51
|
Lowrie ML, Platt SR, Garosi LS. Extramedullary spinal cysts in dogs. Vet Surg 2014; 43:650-62. [PMID: 24798122 DOI: 10.1111/j.1532-950x.2014.12200.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/01/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To (1) synthesize the terminology used to classify extramedullary spinal cysts in dogs to clarify some of the commonly reported misconceptions, and (2) propose a classification scheme to limit confusion with terminology. STUDY DESIGN Literature review. METHODS An online bibliographic search was performed in January 2013 for articles relating to extramedullary spinal cysts in dogs using PubMed (http://www.pubmed.gov/) and Google Scholar (http://scholar.google.com/) databases. Only peer-reviewed clinical literature describing cystic lesions pertaining to the spinal cord and associated structures was included. RESULTS From 1962 to 2013, 42 articles were identified; 25 (95 dogs) reported meningeal cysts, 10 (24 dogs) described 60 extradural cysts, 3 reports (18 dogs) described discal cysts or acute compressive hydrated nucleus pulposus extrusions (HNPE). Spinal cysts were categorized by location based on cross-sectional imaging as meningeal or extradural non-meningeal. Sub-classification was then performed based on surgical findings and pathology. Meningeal cysts included arachnoid diverticulae and Tarlov (perineural) cysts. Extradural non-meningeal cysts included intraspinal cysts of the vertebral joints, ligaments and discs. Discal cysts also fit this category and have been reported extensively in humans but appear rare in dogs. CONCLUSIONS Extramedullary spinal cysts should be first classified according to location with a sub-classification according to pathologic and surgical findings. Previous canine cases of discal cysts appear to represent a different disease entity and the term acute compressive HNPE is therefore preferred.
Collapse
Affiliation(s)
- Mark L Lowrie
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, England
| | | | | |
Collapse
|
52
|
Komp M, Hahn P, Ozdemir S, Merk H, Kasch R, Godolias G, Ruetten S. Operation of Lumbar Zygoapophyseal Joint Cysts Using a Full-Endoscopic Interlaminar and Transforaminal Approach. Surg Innov 2014; 21:605-14. [DOI: 10.1177/1553350614525668] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In appropriate situations, extensive decompression with laminectomy often continues to be described as the method of choice for operations involving lumbar zygoapophyseal joint (z-joint) cysts. Tissue-sparing procedures are nevertheless becoming more common. Endoscopic techniques have become the standard procedures in many areas because of the advantages they offer in terms of surgical technique and in rehabilitation. One key aspect in spinal surgery was the development of instruments for sufficient bone resection carried out under continuous visual control. This enabled endoscopes to be used when operating on z-joint cysts. The objective of this prospective study was to examine the technical possibilities for the full-endoscopic interlaminar and transforaminal technique in lumbar z-joint cysts. A total of 74 patients were followed up for 2 years. The results show that 85% of the patients no longer have any leg pain or that the pain had been almost completely eliminated, and 11 % experience occasional pain. The complication rate was low. The full-endoscopic techniques brought advantages in the following areas: operation, complications, traumatization, and rehabilitation. The recorded results show that full-endoscopic resection of a z-joint cyst using an interlaminar and transforaminal approach provides an adequate and safe supplement, and is an alternative to conventional procedures when the indication criteria are fulfilled. It also offers the advantages of a minimally invasive intervention.
Collapse
Affiliation(s)
- Martin Komp
- Center for Spine Surgery and Pain Therapy, St Anna Hospital, Herne, Germany
| | - Patrick Hahn
- Center for Spine Surgery and Pain Therapy, St Anna Hospital, Herne, Germany
| | - Semih Ozdemir
- Center for Spine Surgery and Pain Therapy, St Anna Hospital, Herne, Germany
| | - Harry Merk
- Clinic for Orthopaedics and Orthopaedic Surgery, Ernst Moritz Arndt University Greifswald, Germany
| | - Richard Kasch
- Clinic for Orthopaedics and Orthopaedic Surgery, Ernst Moritz Arndt University Greifswald, Germany
| | - Georgios Godolias
- Center for Orthopaedics and Traumatology, St. Anna Hospital Herne, Germany
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, St Anna Hospital, Herne, Germany
| |
Collapse
|
53
|
Synovial cyst mimicking an intraspinal sacral mass. Case Rep Neurol Med 2014; 2014:953579. [PMID: 24716025 PMCID: PMC3970337 DOI: 10.1155/2014/953579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/16/2014] [Indexed: 11/18/2022] Open
Abstract
A 68-year-old female had a three-week history of severe low back pain radiating down the posterior left buttocks and left leg exacerbated by standing and walking. Lumbar spine MRI revealed cystic mass with similar intensity to cerebrospinal fluid located on dorsolateral left side of the sacral spinal canal inferior to the S1 pedicle. There was compression of left exiting S1 and traversing S2 nerve roots. Neurosurgery consult was requested to evaluate the cystic mass in the sacral spinal canal. After clinical evaluation, an unusually located synovial cyst was thought possible. Cyst contents were heterogeneous, suggestive of small hemorrhage and acute clinical history seemed reasonable. Left S1 and partial left S2 hemilaminectomy was performed and an epidural, partially hemorrhagic cyst was removed. There was no obvious connection to the ipsilateral L5-S1 facet joint. Pathology revealed synovial cyst, and the patient's leg pain was improved postoperatively. This synovial cyst was unusual as it had no connection with the facet joint intraoperatively and its location in the sacral canal was uncommon.
Collapse
|
54
|
Oliveira J, Silva PS, Pereira P, Vaz R. Paraparesis as the Presenting Form of a Lumbar Hemorrhagic Synovial Cyst: A Case Report and Review of the Literature. JBJS Case Connect 2013; 3:e136. [PMID: 29252292 DOI: 10.2106/jbjs.cc.m.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Joana Oliveira
- Neurosurgery Department, Hospital São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
| | | | | | | |
Collapse
|
55
|
Sasamori T, Hida K, Anzai K, Yano S, Kato Y, Tanaka S, Saito H, Houkin K. A case of cervical juxtafacet cyst with extensive rim enhancement on Gd-DTPA MRI. Clin Imaging 2013; 38:199-201. [PMID: 24332973 DOI: 10.1016/j.clinimag.2013.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/15/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
The authors reported a case of cervical juxtafacet cyst with extensive rim enhancement on gadolinium-diethylenetriamine pentaacid magnetic resonance imaging. Operative finding revealed the epidural space around the mass filled with abundant venous plexus. Histological examination demonstrated that cyst wall was composed of the well-vascularized fibrous connective tissue with some inflammatory changes. We speculate that extensive rim enhancement of juxtafacet cyst may be attributed not only to the chronic inflammatory changes of cyst wall, but to engorged venous plexus within the widened epidural space.
