Ganglion Cysts

Ganglion Cysts in the Lumbar Spine Overview

Ganglion cysts can occur in any joint. In fact, many people are aware of these but have never considered what they are. The small round “bumps” that occur under the skin at the wrist are typically ganglion cysts. Some individuals may remember the “Bible treatment” for these developed years ago where someone had the bright idea to smash a Bible onto the wrist to attempt to pop these cysts. This is not a recommended treatment for ganglion cysts in today’s world.

To understand what a ganglion cyst is, we must understand the design of a diarthrodial joint. This type of joint is the junction of two bones (such as the tibia and the femur at the knee). The surfaces of the joint are covered with a smooth slippery covering called hyaline cartilage. There is a thick burlap-like material that encases the entire joint called the capsule. This capsule is lined by a thin layer of cells called the synovium that produces the thin “oil” that lubricates the joint.

When the joint surfaces start to erode, as in degenerative arthritis, bone spurs start to form at the edges of the joint. Occasionally, the capsule encasing the joint will tear and the synovial lining will “pop out” of this tear. The synovial cells don’t know any better and therefore continue to produce synovial fluid. A cyst forms and will continue to grow. If the cyst grows in a region that has no sensitive structures, such as the wrist, there will be no symptoms. If however, the cyst grows in an area that will cause compression to structures that can’t take compression, symptoms will result.

It just so happens that the facets in the back of the spine are diarthrodial joints and exhibit degenerative changes quite commonly. The condition “degenerative spondylolysthesis” is one of the most common spinal disorders and is a result of wear and tear on the facet joints. (See the section on degenerative spondylolysthesis for further information on this condition). In a small number of patients with this condition, ganglion cysts in the lumbar spine will form.

(Click to Enlarge Image) This is an axial MRI of a small ganglion cyst that is compressing the right L5 nerve (black arrow) on the right. You can see that the facet joint it is originating from is degenerative (irregular surfaces) and the cyst is full of fluid (Black boarder of the cyst wall with white fluid inside).

Are you suffering from symptoms of a lumbar spine ganglion cyst?

Would you like to consult with Dr. Corenman about your condition?
You can set up a long distance consultation to discuss your
current X-rays and/or MRIs for a clinical case review.

REQUEST A SECOND OPINION

(Please keep reading below for more information on this condition.)

Symptoms of Lumbar Spine Ganglion Cysts

If the ganglion cysts, as they commonly do, form outside the canal in the muscles in the rear of the spine, there will be no symptoms. If however, the cysts form in the canal itself, there will be trouble brewing. These cysts act like a bone spur or herniated disc and can compress the nerves in the canal. We know that nerves do not like to be pushed around and symptoms of nerve compression result. Depending upon the nerve, pain can radiate down into the buttocks and all the way down the leg (it is very rare to have these cysts cause problems in the neck-I have seen hundreds in the lower back and only two in the neck).

The symptoms of nerve compression are pain in the buttocks and leg normally worse with standing and better with sitting. There are cases of pain with sitting depending upon the position of the cyst.

Treatment of Lumbar Spine Ganglion Cysts

Non-Surgical

Treatment depends upon the symptoms that develop. Management such as epidural steroid injections and medications can be used. Physical therapy may not be as effective but may be useful. Occasionally, a good interventionist can drain the ganglion cyst and place steroid directly into the cyst which can shrink it.

Surgical

Surgery to remove the cyst is very effective. The cyst material is very sticky and sometimes it is difficult to remove all the cyst wall material if it sticks to the dura. (The dura is the lining of the sac that contains the nerves and the cerebral spinal fluid-CSF). Recurrence rate of the cyst is in the neighborhood of 10%. If the cyst is associated with a degenerative spondylolysthesis (as it is typically) and there is a significant slip or instability, occasionally a fusion of the segment is necessary.

For additional information on ganglion cysts in the lumbar spine, please contact Dr. Donald Corenman, back doctor and spine specialist offering diagnostic and surgical second opinions to patients in the USA and around the world.

Related Content

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel