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Long-term pain relief following percutaneous steroid treatment of spinal synovial cysts: a population-based cohort study
  1. Alexander Fletcher-Sandersjöö1,2,
  2. Erik Edström1,2,
  3. Åsa Kuntze Söderqvist2,3,
  4. Per Grane3,
  5. Adrian Elmi-Terander1,2
  1. 1Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
  2. 2Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
  3. 3Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Dr Alexander Fletcher-Sandersjöö, Department of Neurosurgery, Karolinska University Hospital, Stockholm 17176, Sweden; alexander.sandersjoo{at}


Background Spinal synovial cysts are fluid-filled sacs that develop after facet joint degeneration and can give rise to radicular pain. If resistant to conservative management, surgical decompression or percutaneous steroid treatment is usually recommended. Percutaneous treatment minimizes the risk of spinal instability, but it has been uncertain whether it provides any long-term symptom relief. Moreover, it is unclear whether cyst rupture provides any added benefit.

Objective To assess long-term pain relief in patients with spinal synovial cysts who were treated with percutaneous intra-articular steroid treatment without cyst rupture.

Methods A population-based cohort-study was conducted of all patients with symptomatic synovial cysts who were treated with percutaneous intra-articular steroid treatment without cyst rupture between 1995 and 2014.

Results Thirty-eight patients were included. All patients had variations of lower back and radicular pain. Intra-articular access was achieved in 35 (92%) patients, and there were no treatment-related complications. At short-term assessment, 30 (79%) had pain relief. During the median follow-up of 11 years, 12 (32%) patients showed sustained pain relief without the need for decompressive surgery.

Conclusions Percutaneous intra-articular steroid treatment without cyst rupture is a safe treatment for symptomatic spinal synovial cysts and eliminates the need for surgery in a substantial number of patients. It can be suggested as a first line of treatment.

  • spine
  • spinal cord
  • degenerative
  • lumbosacral
  • spinal nerve

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  • Contributors Study design: All authors. Data collection: AF-S, PG. Statistical analysis: AF-S. Data interpretation: all authors. Draft of manuscript: AF-S, ÅKS. Revision and approval of final manuscript: all authors. Study supervision: AE-T.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the regional ethical review board in Stockholm, Sweden (Dnr: 2016/1708-31/4) who waived the need for informed consent. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The dataset used and/or analyzed during the current study is available from the corresponding author on reasonable request.

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