Collapse
Affiliation(s)
- Toru Sasamori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Kazutoshi Hida
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kimio Anzai
- Minami Sapporo Neurosurgical Clinic, Sapporo, Japan
| | - Shunsuke Yano
- Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - Yasutaka Kato
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
56
|
Intradural intraneural hemorrhagic cyst resulting in progressive cauda equina syndrome after anticoagulation therapy. Spine (Phila Pa 1976) 2013; 38:E1288-90. [PMID: 23759810 DOI: 10.1097/brs.0b013e31829e1440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report a case of lumbar intraneural hemorrhagic cyst after anticoagulation therapy that caused progressive radiculopathy and cauda equina syndrome. The possible pathogenic mechanism, associated diseases, and treatment options are discussed. SUMMARY OF BACKGROUND DATA Various pathological processes can cause progressive cauda equina syndrome. However, there have been no reports of progressive cauda equina syndrome due to compression from an intraneural hemorrhagic cyst after anticoagulation therapy. METHODS A case of lumbar intradural intraneural hemorrhagic cyst with progressive cauda equina syndrome after anticoagulation therapy is presented. RESULTS A 42-year-old-female patient complained at presentation of progressive bilateral lower extremity radiating pain, numbness, and urinary difficulty during the previous 2 months. Lumbar magnetic resonance imaging revealed an L1 cystic lesion with marked mass effect on the surrounding nerve roots. Complete drainage and excision of the lesion was performed, which resulted in excellent postoperative symptoms relief. Pathological examination revealed no definite neoplastic process except some nerve fibers with hemosiderin stain along the cyst wall. On the basis of a combination of intraoperative findings and pathology, an intradural intraneural hemorrhagic cyst that developed after systemic anticoagulation therapy was diagnosed. CONCLUSION This is the first report of an intradural intraneural hemorrhagic cyst causing progressive cauda equina syndrome due to anticoagulation therapy. Surgical excision of the cyst is the definite treatment of choice. LEVEL OF EVIDENCE N/A.
Collapse
|
57
|
Bisson EF, Sauri-Barraza JC, Niazi T, Schmidt MH. Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature. Neurosurg Focus 2013; 35:E3. [DOI: 10.3171/2013.3.focus1385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Synovial cysts are uncommon pathological entities in patients with cervical degenerative spinal disease, and there are only a few reports in the literature. Treatment typically involves decompression; however, biomechanical data indicate that laminectomies in the cervical spine also result in cervical instability, specifically within the cervicothoracic junction, supporting the use of fusion as well. The authors describe the use of fusion with decompression in the treatment of 3 patients with cervicothoracic synovial cysts that presented in an acute fashion with associated myelopathy and neurological decline, and they review the diagnostic elements, histopathology, and treatment of these cysts. All 3 of the patients did well with decompression via a posterior approach with a single-level instrumented fusion from C-7 to T-1. Each patient regained complete neurological function and had no residual neurological deficits. These results are promising, although the sample size of 3 cases is too small to make any conclusive evaluations. Future studies incorporating Class I and Class II data are imperative to make firm conclusions regarding general management of this rare entity.
Collapse
|
58
|
Abrams J, Hsu K, Kondrashov D, McDermott T, Zucherman J. Treatment of facet cysts associated with neurogenic intermittent claudication with x-stop. JOURNAL OF SPINAL DISORDERS & TECHNIQUES 2013; 26:218-21. [PMID: 22134735 DOI: 10.1097/bsd.0b013e31823fadda] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facet degeneration often leads to the formation of synovial facet cysts. As facet cysts invade the spinal canal, they become a contributing factor to spinal stenosis. Previous studies have demonstrated successful treatment of neurogenic intermittent claudication (NIC), a major symptom of spinal stenosis, with an interspinous process device. PURPOSE To compare clinical outcomes of patients with and without synovial facet cysts treated with an interspinous process device. STUDY DESIGN Retrospective review of prospective data of consecutive patients undergoing the X-Stop procedure at an institution. OUTCOME MEASURES Visual Analog Scale; Oswestry Disability Index; sitting, standing, and walking tolerances; and satisfaction survey. METHODS Review of all patients from 2006 to 2010 undergoing X-Stop procedure at an institution. Imaging studies were used to identify the presence and measure the size of the facet cysts in 285 patients with a minimum of 6-month follow-up. Comparative clinical outcomes determined if X-Stop is a successful treatment option for patients with NIC in conjunction with synovial facet cysts (<3 mm, ≥3 mm). RESULTS Fifty-eight of 285 patients (20.4%) were determined to have a synovial cyst as a contributing component of spinal stenosis. Twelve of 58 patients were noted to have a cyst ≥3 mm. The mean follow-up time for patients with and without a facet cyst was 21 months (6-55±12 mo) and 22 months (6-61±12 mo), respectively. The age of the patient at the time of the operation with and without facet cysts was 73 (±10 y). Patients without synovial cysts, with synovial cysts, and cysts ≥3 mm had an average change in Oswestry Disability Index of 15.6, 15.8, and 16.2, respectively. Visual Analog Scale scores were 2.3, 1.8, and 2.3, respectively. In addition, on satisfaction surveys 72.4%, 82.0%, and 77.8% were either very or somewhat satisfied, respectively. Overall complications included 4 spinous process fracture, 4 hematomas, 1 wound infection, and 1 implant migration. CONCLUSIONS No statistical difference was noted in any of the outcome measures among patients with small facet cysts, large facet cysts, or without facet cysts when treated with an interspinous process device. We can thus conclude that X-Stop is an appropriate treatment consideration for NIC with or without the presence of synovial facet cysts.
Collapse
Affiliation(s)
- Joshua Abrams
- St Mary's Spine Center, San Francisco, CA 94117, USA.
| | | | | | | | | |
Collapse
|
59
|
Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Oh HS, Lee CH, Kim MS. Extradural cyst causing spinal cord compression in osteoporotic compression fracture. J Neurosurg Spine 2013; 19:133-7. [PMID: 23662886 DOI: 10.3171/2013.4.spine121101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intraspinal cystic lesions with different pathogeneses have been reported to cause neurological deficits; however, no one has focused on the intraspinal extradural cysts that develop after osteoporotic compression fracture. The reported case features a 66-year-old woman presenting with progressive neurological deficit, back pain, and no history of additional trauma after undergoing conservative treatment for an osteoporotic fracture of L-1. The authors present serial radiographs and MR images demonstrating an epidural cyst successfully treated via a single posterior approach. This appears to be the first such case reported in the literature.
