The June 2016 issue of the Chiropractic Journal of Australia published a case study documenting the case of an elderly woman who had been suffering with pain in her lower back and leg being helped with chiropractic. This case was unique due to the woman having an MRI confirming the presence of a synovial cyst in her lower spine.
A synovial cyst is an uncommon occurrence where a cyst or soft tissue lesion forms inside the spinal column just outside the spinal cord. It is usually found in the lower back and is associated with lower back pain with radiating pain into a leg. It is commonly seen with some amount of spinal degeneration, and is more common in elderly patients. When discovered, the most common form of medical care is surgery.
In this case, a retired 76-year-old woman was suffering for the previous 6 months from pain in her buttocks down her right thigh, down her leg into her right foot. She also reported abnormal sensations in her right leg. With ten being the worst, the woman reported that pain as an eight. Standing and walking made her worse while sitting afforded some minimal relief.
A physical examination was performed which included reflexes and observation. An MRI was performed prior to chiropractic care and showed the presence of a synovial cyst along with a mild amount of spinal degeneration in the lower spine.
Initial chiropractic care was begun on the woman followed by supportive care. The study reports that after only a short course of care, the patient reported a complete resolution of her symptoms.
During a six-month follow-up, it was noted that the patient was still symptom free. At this point, a second MRI was performed to check the status of the cyst. The MRI showed that, although the patient was free from the pain, the cyst did not seem to have changed.
The authors noted that this case puts to question whether or not a synovial cyst is the cause of the pain. They stated, “This case report shows that although symptomatic resolution occurred following conservative care, the synovial cyst may not have resolved. This leaves open the question concerning the mechanism of symptom generation in these cases.” They noted the uniqueness of this case and the findings by adding, “This is the first reported case of MR imaging appearances of a lumbar facet synovial cyst pre- and post- successful conservative management resulting in symptomatic resolution.”