The purpose of this study is to present a case in which synovial cysts appeared to cause

compromise of the neural foramina and the thecal sac leading to initial improper

attribution of neurological signs. Subsequent manipulative care and a specific exercise

program alleviated symptomatology that was concluded to be secondary and separate

from the synovial cysts. The object of this study is to present the false association and

improve differential diagnosis and treatment of spinal synovial cyst and associated

disorders.

A 67-year-old female patient with a history of lumbar synovial cysts previously treated

by surgical means presented with recurrence of bilateral low back and leg pain along with

findings of recurrence of lumbar synovial cyst as demonstrated on MRI with apparent

neurological compromise.

Flexion distractive therapy with home performance of Williams’s low back exercises and

adjunctive interferential therapy. Initial treatment (thrice weekly for 2 weeks) resulted in

50% relief. Frequency of care was progressively diminished with symptomatic

improvement. However, there continued to be recurrence of the symptoms with episodes

as severe as the initial presentation. Subsequent addition of the specific multifidi

stabilization strengthening exercises to address a spondylolisthesis and instability resulted

in a cessation of episodes of severe pain and improvement in functional activities.

Although the distractive therapy was successful in alleviating the constant pain, the

stabilization of the spondylolisthesis was more important in the long term effects on the

patient. There was recurrence of the same low back and leg pain after the surgery and

subsequent recurrence of the synovial cyst. Distractive therapy allowed alleviation of the

symptoms without additional surgical intervention. Episodes recurred until there was

sufficient multifidi strengthening to stabilize the unstable L4-5 spondylolisthesis. The

synovial cyst may be an incidental finding vs a primary cause of the low back and leg

pain. The presence of synovial cysts does not always result in the clinical correlation of

the pathology. In the absence of correlative progressive neurological signs, surgical

intervention may not be necessary. Since there is a high correlation of spondylolisthesis

with spinal synovial cysts, it would be appropriate to assess the relationship of the

spondylolisthesis to the presenting symptoms and consider conservative manual therapy.