Collapse
Affiliation(s)
- Jung-Hee Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
| | | | | | | | | | | | | | | |
Collapse
|
60
|
Kato M, Konishi S, Matsumura A, Hayashi K, Tamai K, Shintani K, Kazuki K, Nakamura H. Clinical characteristics of intraspinal facet cysts following microsurgical bilateral decompression via a unilateral approach for treatment of degenerative lumbar disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1750-7. [PMID: 23543390 DOI: 10.1007/s00586-013-2763-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 01/24/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary intraspinal facet cysts in the lumbar spine are uncommon, but it is unclear whether cyst incidence increases following decompression surgery and if these cysts negatively impact clinical outcome. We examined the prevalence, clinical characteristics, and the risk factors associated with intraspinal facet cysts after microsurgical bilateral decompression via a unilateral approach (MBDU). METHODS We studied 230 patients treated using MBDU for lumbar degenerative disease (133 men and 97 women; mean age 70.3 years). Clinical status, as assessed by the Japanese Orthopedic Association (JOA) score and findings on X-ray and magnetic resonance images, was evaluated prior to surgery and at both 3 months and 1 year after surgery. The prevalence of intraspinal facet cysts was determined and preoperative risk factors were defined by comparing presurgical findings with clinical outcomes. RESULTS Thirty-eight patients (16.5%) developed intraspinal facet cysts within 1 year postoperatively, and 24 exhibited cysts within 3 months. In 10 patients, the cysts resolved spontaneously 1 year postoperatively. In total, 28 patients (12.2%) had facet cysts 1 year postoperatively. The mean JOA score of patients with cysts 1 year postoperatively was significantly lower than that of patients without cysts. This poor clinical outcome resulted from low back pain that was not improved by conservative treatment. Most cases with spontaneous cyst disappearance were symptom-free 1 year later. The preoperative risk factors for postoperative intraspinal facet cyst formation were instability (OR 2.47, P = 0.26), scoliotic disc wedging (OR 2.23, P = 0.048), and sagittal imbalance (OR 2.22, P = 0.045). CONCLUSIONS Postoperative intraspinal facet cyst formation is a common cause of poor clinical outcome in patients treated using MBDU.
Collapse
Affiliation(s)
- Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
61
|
Park HS, Sim HB, Kwon SC, Park JB. Hemorrhagic lumbar synovial cyst. J Korean Neurosurg Soc 2012; 52:567-9. [PMID: 23346333 PMCID: PMC3550429 DOI: 10.3340/jkns.2012.52.6.567] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/28/2012] [Accepted: 12/14/2012] [Indexed: 11/27/2022] Open
Abstract
Synovial cysts of the lumbar spine are an uncommon cause of back and radicular pain. These cysts most frequently present as back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms secondary to spinal canal compromise. Although less common, they can also present with acute spinal cord or root compression symptoms. We report of a case in which hemorrhaging into a right L2-3 facet synovial cyst caused an acute onset of back pain and radiculopathy, requiring surgical excision.
Collapse
Affiliation(s)
- Hyun Seok Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | | | | | | |
Collapse
|
62
|
Rhee J, Anaizi AN, Sandhu FA, Voyadzis JM. Minimally invasive resection of lumbar synovial cysts from a contralateral approach. J Neurosurg Spine 2012; 17:453-8. [DOI: 10.3171/2012.8.spine12101] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Synovial cysts of the lumbar spine result from degeneration of the facet capsule and often mimic symptoms commonly seen with herniated intervertebral discs. In symptomatic patients, the prevalence of synovial cysts may be as high as 10%. Although conservative management is possible, the majority of patients will require resection. Traditional procedures for lumbar synovial cyst resection use an ipsilateral approach requiring partial or complete resection of the ipsilateral facet complex, possibly leading to further destabilization. A contralateral technique using minimally invasive tubular retractors for synovial cyst resection avoids facet disruption. The authors report 2 cases of a minimally invasive synovial cyst resection via a contralateral laminotomy. In both cases, complete resection of the cyst was achieved while sparing the facet joint.
Collapse
|
63
|
Abstract
Two 15-yr-old grizzly bear littermates were evaluated within 9 mo of each other with the symptom of acute onset of progressive paraparesis and proprioceptive ataxia. The most significant clinical examination finding was pelvic limb paresis in both bears. Magnetic resonance examinations of both bears showed cranial thoracic spinal cord compression. The first bear had left-sided extradural, dorsolateral spinal cord compression at T3-T4. Vertebral canal stenosis was also observed at T2-T3. Images of the second bear showed lateral spinal cord compression from T2-T3 to T4-T5. Intervertebral disk disease and associated spinal cord compression was also observed at T2-T3 and T3-T4. One grizzly bear continued to deteriorate despite reduced exercise, steroid, and antibiotic therapy. The bear was euthanized, and a necropsy was performed. The postmortem showed a spinal ganglion cyst that caused spinal cord compression at the level of T3-T4. Wallerian-like degeneration was observed from C3-T6. The second bear was prescribed treatment that consisted of a combination of reduced exercise and steroid therapy. He continued to deteriorate with these medical therapies and was euthanized 4 mo after diagnosis. A necropsy showed hypertrophy and protrusion of the dorsal longitudinal ligament at T2-T3 and T3-T4, with resulting spinal cord compression in this region. Wallerian-like degeneration was observed from C2-L1. This is one of few case reports that describes paresis in bears. It is the only case report, to the authors' knowledge, that describes spinal magnetic resonance imaging findings in a grizzly bear and also the only report that describes a cranial thoracic myelopathy in two related grizzly bears with neurologic signs.
Collapse
|
64
|
El Shazly AA, Khattab MF. Surgical excision of a Juxtafacet cyst in the lumbar spine: A report of thirteen cases with long-term follow up. Asian J Neurosurg 2012; 6:78-82. [PMID: 22347328 PMCID: PMC3277074 DOI: 10.4103/1793-5482.92162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
CONTEXT Juxtafacet cysts of the lumbar spine are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. Surgical treatment is indicated when there is failure of conservative measures. Primary spinal fusion at the time of surgical excision of the cyst is a matter of controversy. Few reports have described long-term follow-up for surgical treatment of spinal cysts. AIM The purpose of this study is to assess the long-term outcome of the surgical excision of a Juxtafacet cyst without spinal fusion. STUDY DESIGN This is a retrospective case series study, level IV evidence. MATERIALS AND METHODS This is a retrospective case series study on 13 patients with Juxtafacet cysts, who were treated with surgical excision of the cysts without spinal fusion. A questionnaire scoring system was used for evaluation of the surgical outcome. RESULTS The study was conducted on 13 patients, seven females (54%) and six males (46%), their age ranging from 38 to 69 years, with a mean age of 52 (±9.93 STD) years. The mean duration of the symptoms was 10.5 (±6.22 STD) months. All patients got benefit from surgery, with six excellent (46%), six good (46%), and one fair outcome (8%), with no surgery-related complications. The mean follow-up period of the patients at the time of this study was 4.2 years (±1.43 STD). CONCLUSION Long-term follow-up for surgical excision of symptomatic Juxtafacet cysts without spinal fusion revealed excellent to good results in 92% of the patients, with a satisfaction rate of 80% (±8.41 STD).
