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:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

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