Incomplete resection of lumbar synovial cysts – Evaluating the risk of recurrence

Scholz, Christoph; Hubbe, Ulrich; Kogias, Evangelos; Klingler, Jan-Helge

doi:10.1016/j.clineuro.2015.05.028

Cited by 25 publications

(20 citation statements)

References 11 publications

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“…Because .90% of patients report resolution of back and We agree with the recommendations made by Epstein 30 and Scholz et al 35 and acknowledge the challenges associated with adequately decompressing an LFC. These cysts are often adherent to the dura, which makes complete excision difficult.…”

Section: Surgicalsupporting

confidence: 76%

“…9,31 Nevertheless, the controversy regarding the use of fusion procedures to improve outcomes with LFC resection and decompression stems from a lack of prospective data; the preponderance of available data are from small to medium retrospective case series that used a variety of surgical indications and techniques.Adhesion of the LFC to the dura occurs in 50% to 55% of cases,9,30,35 potentially increasing the risk of durotomy. Epstein30 noted that 44 of 80 patients (ie, 24 of 45 patients with stenosis and 20 of 35 with stenosis and spondylolisthesis) underwent partial or subtotal cystectomy in an effort to avoid the CSF fistula associated with cyst adhesions to the dura.…”

mentioning

confidence: 99%

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Evaluation and Treatment of Lumbar Facet Cysts

Boody

Savage

2016

J Am Acad Orthop Surg

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Lumbar facet cysts are a rare but increasingly common cause of symptomatic nerve root compression and can lead to radiculopathy, neurogenic claudication, and cauda equina syndrome. The cysts arise from the zygapophyseal joints of the lumbar spine and commonly demonstrate synovial herniation with mucinous degeneration of the facet joint capsule. Lumbar facet cysts are most common at the L4-L5 level and often are associated with spondylosis and degenerative spondylolisthesis. Advanced imaging studies have increased diagnosis of the cysts; however, optimal treatment of the cysts remains controversial. First-line treatment is nonsurgical management consisting of oral NSAIDs, physical therapy, bracing, epidural steroid injections, and/or cyst aspiration. Given the high rate of recurrence and the relatively low satisfaction with nonsurgical management, surgical options, including hemilaminectomy or laminotomy to excise the cyst and decompress the neural elements, are typically performed. Recent studies suggest that segmental fusion of the involved levels may decrease the risks of cyst recurrence and radiculopathy.

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Section: Surgicalsupporting

confidence: 76%

mentioning

confidence: 99%

Evaluation and Treatment of Lumbar Facet Cysts

Boody

Savage

2016

J Am Acad Orthop Surg

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“…It is commonly found in spondylolisthesis, osteoarthritis, and disc degeneration in the mid-60s 4) . The incidence of synovial cyst is reported to be 2.3% 10,22) . L4-5 level is the most affected segment 5) .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Endoscopic Lumbar Foraminoplasty for Resection of Synovial Cyst

Choi

Lee

Park

2016

J Minim Invasive Spine Surg Tech

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Synovial cyst is an extradural mass that compresses nerve root or thecal sac. Surgical excision with partial hemilaminectomy and medial facetectomy is commonly used for synovial cyst. Remarkable advancements in endoscopic spinal surgery have led to successful outcomes comparable to conventional open surgery. Here we introduce percutaneous endoscopic lumbar foraminoplasty for resecting synovial cyst as a minimal invasive technique. A 59-year-old woman presented with radicular pain at left L5 dermatome. Magnetic resonance images demonstrated a synovial cyst at left L4-5 facet joint and degenerative spondylolisthesis on L4-5. Under endoscopy, synovial cyst was removed by piecemeal method after transforaminal endoscopic foraminoplasty that removed part of superior facet. Her symptoms were relieved and the patient was discharged the next day. Therefore, percutaneous endoscopic lumbar foraminoplasty can be used as a minimally invasive surgical option for synovial cyst. It may provide less traumatization and affect less postoperative instability.

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“…In none of these patients did a recurrence occur in a minimum follow up time of one year. 16 Since aspiration of cyst has a failure rate of 50-100% this method is clearly not the method of choice.…”

Section: Discussionmentioning

confidence: 99%

Intraspinal Lumbar Juxtaarticular Cyst Treatment through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome

Kursumovic

Bostelmann

Gollwitzer

et al. 2016

Clinics and Practice

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Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years).Fifteen of twenty procedures were successful and cyst rupture was confirmed by CT-scans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.

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Incomplete resection of lumbar synovial cysts – Evaluating the risk of recurrence

Cited by 25 publications

References 11 publications

Evaluation and Treatment of Lumbar Facet Cysts

Evaluation and Treatment of Lumbar Facet Cysts

Percutaneous Endoscopic Lumbar Foraminoplasty for Resection of Synovial Cyst

Intraspinal Lumbar Juxtaarticular Cyst Treatment through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome

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