Relief From a Cyst Pressing on Your Nerve
A synovial cyst is a small, fluid-filled sac that can press on a nerve and cause leg pain much like a herniated disc. Removing it through a small incision can often correct the problem.
What Is a Spinal Synovial Cyst?
The facet joints at the back of the spine are lined with a thin membrane that makes lubricating fluid. When a facet joint wears down from arthritis, that lining can bulge outward and form a fluid-filled sac called a synovial cyst. Most synovial cysts develop in the lower back, especially at the L4-L5 level, and they’re more common after age 60.
Many cysts cause no symptoms. When a cyst grows into the spinal canal or the opening where a nerve exits, it can press on the nerve and cause sciatica or symptoms of spinal stenosis. Synovial cysts are often linked to facet joint disease and sometimes to spondylolisthesis, a slipping of one vertebra over another.
Who Needs Synovial Cyst Removal?
- Leg pain, numbness or weakness from a cyst pressing on a nerve
- Pain in the buttocks and legs with standing or walking that eases with sitting
- Symptoms that haven’t improved with conservative care, or that came back after a cyst was drained
- An MRI showing a cyst that matches your symptoms
Call 911 or go to the nearest emergency room if you have new numbness in the groin or inner thighs, trouble controlling your bladder or bowels, or weakness in both legs. These can be signs of cauda equina syndrome, a surgical emergency.
Treatments to Try First
- Physical therapy and medications: to calm the irritated nerve
- Epidural or facet joint injections: anti-inflammatory medicine to reduce swelling
- Cyst aspiration or rupture: draining the cyst with a needle, which can help but often doesn’t last because the cyst can refill
Because the cyst tends to come back, removing it surgically is the most reliable way to free the nerve, and surgery can often correct the problem.
How a Synovial Cyst Is Removed
- Anesthesia: You’ll be fully asleep under general anesthesia, positioned face down.
- A small incision: Using X-ray to confirm the level, Dr. Grunch makes a small incision in the lower back.
- Gentle access: The muscles are gently separated, often with a small tube-shaped retractor.
- Reaching the cyst: A small window of bone (a laminotomy) is made, and the thickened ligament is removed.
- Removing the cyst: Under magnification, the cyst is carefully separated from the nerve and the lining of the spinal canal and removed, along with any other tissue narrowing the canal.
- Closing: The skin is closed with dissolvable stitches and skin glue.
If your spine is unstable or slipping at the same level, Dr. Grunch may recommend combining cyst removal with a lumbar fusion to prevent the cyst from returning and keep the spine stable.
Benefits and Risks
Benefits
- Relief of leg pain and numbness for most patients
- A low chance of the cyst coming back when it’s fully removed
- A small incision and usually same-day discharge
Risks
- A spinal fluid leak, which is a bit more common because cysts can stick to the nerve lining, and is usually repaired during surgery
- Infection or bleeding
- Nerve injury, which is rare
- The cyst returning, or instability developing at that level over time
- Risks related to anesthesia
Why Choose Dr. Betsy Grunch for Your Synovial Cyst Removal
- Duke-trained: Dr. Grunch completed her neurosurgical residency and a spine research fellowship at Duke University School of Medicine, one of the top neurosurgery programs in the country, where she received the Spine Young Investigator Award.
- Minimally invasive by design: Minimally invasive spine surgery is one of her signature areas. She works through the smallest opening that will safely do the job, so you can get back on your feet sooner.
- Experience you can count on: She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
- The right operation for your spine: She checks for instability so you get a decompression when that is enough, and a fusion only when you truly need one.
- Second opinions and revisions: She regularly sees patients who had spine surgery elsewhere and want a second opinion or need a revision.
- A teacher at heart: As “Ladyspinedoc,” she is known for explaining spine conditions clearly. You’ll leave your visit understanding your imaging and every option in front of you.
What to Expect
Before surgery
You’ll meet with Dr. Grunch or one of her physician assistants to review your imaging, your exam and your goals, and to decide together whether synovial cyst removal is right for you. Our team will coordinate any pre-operative testing, review your medications (including blood thinners you may need to pause) and walk you through the day of surgery so nothing is a surprise. If you smoke or use nicotine, stopping before surgery lowers the risk of complications.
Procedure day
The surgery usually takes about an hour. Most patients walk the same day and go home that afternoon or evening with a responsible adult to drive them.
Recovery timeline
- First days: Leg pain often improves quickly. Some soreness at the incision is normal.
- First two weeks: Walk every day. Many people with desk jobs return to work within one to two weeks. Your first follow-up visit is about two weeks after surgery.
- Two to six weeks: Gradually increase your activity. Dr. Grunch may start physical therapy.
- Six weeks and beyond: Most patients return to normal activities. Numbness and strength can keep improving for several months.
Every patient heals differently. Your exact timeline will depend on your symptoms, your job and your overall health.
Caring for yourself at home
- Walking: Walk 30 to 60 minutes a day, broken into 10- to 15-minute sessions, and try not to sit for more than 30 minutes at a time.
- Restrictions for about six weeks: No bending at the waist, no twisting and no lifting more than 10 pounds. That includes household chores, yard work, golf and lifting young children or grandchildren.
- Your incision: You may shower the day after surgery without scrubbing the incision. Don’t use ointments or creams, and don’t soak in a bath, hot tub or pool for six weeks. Ice the incision twice a day for 20 minutes during the first week.
- Medications: Take pain medication with food and avoid alcohol while taking it. A daily stool softener helps prevent constipation. Blood thinners are held after surgery until Dr. Grunch’s team tells you to restart them.
- Driving: You may drive once you are no longer taking narcotic pain medication.
- Follow-up: Your first follow-up visit is about two weeks after surgery.
Call the office at 470-293-9800 if you have a fever over 101°F, redness, warmth or significant drainage from the incision, calf pain or swelling, constipation that medication doesn’t relieve, new trouble controlling your bladder or bowels, or back or leg pain that is worse than before surgery. Call 911 for chest pain or shortness of breath.
Download your patient instructions
Print these sheets or save them to your phone so you have them before and after surgery:
- Preparing for surgery: Lumbar Laminectomy (PDF)
- Post-operative guidelines: Minimally Invasive Lumbar Surgery (PDF)
You’ll find instructions for other procedures on our Patient Resources page.
Frequently Asked Questions
Is a synovial cyst cancer?
No. A synovial cyst is a benign, fluid-filled sac caused by wear and tear in the facet joint.
Can’t the cyst just be drained?
It can, but cysts often refill after being drained. Surgical removal is more reliable for lasting relief.
Will the cyst come back after surgery?
It’s uncommon when the cyst is fully removed. If the spine is unstable at that level, a fusion may be recommended to lower that risk.
Will I need a fusion?
Most patients don’t. A fusion is considered only if the spine is slipping or unstable at the level of the cyst.
When can I drive and go back to work?
You may drive once you’re no longer taking narcotic pain medication, often within one to two weeks. Physically demanding jobs can take six weeks or more.
Take the First Step Toward Relief
Leg pain from a synovial cyst can be just as disabling as a herniated disc. Whether you need a treatment plan, a second opinion or a clear explanation of your imaging, Dr. Grunch and the Southern Neurosurgery team are here to help.
Call 470-293-9800 to schedule an appointment or contact us online.
Have a question first? Ask our virtual assistant anything, 24/7.
We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.
Related pages: Facet joint disease · Spinal stenosis · Sciatica · Laminotomy · Lumbar laminectomy
This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk with your own doctor about your symptoms. If you have bladder or bowel changes, groin numbness or rapidly worsening weakness, call 911 or go to the nearest emergency room.