SPINAL SYNOVIAL CYSTS AND INTERSEGMENTAL INSTABILITY: A Chiropractic Case

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Abstract

Objective

This article presents a case in which synovial cysts appeared to cause compromise of the neural foramina and thecal sac with presenting neurological signs.

Clinical Features

A 67-year-old female patient with a history of lumbar synovial cysts and synovectomy presented with recurrence of bilateral low back, leg pain, and apparent neurological compromise along with a recurrence of lumbar synovial cyst as evidenced on magnetic resonance images.

Interventions and Outcome

Flexion distraction therapy, performance of Williams low back exercises and interferential therapy resulted in 50% relief. Frequency of care was progressively diminished as she improved. The patient experienced recurrence of severe episodes; multifidi strengthening exercises were provided to address a concomitant spondylolisthesis and instability, resulting in a cessation of these episodes and improvement in functional activities.

Conclusion

Distraction therapy seemed to alleviate the constant pain without surgical intervention. In this case, the synovial cyst may have been an incidental finding versus a primary cause of the low back and leg pain. For similar patients, in the absence of correlative progressive neurological signs, surgical intervention may not be necessary.

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