. However, if symptoms are unmanageable, other treatments are available.
Osteoid Osteoma
Osteoid means a type of tissue that eventually turns to bone. Osteoma means a type of tumor unique to bones. They are small typical size is less than one inch across. These growths represent around ten percent of all benign bone tumors, with one percent representing spinal tumors.
They can appear and also affect the bones of the arms, hands, fingers, ankles, or feet. They are discovered on the spine around fifteen percent of the time. Osteoid osteomas of the spine affect the posterior, or back area of the vertebrae rather than the anterior, or front region. However, any area of the spine could be affected. But they are most common in the low back.
60% affect the lumbar spine lower back
27% affect the cervical spine or neck region
12% affects the thoracic spine or middle back
Risks
Osteoid osteoma is not cancerous and will not spread out to the various organ systems the way malignant cancer does. It can be discomforting, painful, and could have to be removed. There are some risks associated with osteoid osteomas including:
Scoliosis
It could provoke muscle spasms of the erector spinae. These are the muscles that support the spine and could lead to scoliosis. The spine has a natural curvature. Scoliosis generates an S or C shaped curve to the left, right, or both ways affecting function and mobility. This type is more likely to contribute to the left or right curve of the spine affecting the lower back.
Incorrect diagnosis
Because osteoid osteoma can cause scoliosis, sometimes a doctor will focus on treating the abnormal curve instead of the osteoma.
Nerve root compression
Most individuals do not pose a risk for nerve root compression. But there is a risk if the growth begins to press against the spinal cord, as it can interfere with nerve function. This can lead to spreading/radiating pain and sciatica.
Causes
The causes of osteoid osteoma are not completely understood. What is known is that men are three times more likely to be diagnosed than women. Young people also pose a risk at development. It can develop at any age, but around eighty percent are diagnosed in individuals under 30 years of age. The core of an osteoma is a growth called a nidus. Inside are growing tumor cells, blood vessels, along with cells that progress to bone. A bony shell encapsulates the whole thing.
Signs and Symptoms
Osteoid osteomas usually cause a dull ache at the site of the tumor along with muscle spasms. The pain often gets worse at night. It can be relieved with non-steroidal anti-inflammatory medications like ibuprofen and aspirin. The pain can also be sharp, and occur during the day, worsening with activity and sometimes progressing to severe pain over time. In some cases, however, there are no symptoms.
Diagnosis
Doctors usually notice painful or swollen soft tissue around the tumor during a physical examination. There could be a lump, but this is rare. Imaging tests like an X-ray or a CT scan will be ordered. An x-ray can show the bone thickening, but a CT scan will show the nidus clearly as a dark center surrounded by white cortical bone. Sometimes a CT and MRI imaging scan is used in conjunction to diagnose osteoid osteomas. In some cases, a biopsy could be needed. This is taking a tissue sample and sending it to a lab to be examined under a microscope. However, this is rarely needed.
Treatment
Nonsurgical
Non-steroidal anti-inflammatory medications can be effective relieving symptoms. If it can be controlled with just medication, then this could be the only treatment necessary. Some patients do well trying a different painkiller if the preferred medication no longer works. This needs to be discussed with your doctor, as chronic medication use is associated with issues like ulcers, kidney damage, and concerns about opioid addiction. When this approach is taken, the pain lasts for about three years with the lesion breaking down in five to seven years.
Surgical
If the pain cannot be controlled or the osteoma develops to scoliosis, surgery could be the next step. Most spinal osteomas are surgically removed with open curettage. It is a small incision. The nidus is scooped/scraped out and the cavity walls are removed with a motorized burr. Often a small amount of bone graft material is used to fill in the area. Unfortunately, surgical resection means having to stay at the hospital. Recovery time can be painful.
Radiofrequency ablation
For osteomas that affect the bones other than the spine, radiofrequency ablation. It is a minimally invasive outpatient procedure with a short recovery time. During the procedure, radiofrequency waves generate heat within the nidus around six minutes destroying the tumor. Surgeons use CT scans to precisely target the tumor. The procedure takes one to two hours and afterward, the patient waits in a recovery room for up to four hours.
