Martin Timchur


Objective: To determine the changes to a synovial cyst following symptomatic resolution utilizing a conservative treatment protocol.

Clinical Features: A 76-year- old female had a 6-month history of pain in the right buttock, posterior thigh, calf, ankle and foot and dysaesthesia in the right L5 dermatome.

Intervention and Outcome: Following a short course of conservative chiropractic management, the patient’s symptoms resolved and was subsequently discharged. At 6 months post-discharge she remained asymptomatic and was re-imaged using the same MR imaging parameters. Comparison of both sets of images revealed little change in the appearance of the lesion. 

Conclusion: MR imaging is the gold standard for radiological diagnosis of lumbar synovial cysts. Surgical intervention remains the most commonly employed management protocol with good outcomes and few deleterious effects. However, there is a growing body of evidence for symptomatic relief using less invasive protocols, including chiropractic (as in this case) and physical therapy. This study was conducted to consider the correlation between symptomatology and radiological findings.  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.