Collapse
Affiliation(s)
- Ayman A El Shazly
- Departments of Neurosurgery and Orthopedics, Ain Shams University, Ramses Extension Road, Abbasia Square, Cairo, Egypt
| | | |
Collapse
|
65
|
Mattei TA, Goulart CR, McCall TD. Pathophysiology of regression of synovial cysts of the lumbar spine: the 'anti-inflammatory hypothesis'. Med Hypotheses 2012; 79:813-8. [PMID: 23021571 DOI: 10.1016/j.mehy.2012.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/25/2012] [Accepted: 08/30/2012] [Indexed: 12/12/2022]
Abstract
The term 'synovial cysts' of the lumbar spine refers to cysts that arise from the zygapophyseal joint capsule of the lumbar spine. Although several cases of regression of lumbar spine synovial cysts after oral anti-inflammatory therapy as well as local steroid injection have already been reported in the literature, no study up to now has addressed the role of 'inflammation suppression' in the regression of such lesions. In fact most of the previous studies have regarded 'spontaneous rupture' as well as 'instability resolution' as the most probable explanations for such phenomenon. In this article the authors review the current experimental data about the role of cytokines and inflammation in the development of synovial cysts of the lumbar spine. Additionally with basis on both our clinical experience of regression of a synovial cyst after conservative treatment with a non-steroidal anti-inflammatory drug (Cox-2 inhibitor) as well as on the experimental data supporting the multi-factorial effects of such drugs on the lumbar facet joints, the authors hypothesize that inhibition of inflammation might play a significant role in the pathophysiology of lumbar spine synovial cysts' regression.
Collapse
Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, University of Illinois, Peoria, IL, USA.
| | | | | |
Collapse
|
66
|
Machino M, Yukawa Y, Ito K, Kanbara S, Kato F. Spontaneous hemorrhage in an upper lumbar synovial cyst causing subacute cauda equina syndrome. Orthopedics 2012; 35:e1457-60. [PMID: 22955421 DOI: 10.3928/01477447-20120822-41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lumbar spine synovial cysts are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. They are common in lower lumbar lesions but rare in upper lumbar lesions. Several cases of hemorrhage into lower lumbar juxtafacet cysts after trauma or anticoagulation therapy have been reported in the literature. This article describes a case of subacute cauda equina syndrome resulting from spontaneous hemorrhage into an upper lumbar synovial cyst. A 65-year-old man presented with a 3-month history of intermittent bilateral lumbar pain. One week before, he experienced a sudden exacerbation of lumbar pain and began falling frequently; he also reported weakness and tingling in his lower limbs. A hematic collection associated with a large juxtafacet cyst at L2-L3 was suspected on magnetic resonance imaging. He underwent surgical decompression, and the cyst was resected. Microscopic examination was consistent with the diagnosis of a synovial cyst. Two days postoperatively, he was walking independently. Although several descriptions exist of hemorrhagic lumbar juxtafacet cysts after trauma or anticoagulant therapy, to the authors' knowledge, this is the first documented case of hemorrhage in an upper lumbar synovial cyst with no previous traumatic event or medication use. Magnetic resonance imaging was essential in making the preoperative diagnosis. Surgical removal of the cyst was an effective treatment.
Collapse
Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan.
| | | | | | | | | |
Collapse
|
67
|
Ha SW, Ju CI, Kim SW, Lee S, Kim YH, Kim HS. Clinical outcomes of percutaneous endoscopic surgery for lumbar discal cyst. J Korean Neurosurg Soc 2012; 51:208-14. [PMID: 22737300 PMCID: PMC3377877 DOI: 10.3340/jkns.2012.51.4.208] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/26/2012] [Accepted: 04/15/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up. METHODS All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria]. RESULTS All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was 8.25±0.5. At the last examination followed longer than 6 month, the mean VAS for leg pain was 2.25±2.21. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia. CONCLUSION The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach.
Collapse
Affiliation(s)
- Sang Woo Ha
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | | | | | | | | | | |
Collapse
|
68
|
Chung D, Cho DC, Sung JK, Choi E, Bae KJ, Park SY. Retrospective report of symptomatic postoperative discal pseudocyst after lumbar discectomy. Acta Neurochir (Wien) 2012; 154:715-22. [PMID: 22223287 DOI: 10.1007/s00701-011-1219-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 10/27/2011] [Indexed: 01/30/2023]
Abstract
BACKGROUND Rarely, a symptomatic discal pseudocyst can develop after discectomy. Only very recently one clinical article and one case report about this type of pseudocyst were published: Kang and Park (J Korean Neurosurg Soc 49(1):31-36, 2011); Young PM, Fenton DS, Czervionke LF (Spine J. 9(2):e9-e15, 2009). Here, in an attempt to more clearly discriminate this peculiar cyst, the authors retrospectively report the clinical, radiological, and histological findings in 12 symptomatic patients with cystic lesions attached to an operated disc. METHODS From January 2007 to May 2010, 12 patients who experienced recurrent symptoms after successful lumbar discectomy were diagnosed with postoperative discal pseudocyst (PDP). After discectomy, the mean time to relapsing radiculopathy was 23.3 days (range, 9-38 days) with a mean of 6.8 ± 1.3 on the visual analogue scale (VAS). PDPs were detected on magnetic resonance imaging (MRI) at 31.2 days (range, 14-60 days) after the initial surgery. Of these 12 patients, 6 were treated conservatively (group C) and 6 by surgery (group S). RESULTS In the six patients in group C, the mean duration of relapsing pain was 77.8 days (range, 20-225 days), and near total or total regression of the cyst was detected at a mean of 82.7 days (range, 23-240 days) after initial detection by MRI. Time to spontaneous regression of PDP varied widely. In the six patients in group S, surgical treatment was administered within a few days of MRI diagnosis and achieved successful pain relief. CONCLUSIONS Postoperative discal pseudocyst appears to develop after lumbar discectomy and can regress spontaneously.
Collapse
Affiliation(s)
- Daeyeong Chung
- Department of Neurosurgery, Kyungpook National University Hospital, Jung-gu, Daegu, Republic of Korea
| | | | | | | | | | | |
Collapse
|
69
|
Nojiri H, Sakuma Y, Uta S. Degenerative intraspinal cyst of the cervical spine. Orthop Rev (Pavia) 2011; 1:e17. [PMID: 21808679 PMCID: PMC3143991 DOI: 10.4081/or.2009.e17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 07/28/2009] [Accepted: 07/28/2009] [Indexed: 11/23/2022] Open
Abstract
We describe two cases of degenerative intraspinal cyst of the cervical spine that caused a gradually progressive myelopathy. One case had a cyst that arose from the facet joint and the other case had a cyst that formed in the ligamentum flavum. The symptoms improved immediately after posterior decompression by cystectomy with laminoplasty.
