The Variability of Lumbar Facet Joint Synovial Cyst Recurrence Requiring Revision Surgery After Decompression-only and Decompression/Fusion

Abstract

Study Design: This is a retrospective study. Objective: The objective of this study was to evaluate lumbar spine synovial cyst recurrence rates of decompression-alone versus decompression/fusion procedures. Background: Improvements in imaging modalities allow for increased diagnosis and surgical treatment of symptomatic spinal juxtafacet synovial cysts. Conservative management may be used as a first-line management strategy, however rarely provides durable, effective relief of symptoms. Surgical treatment of spinal synovial cysts ranges from decompression and cyst excision to decompression with fusion procedures. Decompression procedures alone have a higher risk of recurrence of spinal synovial cysts. Methods: We retrospectively reviewed 87 patients undergoing surgical treatment of lumbar spinal juxtafacet synovial cysts as a single institution over 20 years. Surgical treatment consisted of either decompression versus decompression/fusion procedures. Preoperative symptoms included back pain, radiculopathy, motor deficits, or sensory deficits. The incidence of recurrence of spinal synovial cysts at the same-site or differing sites was compared between 2 categories of surgical treatment. Revision surgical procedure rates were also evaluated. Results: A total of 55 (63%) patients were treated with an index decompression-only procedure for the lumbar spinal synovial cyst compared with 32 (37%) patients treated with an index decompression and fusion procedure. Fifty-eight (68%) of the lumbar spinal cysts occurred at the L4–L5 level. There were 10 (11.5%) spinal synovial cyst recurrences in the decompression-only group, and 0 recurrences in the decompression/fusion group. Revision decompression procedures were performed in 4 of the 10 (4.6%) recurrences, and 6 of 10 (6.9%) recurrences had subsequent decompression and fusion surgery. The mean time to recurrence was 23.9±17.3 months. The mean length of follow-up was 65.1±48.6 months. Both recurrence and nonrecurrence cohorts had significant symptomatic improvement using Odom criteria. Conclusions: Decompression and cyst excision was the more common surgical treatment of lumbar spinal synovial cysts compared with decompression/fusion procedure in our study. The rate of synovial cyst recurrence and revision surgery in patients undergoing index decompression was relatively low and comparable to current literature. Symptomatic improvement of patients undergoing decompression versus decompression/fusion was similar in our study. Although the fusion may be required for the extent of pathology or coexisting instability, decompression and excision of spinal synovial cysts provide durable, effective treatment with a known, appropriate risk of recurrence and subsequent revision surgery.

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

“…SC recurrence rates (development of a new SC at the same level, after surgical removal) have been reported to range from 15 to 25% among patients undergoing DwoutF procedures [ 17 , 18 ], while case series in which decompression and excision with fusion (DF) was carried out reported rates close to 0% [ 19 , 20 ], data in accordance with our case series.…”

Transforaminal Epiduroscopic Laser Ablation for Removal of a Postlaminectomy Synovial Cyst: A Case Report

“…After surgical treatment, the pain is resolved considerably, but approximately 1.6% of patients experience side effects such as a dural tear, spinal nerve injury, epidural hematoma, seroma, cyst recurrence, or deep venous thrombosis [6]. Nevertheless, surgical resection has a recurrence rate of 11% after an average of 2 years, and surgical resection plus fusion has no recurrence rate for a follow up of 65 months [7]. Although surgery is effective for pain management, non-surgical treatment is often attempted, due to the cost of surgery and the risk of anesthesia and complications during surgery.…”

“…There is a limitation in this report, which is the fact that the follow-up period is short. In other paper, after removal of cyst, the degree of pain was followed up to 6 months [15] or other papers report recurrence of cyst within 6 months [16,17], but the recurrence of cyst was reported as an average of 24 months [7]. In addition, symptomatic fibrotic change in the area where cyst is removed will occur after 6 months.…”

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

“…Cyst excision, either endoscopic or open without fusion, may provide better results in patients without proven instability, but a degree of facetectomy may be necessary in order to prevent cyst relapsing [ 8 , 14 , 20 ]. Rosenstock and Vajkoczy [ 9 ] established treatment indications based on the cyst's location in MR images.…”

“…Spinal cystic lesions originate from ligamentous and synovial structures; they have different histological characteristics and have been classified as synovial cysts (those with a definite synovial lining), pseudocysts derived from the degeneration of the ligamentum flavum, and pseudocysts without evidence of a synovial lining (ganglion cysts) [3]. Their origin has been related to segmental instability and degenerative changes with facet joint hypertrophy, showing a variable clinical repercussion, varying from an asymptomatic casual finding to lumbar and/or radicular pain and, less frequently, radicular neurological deficit or cauda equina syndrome [1,[4][5][6][7][8][9][10][11][12].…”