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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Synovial 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Surgical 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.</jats:p></jats:sec>

Percutaneous Endoscopic Lumbar Approach to a Facet Joint Synovial Cyst: Case Report and Review of the Literature

“…Bruder et al analyzed 141 cases and reported a success rate of 94% with open resection through a hemi-laminectomy. In this series, there was a 7% recurrence and only 9% required spinal instrumentation on follow up 5) . A meta-analysis by Campbel et al reported clearly the superiority of open resection over percutaneous needle aspiration.…”

“…Lumbar facet joint synovial cysts are rare lesions that may cause radiculopathy, neurogenic claudication and even cauda equina syndrome 2,[4][5][6][7] . The most frequent site where it is found is anterior to the yellow ligament, postero-lateral to the dura and its contents, at the L4-5 level [4][5][6] . It does not respond well to clinical management, oftentimes requiring surgical intervention.…”

An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

“…They have a variable prevalence that goes from 1% in CT studies to a 2.2% as a casual finding during laminectomies [ 15 ], and to a 6.5% in MRI studies, being symptomatic in approximately half of the cases [ 2 ]. Even though they have a controversial origin [ 16 ], the most accepted theory is that it is a complex early disc degeneration process, with a pressure increase and facet hypertrophy associated with degenerative spondylolisthesis, which shows the role of instability in the development of facet joint cysts [ 1 ], being responsible for the symptoms [ 17 ].…”

Lumbar Spine Synovial Cyst: A Case Series Report and Review of Surgical Strategies

“…There is a plethora of different treatment strategies for the management of lumbar spine synovial cysts. However, total cyst excision via small flavectomy as the least invasive approach should be considered surgical therapy of choice 13,[21][22][23] . Spinal fusion is also considered an option when spinal instability is concerned to avoid cyst recurrence 10 .…”