Minimally Invasive Approach For Extraforaminal Synovial Cyst L5-S1

Campa-Santamarina, Jose Torres; Towne, Sara; Alimi, Marjan; Navarro-Ramírez, Rodrigo; Härtl, Roger

doi:10.7759/cureus.362

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…As mentioned above, most cysts are found posterolateral to the thecal sac. 23,24 However, juxtafacet cysts can arise anywhere adjacent to the facet joints, and cause intra-or extraforaminal nerve compression; 24,40,43,64,92 even intradural cysts have been reported. 9,89 Just as disc herniation can occur far lateral to the foramen, 58 synovial cysts can cause far-lateral nerve impairment as well.…”

Section: Location Of Cystmentioning

confidence: 99%

Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts

Bruder

Cattani

Geßler

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVESynovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery.METHODSA total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors’ department were analyzed. Medical reports with regard to signs and symptoms, operative findings, complications, and short-term outcome were reviewed. Assessment of long-term outcome was performed with a standardized telephone questionnaire based on the Oswestry Disability Index (ODI). Furthermore, patients were questioned about persisting pain, symptoms, and further operative procedures, if any. Subjective satisfaction was classified as excellent, good, fair, or poor based on the Macnab classification.RESULTSThe approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation.CONCLUSIONSSurgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion.

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Section: Location Of Cystmentioning

confidence: 99%

Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts

Bruder

Cattani

Geßler

et al. 2017

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

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“…In previously reported extraforaminal JFC cases, a microscopic paraspinal approach was mainly used to resect the cysts at the L5-S1 level with total or partial facet joint removal [10,11] because anatomical obstacles, such as narrow surgical corridor due to the large facet joint, prominent L5 transverse process, and iliac bone, limit the approach to reach the extraforaminal cyst. The Wiltse approach is a minimally invasive procedure proposed to remove extraforaminal JFCs, but the tubular retractor docked onto the facet joint may obstruct the visualization of the facet itself [16]. Recently, a transforaminal endoscopic approach with optimized oblique access to obscure pathology was performed to successfully remove lumbar extraforaminal JFCs at the L5-S1 level [12].…”

Section: Discussionmentioning

confidence: 99%

A Novel Technique of the Full Endoscopic Interlaminar Contralateral Approach for Symptomatic Extraforaminal Juxtafacet Cysts

Kim

Lee

et al. 2022

J Minim Invasive Spine Surg Tech

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Objective: Extraforaminal juxtafacet cyst is rare and present a surgical challenge due to its anatomical location. This study aimed to introduce the surgical technique of interlaminar contralateral endoscopic lumbar foraminotomy (ICELF) for extraforaminal juxtafacet cyst removal and reveal its approach-related benefits.Method: The endoscope was docked on the ipsilateral spinolaminar junction and access the contralateral foraminal area through the contralateral sublaminar space created by the fine drilling. As the foraminal was enlarged by foraminal ligament removal and the superior articular process drilling, the endoscope was introduced deeper to the extraforaminal area without violation of the foraminal disc. Combined foraminal stenosis was also resolved while exploring the foraminal space. Subsequently, the extraforaminal cyst was safely and entirely removed while exposing the cyst-nerve root adhesion site with an endoscopic view looking up obliquely.Results: Radiating pain in the right leg, back pain, leg hypesthesia, and ankle weakness improved. Conclusion: ICELF for the treatment of extraforaminal JFC can be an alternative surgical method to resolve symptomatic foraminal stenosis and the cyst simultaneously. The endoscopic system moves parallel to the exiting nerve root during ICELF, facilitating clear visualization of the cranial-dorsally or cranial-ventrally located extraforaminal JFCs. The entire cyst contour and the site of cyst-nerve root adhesion can be detected without nerve root retraction, and meticulous dissection is possible without violating the cystic wall.

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Minimally Invasive Approach For Extraforaminal Synovial Cyst L5-S1

Cited by 2 publications

References 23 publications

Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts

Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts

A Novel Technique of the Full Endoscopic Interlaminar Contralateral Approach for Symptomatic Extraforaminal Juxtafacet Cysts

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