Decompression with or without Fusion for Lumbar Synovial Cysts—A Systematic Review and Meta-Analysis

Abstract

The management of symptomatic lumbar synovial cysts (LSC) is still a matter of debate. Previous systematic reviews did not stratify data according to different treatment techniques or incompletely reported comparative data on patients treated with lumbar posterior decompression (LPD) and lumbar decompression and fusion (LDF). The aim of our study was to compare LPD and LDF via a systematic review and meta-analysis of the existing literature. The design of this study was in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review questions were as follows: among patients suffering from symptomatic lumbar synovial cysts (population) and treated with either posterior lumbar decompression or posterior decompression with fusion (intervention), who gets the best results (outcome), in terms of cyst recurrence, reoperation rates, and improvement of postoperative symptoms (comparison)? The search of the literature yielded a total of 1218 results. Duplicate records were then removed (n = 589). A total of 598 articles were screened, and 587 records were excluded via title and abstract screening; 11 studies were found to be relevant to our research question and were assessed for eligibility. Upon full-text review, 5 were excluded because they failed to report any parameter separately for both LPD and LDF. Finally, 6 studies for a total of 657 patients meeting the criteria stated above were included in the present investigation. Our analysis showed that LDF is associated with better results in terms of lower postoperative back pain and cyst recurrence compared with LPD. No differences were found in reoperation rates and complication rates between the two techniques. The impact of minimally invasive decompression techniques on the different outcomes in LSC should be assessed in the future and compared with instrumentation techniques.

Percutaneous uniportal full-endoscopic surgery for treating symptomatic lumbar facet joint cysts under local anesthesia combined with monitored anesthesia care: a preliminary report of eight cases with at least 1 year follow-up

“…Page et al ( 30 ) reported a predictive model for lumbar synovial cyst recurrence following decompression without fusion and found some predictive factors of recurrence, including a facet inclination angle of >45°, canal stenosis of >50%, T2 joint space hyperintensity, and the presence of grade I spondylolisthesis. One systematic review and meta-analysis showed that decompression combined with fusion was associated with better results in terms of lower postoperative back pain and cyst recurrence compared with decompression alone; however, there were no differences in the reoperation and complication rates ( 31 ). None of the patients in this study experienced recurrence or reoperation during the follow-up period.…”

Perspective: Operate on lumbar synovial cysts and avoid ineffective percutaneous techniques

“…Benato [1] J 1]. [10] e 1 of 15 patients with LSC were typically older, exhibited significant degenerative facet disease, and developed larger and more anteriorly located LSC more likely to be associated with radicular pain.…”

“…Five studies showed that patients with LSC/Stenosis undergoing primary decompressions/fusions resulted in lower LSC recurrence rates vs. for those having decompressions alone [ Table 1 ]. [ 1 , 7 , 9 , 14 , 16 ] Utilizing 4 databases (i.e., 17 studies; 824 patients), Ramhmdani et al . (2019) found that patients with LSC/Stenosis/DS were; “...more likely to undergo spinal fusion surgery than laminectomy alone compared with patients with LSC and no preoperative DS” [ Table 1 ].…”

“…Lumbar synovial cysts (LSC), best diagnosed on MR studies, may cause symptoms ranging from unilateral radiculopathy to cauda equina syndromes/compression [Table 1]. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Typically, attempts at percutaneous cyst aspiration, injection (i.e. with/without steroids/other), dilatation, and/or disruption typically fail.…”

What Types of Strategies Are Effective in Lumbar Spine Surgery? Considering the Etiology, Imaging Findings, and Risk of Complications

“…In conclusion, as a strategy for lumbar spine surgery, the etiology and pathophysiology of the disease are first inferred [ 1 , 16 ], and the extent of the surgery is then determined based on spinal canal stenosis, the presence or absence of bony unions such as DISH [ 7 ], and the morphology of the fracture [ 17 ] based on image analysis [ 4 , 5 , 7 ]. Next, after selecting minimally invasive surgery [ 10 ], microendoscopic surgery [ 9 , 10 ], or conventional surgery as the surgical method, appropriate spinal instruments and cages [ 18 ] are selected.…”