Spinal Facet Cyst

A spinal cyst, often called a facet joint cyst, is a fluid-filled sac that develops near the joints in the spine (called facet joints).
These joints help stabilize the spine and allow for smooth movement. Over time, wear-and-tear or arthritis can cause these joints to swell and form cysts.

While small cysts may not cause symptoms, larger ones can press on nearby nerves, leading to back pain, leg pain, numbness, or weakness.
Facet cysts are most common in the lower back (lumbar spine) but can also occur in the neck (cervical spine).

Facet cysts usually form due to degenerative changes in the spine.
As facet joints wear down, they may produce excess joint fluid, which collects and forms a cyst.

• Spinal arthritis (facet joint osteoarthritis): the most common cause.
   
• Degenerative disc disease: increased motion and stress on facet joints accelerate wear.
   
• Spinal instability or spondylolisthesis: when a vertebra slips forward, the facet joints compensate and become irritated.
   
• Aging: natural degeneration over time makes cysts more likely.
   
• Prior spine surgery or trauma: can lead to increased stress on nearby joints.
   

Symptoms depend on the size and location of the cyst and whether it is pressing on a nerve or the spinal cord.

• Localized back pain that worsens with standing, walking, or twisting.
   
• Leg pain, cramping, or sciatica-like symptoms when the cyst presses on a nerve root.
   
• Numbness or tingling in the legs or feet.
   
• Weakness in the legs or difficulty with walking or balance.
   
• Pain relief when sitting or leaning forward, which temporarily increases space around the nerves.
   
• Severe or urgent symptoms: sudden bladder or bowel control changes or rapidly worsening weakness — these require immediate medical attention.

Dr. Fried uses a thorough evaluation to confirm the presence of a facet cyst and rule out other causes of nerve compression.

• Medical history: discussion of symptoms, lifestyle, and progression over time.
   
• Physical and neurological exam: checking reflexes, muscle strength, sensation, and gait.
   
• Imaging studies:
   
  • MRI: best for visualizing the cyst, nerves, and surrounding soft tissues.
     
  • X-rays: assess alignment, arthritis, and instability.
     
  • CT scans: provide detailed views of bone and facet joint structure.
     
• Diagnostic injections: may be used to confirm which joint or nerve is the source of pain.
  
   

Treatment depends on how severe the symptoms are and whether the cyst is causing nerve compression or spinal instability.
Dr. Fried begins with conservative care whenever possible, progressing to minimally invasive surgical options if needed.