The treatments described for spinal synovial cysts range from percutaneous puncture to arthrodesis. There is a fear of postoperative instability after surgical resection of cysts mainly when they are associated with degenerative spondylolisthesis. We report one consecutive series of 50 patients with lumbar synovial cysts operated on with microsurgery without arthrodesis. Functional status was assessed postoperatively by the MacNab success scale and by self-assessment using the Weiner scale, SF-36, and Oswestry scale. The presence of pre- and postoperative instability was determined with static and dynamic lumbar spine X-ray before surgery and in the last follow-up at 2 years to evaluate the presence of spondylolisthesis before and after surgery. Facet inclination angle and the stage of disc degeneration at the level of the cysts were evaluated. Disc degeneration was defined by modified Pfirrmann’s grading system. The mean Oswestry index was 12 ± 12.6% (Median 8, 0-53). Based on the MacNab scale, 98% were considered excellent and good. The Weiner scale showed that low back pain was present in 16% of patients postoperatively. There was significant improvement of leg strength and pain in 96% and 94%, respectively. Only 3 patients were reoperated on with late fusion. The microsurgical treatment for synovial cysts without arthrodesis presented excellent and good results in the majority of cases. Total surgical resection was obtained in all cases, with a late fusion rate of only 6% and no recurrence at the operated site. It is necessary to carry out prospective randomized studies to clarify the best therapeutic options.

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