Collapse
|
70
|
Using precisely controlled bidirectional orthopedic forces to assess flexibility in adolescent idiopathic scoliosis: comparisons between push-traction film, supine side bending, suspension, and fulcrum bending film. Spine (Phila Pa 1976) 2011; 36:1679-84. [PMID: 21221052 DOI: 10.1097/brs.0b013e31820e6265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE To validate the effectiveness of push-traction film (PTF) in assessment of curve flexibility in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA There is no agreement among surgeons about the most advantageous method in flexibility evaluation of scoliosis. As all methods available provide the orthopedic force from one direction and use a single torque, it is difficult for them to achieve the postoperative correction; also they could not meet the needs for different types of curves. METHODS Precisely controlled bidirectional (push and traction) orthopedic forces were applied for curve flexibility evaluation in 31 consecutive adolescent idiopathic scoliosis patients. The correction rate (CR) of postoperation, supine side-bending, suspension, and fulcrum bending radiographs were compared with PTF in instrumented main thoracic (MT) and thoracolumbar/lumbar curves. Correlation and linear regression analyses were also been done to find the best predictor among the four methods. RESULTS In MT group, CR of PTF was significantly higher than that of side bending (P = 0.010) and suspension (P = 0.000) but not significantly different from that of fulcrum bending (P = 0.335). In TL/L group, CR of PTF was significantly higher than that of suspension (P = 0.000), but not significantly different from that of side bending (P = 0.681) and fulcrum bending (P = 0.382). There was no significant difference between CR of PTF and postoperation in both MT (P = 0.122) and TL/L (P = 0.068) groups. Correlation and linear regression analyses showed that PTF provided the highest correlation of the four methods, with the postoperative angle in both MT (r = 0.957) and MT/L group (r = 0.779). CONCLUSION To our knowledge, this was the first report about using precisely controlled bidirectional correction forces for curve flexibility evaluation. Although it did not achieve the best CR among the four methods studied, correlation and regression analyses confirmed that PTF was a more stable and accurate method to predict flexibility. We believe that further exploration of a more rational push-traction force ratio would help to obtain a better flexibility.
Collapse
|
71
|
Subaxial cervical synovial cysts: report of 35 histologically confirmed surgically treated cases and review of the literature. Spine (Phila Pa 1976) 2011; 36:E1285-9. [PMID: 21358479 DOI: 10.1097/brs.0b013e31820709a8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study OBJECTIVE The authors' aim of the present study is to report their experience with subaxial cervical synovial cysts hoping to provide further insight into these lesions including the presenting symptoms, possible mechanisms of cyst development associated with cervical level, surgical treatments and clinical outcomes. SUMMARY OF BACKGROUND DATA Synovial cysts are relatively common in the lumbar spine and very uncommonly identified in the subaxial cervical spine. Several case reports and a few small series have been reported in the literature over the past four decades. METHODS The authors retrospectively reviewed the cases of 35 patients who underwent surgical treatment for histologically confirmed symptomatic subaxial cervical synovial cysts between 1993 and 2009. The presenting symptoms, age, sex, cervical level, operation, complications and outcomes were analyzed in this cohort. Preoperative and postoperative neurologic assessments were done by staff neurologists independent of the operating surgeon. This study was approved by the Mayo Clinic institutional review board. RESULTS Thirty-five patients underwent surgical treatment for their synovial cysts and follow-up for at least 12 months postoperatively. The mean follow-up time was 49 months (range, 12-134). There were no deaths associated with the surgery. There was one postoperative infection in a patient undergoing a decompressive laminectomy and posterior instrumented fusion. Patient outcomes were assessed using the Modified Rankin Score for 12 patients was 0, 17 patients was 1, 4 patients was 2, and 2 patients was 3. CONCLUSION This series of 35 patients with subaxial cervical synovial cysts surgically treated over a period of 17 years illustrates the relative rarity of these lesions. Magnetic resonance imaging is currently the optimal radiographic study to identify these lesions. Surgical resection can be an effective treatment.
Collapse
|
72
|
Spontaneous regression of a symptomatic atlanto-occipital joint cyst. Case report. Neurochirurgie 2011; 57:129-32. [DOI: 10.1016/j.neuchi.2011.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 03/21/2011] [Indexed: 11/22/2022]
|
73
|
Xu R, Solakoglu C, Maleki Z, McGirt MJ, Gokaslan ZL, Bydon A. Hemorrhagic synovial cyst: the possible role of initial trauma and subsequent microtrauma in its pathogenesis: case report. Neurosurgery 2011; 68:E858-65; discussion E865. [PMID: 21311282 DOI: 10.1227/neu.0b013e3182080127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Intraspinal synovial cysts are uncommon causes of back and radicular leg pain. Usually associated with degenerative spinal disease, these juxtafacet cysts are usually located in the lumbar spine and may rarely undergo intracystic hemorrhage. The pathogenesis of these cysts are unclear, and risk factors that may contribute to hemorrhagic complications are largely unknown. CLINICAL PRESENTATION A 68-year-old man presented to the clinic 4 months after a fall on ice with persistent back pain and lumbar radiculopathy. A week after the initial clinic consultation, the patient presented to the emergency room with increased pain and worsening weakness in the left foot. An emergent magnetic resonance image showed thecal sac compression secondary to a large, juxtafacet cyst that was hyperintense on T1-weighted and hypointense on T2-weighted images. Lumbar decompressive laminectomies were performed at L3 and L4 with cyst removal and stabilization. CONCLUSION We present the eighth reported case of a hemorrhagic juxtafacet cyst secondary to physical trauma, the second in which the patient's symptoms acutely worsened several months after the initial insult without new trauma. We also present summary statistics of the 31 cases of hemorrhagic juxtafacet cysts reported in the literature and propose a putative mechanism that may account for the development and progression of symptoms in some patients.
Collapse
Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
| | | | | | | | | | | |
Collapse
|
74
|
Moon HJ, Kim JH, Kim JH, Kwon TH, Chung HS, Park YK. Cervical juxtafacet cyst with myelopathy due to postoperative instability. Case report. Neurol Med Chir (Tokyo) 2011; 50:1129-31. [PMID: 21206195 DOI: 10.2176/nmc.50.1129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 74-year-old man presented with a cervical juxtafacet cyst on the right side of C5-6 and prominent myelopathy. He had been treated with anterior cervical discectomy and fusion at C4-5 as well as anterior foraminotomy of the right C5-6 lesion 20 months previously. The patient underwent complete surgical excision of the lesion. The patient recovered uneventfully, and the myelopathy resolved. Reexamination of the images revealed that we failed to investigate a suspicious minimal cervical juxtafacet cyst on the initial preoperative images and that the degree of subluxation at C5-6 on flexion radiography had increased postoperatively. Therefore, the surgeon should be aware that juxtafacet cyst can be progressive in planning of cervical spinal surgery which can cause or aggravate instability in the presence of an incidental, suspicious juxtafacet cyst on preoperative imaging at the same level, even if the lesion is very small and subclinical.
