Spine Disorders
WHEN TO SEE A SPINE
SPECIALIST You should
seek the advice of a spine specialist if neck or back pain persists for more
than two weeks or if it is progressive in intensity and/or distribution. You
should seek immediate healthcare attention if neck or back pain occurs as the
result of an injury or if it is associated with serious illness and/or a high
fever. Additional signs and symptoms which warrant prompt medical attention
include:
SCREENING AND DIAGNOSIS A facet
cyst may be associated with focal low back pain. It can also occur without
symptoms. Physical examination can not be used to confirm the presence of a
facet cyst. MRI will definitively visualize and demonstrate a synovial cyst,
however, a synovial cyst is rarely suspected before being discovered on MRI
evaluation. A facet
cyst is not typically evident on routine spinal x-rays, although there may be
radiographic evidence of advanced degenerative changes involving the spinal
facet joint where the cyst is located. The cyst can also be difficult to detect
with computerized tomography (CT) because of its fluid density. This cyst is
more likely to be seen with CT if there has been bleeding into the cyst or if
there calcification within the cyst wall. Magnetic resonance imaging (MRI) is
the best diagnostic method for identifying a facet cyst. It also provides an
excellent method for assessing the joint from which the cyst arises. PROGNOSIS A facet
cyst can spontaneously regress without intervention. It usually does not
completely resolve but it can get smaller in size. A reduction of size may lead
to the resolution of related signs and symptoms. A cyst may also fluctuate in
size over time. This may be associated with intermittent symptomatology. If
surgery is required to excise a symptomatic cyst it is usually associated with
a good success rate. COMPLICATIONS A cyst may
become large enough to compromise one or more adjacent spinal nerve roots. It
can encroach upon the central spinal canal (spinal stenosis) and/or the
adjacent opening along the side of the spine referred to as the neuroforamina
(lateral stenosis).
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