However, radiofrequency ablation is not as commonly used to treat spinal osteomas. This comes from the risk of thermal nerve damage. The needle tip can reach 194 degrees Fahrenheit, which is more than enough to damage the nerves. Candidates for radiofrequency ablation are usually young patients with no history of neurological problems. Osteoid osteoma is not as scary as it sounds, remember the best defense is a knowledgeable doctor and chiropractor. If back pain is presenting, do not wait to get treatment. There is a spine specialist who can help.
Chronic Pain Chiropractic Relief
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Dr. Alex Jimenez has a great therapy for cervical sprains. He is great with his hands; he has been able to relieve a lot of headaches and a lot of cervical sprains with the special techniques that he has.
Sandra Rubio
Vertigo is the sensation of spinning or a rocking whenever you’re still. It tends to last for hours even days. Medically, it is distinct from dizziness since it involves the feeling of motion. Vertigo is a health issue affecting the internal ear, particularly in the semicircular canals. These structures line with cells within the inner ear that are responsible for providing feedback on our position, and they act like a gyroscope for your own body.
Causes for Vertigo
Various causes can cause vertigo. The reason may be central or peripheral. While peripheral problems�are due to a health issue in the inner ear, central problems can�occur in the brain or spinal cord. Small crystals within the ear, known as otoconia, can also become loose and lead to irritation in a health issue called benign paroxysmal positional vertigo or BPPV. A�buildup in the inner ear can also lead to vertigo. Headaches, head injuries, strokes, tumors, and multiple sclerosis may also cause vertigo.
Head injuries can increase the risk factor for developing vertigo. Additionally, drugs and/or medications like aspirin, blood pressure prescriptions, and even antidepressants have been found to cause vertigo. For some people, vertigo�is caused by alcohol consumption.
Diagnosis and Treatment for Vertigo
To diagnose vertigo, a health professional will need a full record of your signs and symptoms, including recent illnesses, previous medical problems, and�use of drugs and/or medications. Afterward, a physical exam is performed. For vertigo, these often feature a neurological examination to examine brain function and determine if it is peripheral or central.
The health issue may pinpoint signs or symptoms of abnormal eye movement. The Dix-Hallpike test or the roll test may be done to determine this diagnosis. The evaluation repositions the head and tracks symptoms. The head is quickly transferred from side to side. An MRI or a CT scan can also help exclude structural issues. Electronystagmography may additionally be carried out to diagnose the health issue. A vertigo diagnosis is essential before following up with the best treatment.
The most effective treatments in the event of peripheral vertigo include partial repositioning movements. It’s called the canalith repositioning procedure or the Epley maneuver. Particular head movements are performed to move the crystals back into place. Cawthorne head exercises may also be performed to achieve this in a series of eye and head movements. These improve vertigo and contribute to the decreased sensitivity of the nerves. However, this needs to be done on a regular basis for optimum results. A qualified and experienced healthcare professional, such as a chiropractor, can perform these types of treatments.
Furthermore,�chiropractic care can help correct any spinal misalignments, or subluxations, which may be contributing to vertigo. Chiropractic care is a safe and effective alternative treatment option which focuses on the treatment of a variety of injuries and conditions associated with the musculoskeletal and nervous system. A chiropractor may also offer lifestyle modifications to help speed up the recovery process. Although some drugs and/or medications, such as�Meclizine, can be used to manage vertigo, keep in mind that these may only provide temporary relief.
Vertigo may occur due to health issues in the inner ear as well as due to disturbances in the pathways of the nervous system. Regardless of the cause, the persistent sensation of dizziness, followed by other symptoms, can ultimately impact an individual’s quality of life. Many healthcare professionals like chiropractors can help treat symptoms of vertigo.
Dr. Alex Jimenez D.C., C.C.S.T.
Prognosis for Vertigo
Most patients with peripheral vertigo can find substantial relief with treatment. It’s been suggested that the Epley maneuver in cases of BPPV cures as many as 90 percent of affected patients. It is unlikely that vertigo will persist past a few days, although there is a 15 percent recurrence of BPPV in the first year after an episode. Tests for any structural�problems of the brain, spinal cord, or ear may be necessary if vertigo continues.
If you are feeling dizzy with an awareness of motion, you might have vertigo. Ensure that your world stops spinning with the help of a certified and experienced chiropractor. Many trained in the Epley maneuver and the Cawthorne head exercises for vertigo. A chiropractor can even offer you instruction on how to do these exercises. Contact a healthcare professional to complete an analysis of your symptoms and follow up with treatment.� The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
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