Collapse
Affiliation(s)
- Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, R.O.K
| | | | | | | | | | | |
Collapse
|
75
|
Kim SW, Choi JH, Kim MS, Chang CH. A ganglion cyst in the second lumbar intervertebral foramen. J Korean Neurosurg Soc 2011; 49:237-40. [PMID: 21607185 DOI: 10.3340/jkns.2011.49.4.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/12/2010] [Accepted: 03/27/2011] [Indexed: 11/27/2022] Open
Abstract
Ganglion cysts usually arise from the tendon sheaths and tissues around the joints. It is usually associated with degenerative arthritic changes in older people. Ganglion cyst in the spine is rare and there is no previous report on case that located in the intervertebral foramen and compressed dorsal root ganglion associated severe radiculopathy. A 29-year-old woman presented with severe left thigh pain and dysesthesia for a month. Magnetic resonance imaging revealed a dumbbell like mass in the intervertebral foramen between second and third lumbar vertebrae on the left side. The lesion was removed after exposure of the L2-L3 intervertebral foramen. The histological examination showed fragmented cystic wall-like structure composed of fibromyxoid tissue but there was no lining epithelium. A ganglion cyst may compromise lumbar dorsal root ganglion when it located in the intervertebral foramen. Although it is very rare location, ganglion cyst should be included in the differential diagnosis for intervertebral foraminal mass lesions.
Collapse
Affiliation(s)
- Sang Woo Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
| | | | | | | |
Collapse
|
76
|
BLAIR WAKAH, LEVINE JONATHANM, KERWIN SHARONC, SPAULDING KATHYA, YOUNG BENJAMIND, POOL ROYR. IMAGING DIAGNOSIS-SYNOVIAL MYXOMA OF LUMBAR VERTEBRAE ARTICULAR PROCESS JOINT. Vet Radiol Ultrasound 2011; 52:309-12. [DOI: 10.1111/j.1740-8261.2010.01795.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
77
|
Bydon A, Xu R, Parker SL, McGirt MJ, Bydon M, Gokaslan ZL, Witham TF. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. Spine J 2010; 10:820-6. [PMID: 20488765 DOI: 10.1016/j.spinee.2010.04.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 03/14/2010] [Accepted: 04/08/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear. PURPOSE To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence. STUDY DESIGN Systematic review of the literature. PATIENT SAMPLE All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion. OUTCOME MEASURES Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales. METHODS We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts. RESULTS Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4-L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion. CONCLUSIONS Surgical decompression results in symptomatic resolution in the vast majority of patients; however, recurrent back pain occurs in a significant number of patients. Cyst recurrence occurs in less than 2% of patients but has never been reported after cyst excision with concomitant fusion. The lack of cyst recurrence after concomitant fusion supports the need to investigate the value of fusion of the involved motion segment in the treatment of symptomatic synovial cysts of the spine.
Collapse
Affiliation(s)
- Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | | | | | | | | | | | | |
Collapse
|
78
|
Abstract
Bydon A, Xu R, Parker SL, et al. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systemic review of reported postoperative outcomes. Spine J 2010;10:820-826 (in this issue).
Collapse
Affiliation(s)
- Arun Gupta
- Physiatry Department, Hospital for Special Surgery, New York, NY 10021, USA
| | | |
Collapse
|
79
|
Aizawa T, Ozawa H, Kusakabe T, Nakamura T, Chanplakorn P, Itoi E. C1/2 facet cyst revealed by facet joint arthrography. J Orthop Sci 2010; 15:603-7. [PMID: 20721733 DOI: 10.1007/s00776-009-1472-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 11/02/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | | | | | | | | | | |
Collapse
|
80
|
Factors associated with recurrent back pain and cyst recurrence after surgical resection of one hundred ninety-five spinal synovial cysts: analysis of one hundred sixty-seven consecutive cases. Spine (Phila Pa 1976) 2010; 35:1044-53. [PMID: 20173680 DOI: 10.1097/brs.0b013e3181bdafed] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Compare outcomes of different treatment methods for intraspinal synovial cysts. SUMMARY OF BACKGROUND DATA Intraspinal synovial cysts are cited as an increasing cause of back pain and radiculopathy. To date, few studies have compared outcomes of differing treatment methods in patients with synovial cysts. METHODS We retrospectively reviewed 167 consecutive patients undergoing surgical management of 195 symptomatic synovial cysts at a single institution over 19 years. The incidence of postoperative mechanical back pain, radiculopathy, and cyst recurrence was compared between patients undergoing unilateral hemilaminectomy (n = 51), bilateral laminectomy (n = 39), facetectomy with in situ fusion (n = 18), and facetectomy with instrumented fusion (n = 56). RESULTS A total of 155 (97.5%) patients presented with radiculopathy, 132(82.5%) with mechanical back pain, 31 (20%) with neurogenic claudication, and 5 (3.2%) with bladder dysfunction. Most cysts occurred in the lumbar spine. After surgery, back and radicular pain improved in 91.6% and 91.9% patients, respectively. By a mean follow-up of 16 +/- 9 months, 36 (21.6%) patients developed recurrent back pain, 20 (11.8%) recurrent leg pain, and 5 (3%) recurrent synovial cysts. Patients undergoing laminectomy had a significantly increased cyst recurrence incidence compared to fusion groups via log-rank test (P = 0.042), and this risk was decreased to baseline with instrumented fusion on reoperation. Laminectomy was also associated with the highest increased risk of recurrent back pain in both log-rank test (P = 0.018) and proportional hazards regression (HR): 1.64 (1.00-3.45), P = 0.05. Instrumented fusion had the lowest risk for back pain recurrence. CONCLUSION Hemilaminectomy or laminectomy remains one of the mainstay surgical treatments for symptomatic intraspinal synovial cysts. Our experience shows that the majority of patients undergoing decompression/excision of synovial cysts will have immediate improvement in back and leg pain. However, within 2 years, patients receiving hemilaminectomy or laminectomy alone have an increased incidence of back pain and cyst recurrence. Decompression with instrumented fusion appears to be associated with the lowest incidences of cyst recurrence or back pain.
Collapse
|
81
|
Aydin S, Abuzayed B, Yildirim H, Bozkus H, Vural M. Discal cysts of the lumbar spine: report of five cases and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1621-6. [PMID: 20364391 DOI: 10.1007/s00586-010-1395-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 03/17/2010] [Accepted: 03/21/2010] [Indexed: 12/20/2022]
Abstract
Discal cysts are rare causes of low back pain and radiculopathy. Only few reports in the literature describe these pathologies. In this article, the authors report five cases (3 males and 2 females) of lumbar discal cysts treated surgically by microdiscectomy. These patients were admitted with a history of back pain and/or sciatalgia. Magnetic resonance imaging of the lumbar spine of all patients revealed lumbar discal cysts, causing compression to the spinal dura and roots. All patients were treated by partial hemilaminectomy and microscopic cyst resection. Postoperatively, the complaints showed improvement, and the patients were discharged with no complications. The cases of lumbar discal cysts are described in the literature as individual case reports, therefore; the authors performed a wide systemic review of all these cases published in PubMed and MedLine, including the patients in the present report. The data of all patients were analyzed to obtain statistically based estimated information about the incidence, the epidemiology, the natural history and the optimum management of these lesions.
