DEAR DR. GOTT: My wife is 83-years-old and in fairly good health. A few months ago her left leg started bothering her. Two doctors told her it was arthritis. Plain films and MRIs showed that there was a cyst on her spine. They advised no surgery due to paralysis that could happen because of where the cyst laid.
Her symptoms are leg and back pain and weakness with a feeling of water running down her leg. This is very bothersome. She has seen an orthopedist, had physical therapy with no help for her symptoms and has also had chiropractic treatments. Is there anything that can be done to help her?
DEAR READER: Arthritis and other degenerative diseases can result in the body producing excess synovial fluid that can build up within the joint, creating a synovial cyst. Because your wife’s physician told her she has arthritis, my initial thought this is the case for your wife. If indeed this is correct, the cyst is likely placing pressure on her nerve roots within the spinal canal, resulting in low back and leg pain and other possible symptoms.
Treatment depends on several factors. In instances when symptoms don’t disrupt a person’s life, treatment isn’t necessary. In others, periodic monitoring with an MRI or other imaging study might be all that is required until change is seen. In the case of your wife who is obviously bothered and her life is dramatically disrupted, aspiration of the cyst might be an alternative option to surgery. This decision would likely be left to a neuroradiologist who would be guided by the size of the cyst and its location, since he will have to strategically place a needle into the cyst. Aspiration is far less of a risk than surgery would be, but even if the procedure is possible, it may only relieve her symptoms short-term, as this type of cyst has the capability of reforming once aspirated.
Another option is steroid injections into the facet joint or into the area surrounding the cyst to reduce inflammation. Again, this is a temporary solution to reducing pain in some individuals, while others may not experience any pain relief at all. At this stage and if steroid injections are a viable consideration, no more than three per year are recommended.
Her MRI tells the story. Therefore, still another option might be to take her films to another surgeon who can review the films and agree with the decision not to operate or to indicate why he or she feels it might be a viable option. In this instance, be sure to be referred to a physician who specializes in issues involving the spine.
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