Evan's story

  Synovial cyst

Evan was in the Mayfield Spine Surgery Center in September, ready for a procedure to remove a cyst that was inflaming nerves in the lumbar region of his spine. He remembers what Dr. Robert Bohinski, a spine specialist and neurosurgeon at Mayfield, told him.

"He said, 'We do this all the time. It's going to be fine,'" the 62-year-old restaurant operator recalls.

Dr. Bohinski's prescience hit Evan soon after he emerged from anesthesia a few hours later. As he started to sit up, he recalled the last five months, when even the slightest movement would send pain shooting through his back and left leg.

But when he sat up – no pain. Then he got dressed, putting on his own socks for the first time in a while. Then he stood up – still no pain.

"I was very tentative," he says. "For the last five months, I just hadn't been able to get comfortable. But there was no pain."

Dr. Bohinski says a small cyst, about the size of a pea, was compressing the nerve running down the back of Evan's leg.

"The cyst arises from the facet joint in the back of the spine," he says. "Creation of a minimally invasive portal into the spine allowed us to carefully free the cyst from the nerve and remove it."

A synovial cyst is a fluid-filled pouch from an arthritic facet joint. Stress on the joint produces extra fluid that extrudes into the spinal canal and pinches the nerve roots.

Evan had arrived at the Spine Surgery Center at about 11 o'clock that morning. A few minutes after 4 p.m., he was headed home. He relished the outpatient procedure, the same type that Mayfield neurosurgeons have been performing at the Spine Surgery Center for years. He says he would much rather recover in a familiar place.

"I'm thrilled," he says. "Who doesn't want to be able to be home and sleep in your own bed?"

Six weeks after the surgery, he had slowly restarted his exercise routine and is sleeping better. It's a far cry from the pain he experienced starting in February, when he first strained his back shoveling snow.

"You get stiff and sore and you keep moving," he says. "But the next morning I knew – this was not good."

Evan tried a chiropractor. He tried physical therapy. He called his primary care doctor and scheduled a magnetic resonance imaging (MRI) scan, which would give a detailed picture of his spine. That showed a synovial cyst, filled with fluid and bumping up against a nerve in his back. Even after draining the fluid, the pain got even worse, he says.

That's when Evan called Mayfield, and he was seen by nurse practitioner Jody Beckington, who recommended an epidural injection before resorting to surgery. That shot relieved the pain enough to get Evan through his son's wedding in July, but soon after that, the pain returned. When playing golf in August, a practice swing dropped him to one knee.

Dr. Bohinski presented him with options, including surgery. Evan didn't have any disc issues. While spinal fusion surgery would remove the cyst and might be required someday, a less invasive surgical option would relieve the pressure on the nerve. Another alternative was to return to some of the conservative treatments to relieve pressure on the nerve and reduce his symptoms.

"Because Evan had not had durable success with more conservative treatment options, it made sense to recommend a simple surgical procedure that would address the actual source of the problem by directly removing the cyst," Dr. Bohinski says.

Evan didn't hesitate – he chose the surgery. Today, he is convinced he made the right choice.

"The only pain I have felt is soreness," he says. "I marvel at the attention to all of those details. There's nothing like modern medicine."

~ Cliff Peale

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