Collapse
Affiliation(s)
- Sabri Aydin
- Department of Neurosurgery, VKV American Hospital, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
82
|
Kim JS, Lee SH. Carbon dioxide (CO2) laser-assisted ablation of lumbar discal cyst. Photomed Laser Surg 2010; 27:837-42. [PMID: 20035601 DOI: 10.1089/pho.2008.2397] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical usefulness of CO2 laser dissection in patients who had undergone lumbar discal cyst removal. METHODS Clinical and radiological data were reviewed for 14 patients who underwent single lumbar level CO2 laser dissection followed by lumbar discal cyst removal between 2003 and 2008. They were followed up with plain radiographs, and their mean follow-up period was 20.1 months. RESULTS Patients' mean hospital stay after operation was 3.5 days. Pain scores on a visual analog scale (VAS) for back and leg pain improved from a preoperative mean of 4.3 and 8.1 to postoperative 1.9 and 1.8, respectively (P<0.001). Clinical outcomes based on the Oswestry disability index (ODI) improved from a preoperative mean of 46.47% to 14.81% postoperatively (P<0.001). CONCLUSION Our results demonstrate that the CO2 laser could be a useful surgical tool for the surgical excision of lumbar discal cysts.
Collapse
Affiliation(s)
- Jin-Sung Kim
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
| | | |
Collapse
|
83
|
The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine (Phila Pa 1976) 2009; 34:2518-24. [PMID: 19927101 DOI: 10.1097/brs.0b013e3181b22bd0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A clinicopathologic study of synovial cysts in the ligamentum flavum (LF) in patients with spinal stenosis. OBJECTIVE To investigate the pathogenesis of lumbar juxtafacet cysts. SUMMARY OF BACKGROUND DATA Contradictions in the terminology applied to lumbar juxtafacet cysts arise from the frequent sparsity of synovial lining cells, which has led to synovial cysts often being called "ganglion cysts" despite lacking confirmatory pathology. METHODS A total of 27 consecutive patients with radiologically confirmed stenosis underwent laminectomy. LF/facet joint (FJ) relationships were retained by en bloc excision of the LF and the medial inferior FJ. Controls were LF/FJ specimens from 47 cadaver lumbar spines. RESULTS The 27 patients yielded 51 LF/FJ specimens containing 28 synovial cysts, 12 of which were unilateral and 8 were bilateral. Fragments of articular cartilage and bone were embedded in the walls of 89% of cysts and in the walls of a bursa-like channel originating from the medial aspect of the FJ capsule and extending into the LF. Communication with the FJ via this channel was observed in 21 (75%) of the 28 synovial cysts. Extending up to 12 mm in length, the channel was present in nearly all control spines at the L4-L5 level but in only about half at the T12-L1 level. CONCLUSION Cysts having an extensive or meagre synovial cell lining are common in the LF of patients with symptomatic lateral or central stenosis. The cysts communicate with the FJ by a bursa-type channel within the LF. Advanced osteoarthritis of the FJ causes the liberation of fragments of cartilage and bone into the synovial fluid of the joint space. This enables some fragments to escape from the joint into the channel and become lodged within its wall where they provoke granulation tissue and scar formation. The tissue response to articular debris may block the synovial-lined channel to cause synovial cyst formation.
Collapse
|
84
|
DePalma MJ. Driving the lane: a clearer view of facet joint cyst intervention. Spine J 2009; 9:921-3. [PMID: 19775940 DOI: 10.1016/j.spinee.2009.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 08/13/2009] [Indexed: 02/03/2023]
Affiliation(s)
- Michael J DePalma
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Spine Center, 8700 Stony Point Pkwy, Suite 260, Richmond, VA 23235, USA.
| |
Collapse
|
85
|
Dumay-Levesque T, Souteyrand AC, Michel JL. Steroid injection performed with fluoroscopy for treatment of a discal cyst. J Rheumatol 2009; 36:1841-3. [PMID: 19671827 DOI: 10.3899/jrheum.090050] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
86
|
Cho SM, Rhee WT, Choi SJ, Eom DW. Lumbar intraspinal extradural ganglion cysts. J Korean Neurosurg Soc 2009; 46:56-9. [PMID: 19707495 DOI: 10.3340/jkns.2009.46.1.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 12/30/2008] [Accepted: 06/29/2009] [Indexed: 11/27/2022] Open
Abstract
The lumbar intraspinal epidural ganglion cyst has been a rare cause of the low back pain or leg pain. Ganglion cysts and synovial cysts compose the juxtafacet cysts. Extensive studies have been performed about the synovial cysts, however, very little has been known about the ganglion cyst. Current report is about two ganglion cysts associated with implicative findings in young male patients. We discuss about the underlying pathology of the ganglion cyst based on intraoperative evidences, associated disc herniation at the same location or severe degeneration of the ligament flavum that the cyst originated from in young patients.
Collapse
Affiliation(s)
- Sung Min Cho
- Department of Neurosurgery, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Korea
| | | | | | | |
Collapse
|
87
|
Kim JS, Choi G, Jin SR, Lee SH. Removal of a discal cyst using a percutaneous endoscopic interlaminar approach: a case report. Photomed Laser Surg 2009; 27:365-9. [PMID: 19382841 DOI: 10.1089/pho.2008.2279] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Here we report on a percutaneous endoscopic interlaminar approach using a side-firing Ho:YAG laser for the treatment of lumbar discal cyst with a successful clinical outcome. A 27-year-old man presented with left gluteal and leg pain due to a discal cyst at the L5-S1 level. A percutaneous endoscopic interlaminar approach was used to remove the cyst, achieving complete decompression of the nerve root. The symptoms were relieved and the patient was discharged the next day. A percutaneous endoscopic interlaminar approach using a side-firing Ho:YAG laser appears to be a suitable alternative treatment for selected patients with lumbar discal cysts.
Collapse
Affiliation(s)
- Jin-Sung Kim
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
| | | | | | | |
Collapse
|
88
|
Ikuta K, Tono O, Oga M. Prevalence and clinical features of intraspinal facet cysts after decompression surgery for lumbar spinal stenosis. J Neurosurg Spine 2009; 10:617-22. [DOI: 10.3171/2009.2.spine08769] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Object
Although many cases of primary intraspinal facet cysts in the lumbar spine have been reported, there have only been a few reports of postoperative intraspinal facet cysts in the lumbar spine. The purpose of this study was to investigate the prevalence and clinical features of postoperative intraspinal facet cysts in the lumbar spine.
Methods
Data from 81 patients undergoing microendoscopic posterior decompression to treat lumbar spinal stenosis were reviewed. The development of a postoperative intraspinal facet cyst was observed using MR imaging during 1 year after surgery. If the patient demonstrated a postoperative intraspinal facet cyst, additional MR imaging was performed to evaluate the natural course of the cyst. Furthermore, the authors conducted a comparative evaluation to identify the factors associated with the causes of cyst development.
