Microdecompression for lumbar synovial cysts: an independent assessment of long term outcomes

Weiner, Bradley K.; Torretti, Joel; Stauff, Michael P.

doi:10.1186/1749-799x-2-5

Cited by 32 publications

(15 citation statements)

References 23 publications

(16 reference statements)

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“…19) Many reports have confirmed that gross total resection, usually without the need for extensive facetectomy or spinal fusion, provides satisfactory results in 80-90% of patients with excellent to good outcomes. 7,28,39) The significant reduction of VAS score at discharge (p º 0.05) and the remarkable MacNab score at follow up in the present study further confirm the effectiveness of this technique. Gross total resection is also particularly safe because the rate of perioperative complications is low at 3%, 26) including CSF fistula, epidural hematoma, seroma, discitis, and phlebitis, compared to instrumented procedures.…”

Section: Discussionsupporting

confidence: 73%

“…Outcome data at an average of 10 years follow up after surgical excision of 46 LSCs, with arthrodesis always performed in the presence of degenerative spondylolisthesis, found that subsequent additional surgery was necessary in 15%, with no statistical differences for any outcome measure between patients undergoing concomitant fusion and those undergoing only decompression. 39) In this aspect, minimally invasive techniques might be particularly useful, as the use of tubular retractors may minimize the risk of spinal instability even in a case of spondylolisthesis. 34) The review of the literature on this subject did not yield new satisfactory insights: in fact, no significant difference in clinical outcomes between endoscopic versus open surgery, except for the lower blood loss and soft tissue trauma of the minimally invasive techniques, has been reported.…”

Section: Discussionmentioning

confidence: 99%

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Synovial Cysts of the Lumbar Spine

Ganau

Ennas

Bellisano

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Symptomatic lumbar synovial cysts (LSCs) are a rare cause of degenerative narrowing of the spinal canal, with thecal sac or nerve root compression. True synovial cysts have a thick wall lined by synovial cells, containing granulation tissue, numerous histiocytes, and giant cells. In contrast, pseudo-cysts lack specialized epithelium, have a collagenous capsule filled with myxoid material, and may be classified into ganglion cysts, originating from periarticular fibrous tissues, and ligamentous cysts, arising from the ligamentum flavum or even from the posterior longitudinal ligament. Here we present the surgical series of the Chair of Neurosurgery at the University of Cagliari (Italy) including a total of 17 LSCs. Surgical technique consisted of facet sparing excision of LSC, achieved by simple hemilaminectomy/laminectomy, and diagnosis was always confirmed by histological specimen examination, which detected the typical synovial epithelium, the intracystic presence of hemosiderin, histiocytes, and calcifications. Further immunohistochemical investigation revealed positive staining for cytokeratin: CK5, CK6, and AE1/AE3. Clinically, our cohort experienced rapid and complete resolution of symptoms, without perioperative complications, or recurrence of cysts or vertebral instability at a median follow up of 28 months, when the MacNab score was generally excellent. A review of the literature, retrieving articles published from 1973, collected a total of 101 articles concerning all the cases of LSC scientifically described to date. Both clinical and histological findings described in our study support the theory of degenerative microtraumatic pathogenesis of synovial cysts.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Synovial Cysts of the Lumbar Spine

Ganau

Ennas

Bellisano

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…These patients required more invasive removal of the facet joint and accurate neural dissection. Weiner declares that adherence to the dura is a common finding and that it has to be "carefully teased free so that no cyst pseudocapsule" remains [12]. Epstein emphasizes that "utilizing the operating microscope is extremely helpful in avoiding CSF fistulas during decompression and removal of synovial cysts, as these fistulas are more likely to arise secondary to dense adhesions between the cyst capsule and underlying dura/nerve roots" [13].…”

Section: Discussionmentioning

confidence: 98%

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

Scholz

Hubbe

Kogias

et al. 2015

Clinical Neurology and Neurosurgery

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“…Although all of the cysts in their series were actually true synovial cysts that were treated with hemilaminectomy/ laminectomy with facet sparing, none of these patients, even those with preoperatively fixed spondylolisthesis, presented with instability at a median follow-up of 28 months. Forty-six patients with a LISC treated with microscopic decompression were followed up for nearly 10 years by Weiner et al 49 The only indication for concomitant fusion (noninstrumented) in this series was the presence of spondylolisthesis, which was involved in 50% of their patient population. Even though the authors did not differentiate static from dynamic spondylolisthesis, 89% of the patients reported satisfaction with the surgery 10 years later, with no statistical differences for any outcome measure between patients who underwent fusion and those who did not.…”

Section: Discussionmentioning

confidence: 98%

Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases

Sukkarieh

Hitchon

Awe

et al. 2015

SPI

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OBJECT The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach. METHODS All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times. RESULTS There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m2. Sixty-nine percent (9 of 13) of the cysts were at L4–5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series. CONCLUSIONS The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.

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Microdecompression for lumbar synovial cysts: an independent assessment of long term outcomes

Cited by 32 publications

References 23 publications

Synovial Cysts of the Lumbar Spine

Synovial Cysts of the Lumbar Spine

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

Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases

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