Surgically managed symptomatic intraspinal lumbar facet synovial cyst outcome of surgical treatment with resection and instrumented posterolateral fusion, a case series

Abstract

Background There is controversy regarding the treatment of symptomatic synovial cysts, specifically, the need for a concomitant fusion when surgical resection of the synovial cysts is required. We present a retrospective review of a series of patients treated for symptomatic synovial cysts of the lumbar region during the last 20 years by a single surgeon, analyzing the current available literature. Methods Retrospective review. The same surgical technique was applied to all patients. Demographic, clinical, surgical data and synovial cyst recurrence rate were recorded. Postoperative results reported by patients were documented according to the McNab score. Results Sixty nine subjects, with mean follow-up of 7.4 years. 62% (43) were female, with a mean 57.8 years at the time of surgery. In 91.3% (63), the primary management was conservative for a minimum period of 3 months. All subjects underwent surgery due to the failure of conservative treatment. The segment most operated on was L4–L5 (63.77%). 91.3% (63) of the sample reported excellent and good and 6 subjects (8.6%) fair or poor results. There was no evidence of synovial cysts recurrence at the operated level. Conclusion In symptomatic synovial cysts, it seems that conservative treatment is only effective in a limited number of patients and in the short term. Thus, the recommendation of a surgical indication should proceed as soon as the conservative management fails to result in significant symptom relief. Based on our results, we recommend, together with the resection of the cyst, the instrumentation of the segment to avoid its recurrence and the management of axial pain.

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

“…(2022) observed that 100% of 69 patients with LSC failed to improve following 3 months of non-surgical management; all 69 underwent decompressions/instrumented posterolateral lumbar fusions that resulted in no LSC recurrence [ Table 1 ]. [ 11 ] Further, utilizing Macnab’s Outcomes Criteria, 91.3% demonstrated good/excellent results (63 patients), with only 8.6% (6 patients) showing fair/poor outcomes.…”

“…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.…”

Clinical Acute Presentation of Lumbar Facet Joint Ganglia With Bilateral Sciatica

“…However, neurogenic claudication, neurological deficit, and cauda equina compromise have also been reported. 2,5,7,[9][10][11] The spinal ganglia occurred most frequently in the 6th decade of life with a slight female predominance. [2][3][4][5]9,11,12 It can be unilateral, bilateral at a single or multilevel, and the majority are asymptomatic, incidentally found on magnetic resonance imaging (MR).…”

“…2,5,7,[9][10][11] The spinal ganglia occurred most frequently in the 6th decade of life with a slight female predominance. [2][3][4][5]9,11,12 It can be unilateral, bilateral at a single or multilevel, and the majority are asymptomatic, incidentally found on magnetic resonance imaging (MR). 3,4,7,12,13 The conservative treatment has short-term or no clinical improvement so decompression and surgical excision are the preferred choices in symptomatic patients.…”

“…3,4,7,12,13 The conservative treatment has short-term or no clinical improvement so decompression and surgical excision are the preferred choices in symptomatic patients. [2][3][4][5]9,14,15 Cauda equina syndrome caused by lumbar facet joint ganglion is extremely rare and warrants emergent surgery. 9,16 The authors describe 2 case reports about lumbar facet joint ganglia presented with acute bilateral sciatica and motor-sensitive deficits.…”