Results
A postoperative intraspinal facet cyst developed in 7 patients (8.6%) during 1 year after surgery. Spondylotic spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis were revealed before surgery in 2, 4, and 1 patient, respectively. In 5 patients, the cysts developed within 3 months after surgery. Although 3 patients exhibited symptoms caused by cyst development, all symptoms were relieved by conservative treatment. On radiographic evaluations, postoperative segmental spinal instability, including a progression of spondylolisthesis and disc degeneration, was revealed in 6 (86%) of the 7 patients. Spontaneous regression of the cysts was observed in 5 (71%) of these 7 patients. On comparative evaluation of patients with and without postoperative intraspinal facet cysts, the presence of segmental spinal instability before surgery (including degenerative spondylolisthesis) and the appearance of postoperative segmental spinal instability were related to the development of the cysts.
Conclusions
The prevalence of postoperative intraspinal facet cysts, including asymptomatic cysts, was 8.6% during 1 year after decompression surgery for lumbar spinal stenosis. The development of postoperative intraspinal facet cysts was related to the presence of segmental spinal instability before surgery (including degenerative spondylolisthesis) and postoperative segmental spinal instability, including a progression of spondylolisthesis and disc degeneration after surgery. A postoperative intraspinal facet cyst, which can be expected to regress spontaneously with a probability > 50%, should be recognized as one of the postoperative complications of decompression surgery for lumbar spinal stenosis.
Collapse
Affiliation(s)
- Ko Ikuta
- 1Department of Orthopedic Surgery, Karatsu Red Cross Hospital, Karatsu City; and
| | - Osamu Tono
- 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Masayoshi Oga
- 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| |
Collapse
|
89
|
Allen TL, Tatli Y, Lutz GE. Fluoroscopic percutaneous lumbar zygapophyseal joint cyst rupture: a clinical outcome study. Spine J 2009; 9:387-95. [PMID: 18809358 DOI: 10.1016/j.spinee.2008.08.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 08/05/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar zygapophyseal joint (Z-joint) synovial cysts can cause low back pain (LBP), spinal stenosis, and lower extremity radiculopathy. In the literature, there are several minimally invasive techniques described with mixed results. Typical recommended treatment is surgical resection of the cyst. Currently, there is little information available concerning the efficacy and outcome with treatment of Z-joint synovial cyst by percutaneous, fluoroscopic, contrast-enhanced distention, and rupture. PURPOSE To evaluate the therapeutic value and safety of Z-joint cyst rupture in symptomatic patients. STUDY DESIGN/SETTING Retrospective cohort study in an academic outpatient physiatric spine practice. PATIENT SAMPLE Thirty-two patients with moderate-to-severe LBP and leg pain (18 women and 14 men with an age range of 46-86 y; mean age, 66 y) with an average preprocedure symptom duration of 5 months. The patient's clinical symptoms correlated with magnetic resonance imaging studies documenting the presence of a synovial cyst at the corresponding level and side of symptoms. Patients had at least 6 months follow-up (range, 6-24). OUTCOME MEASURES Numerical Pain Rating Scale, Roland-Morris Disability Questionnaire, North American Spine Society four-point patient satisfaction survey, recurrence of synovial cyst requiring repeat rupture, and need for surgical intervention. METHODS Patients with symptomatic lumbar Z-joint synovial cyst were identified and their charts were reviewed. Patients included in the study either had symptomatic lumbar LBP or LBP with associated lower extremity radiculopathy. All patients in the study had magnetic resonance imaging's documenting Z-joint synovial cyst that corresponded with the patients' clinical symptoms. All patients received fluoroscopically guided, contrast-enhanced, percutaneous facet cyst distention and rupture followed by an intra-articular facet joint injection of 1 cc kenalog and 1 cc of 1% lidocaine. Seventeen of the patients also received a transforaminal epidural steroid injection just before facet cyst rupture. Telephone follow-up was conducted on all patients. RESULTS Excellent long-term (average follow-up 1 y; range, 6-24 mo) pain relief was achieved in 23 (72%) of 32 patients undergoing facet cyst rupture. Twelve patients (37.5%) had synovial cyst recurrence and 11 chose to undergo repeat rupture, which resulted in 5 patients (45%) obtaining complete relief of symptoms and 6 patients (55%) requiring surgical intervention for cyst removal. Fisher exact test demonstrated that all patients who did not have a cyst recurrence were a success and obtained complete relief of symptoms (p<.0002). Patients who underwent a repeat rupture had a 50% chance of a successful outcome. There was no statistical significance between a successful outcome and level of facet cyst rupture, the presence of spondylolisthesis, sex, age, or having a transforaminal epidural steroid injection at the time of the procedure. Wilcoxon signed-rank test demonstrated that the difference in Numerical Pain Rating Scale and Roland-Morris Disability Questionnaire scores before and after the procedure was statistically significant (p<.0001). No complications were reported. CONCLUSIONS Fluoroscopic percutaneous Z-joint cyst rupture appears to be a safe and effective minimally invasive treatment option. This procedure should be considered before surgical intervention.
Collapse
Affiliation(s)
- Tracy L Allen
- Physiatry Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | | | | |
Collapse
|
90
|
Miyatake N, Aizawa T, Hyodo H, Sasaki H, Kusakabe T, Sato T. Facet cyst haematoma in the lumbar spine: a report of four cases. J Orthop Surg (Hong Kong) 2009; 17:80-4. [PMID: 19398800 DOI: 10.1177/230949900901700118] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present 4 cases of facet cyst haematoma in the ligamentum flavum of the lumbar spine. All patients presented with a one-to-3-month history of back pain or numbness in the legs, and sudden neurological deterioration. One also developed cauda equina syndrome and another developed radiculopathy. In all cases, magnetic resonance imaging showed a mass with high signal intensity on both T1- and T2-weighted images. Facet arthrography and computed tomography revealed communication between the mass and the neighbouring facet joint. The haematomas were removed en bloc with the ligamentum flavum. They were surrounded by the ligament and contained degenerated and lacerated elastic fibres but no synovial lining cells. Facet cyst haematoma is so-named because of bleeding from tissue adjacent to the facet joint into a pre-existing facet cyst.
Collapse
Affiliation(s)
- N Miyatake
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | | | | | | | | | | |
Collapse
|
91
|
Santos FGDPL, Souza RAD, Brotto MPD, Suguita FM, Amaral DT, Amaral LLFD. Formações císticas epidurais relacionadas a bursite interespinhosa, cisto sinovial e cisto discal. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000200013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os autores apresentam casos de cistos epidurais, dentre eles os cistos sinoviais, discais, do ligamento amarelo e relacionados a bursite interespinhosa, todas essas condições determinando compressão radicular, do saco dural ou estenose do canal vertebral. Descrevem as características de imagem e localização na ressonância magnética nessas diferentes afecções.
Collapse
|
92
|
Miao EY. Synovial Cyst of the Lumbar Spine Treated With Electroacupuncture. Med Acupunct 2009. [DOI: 10.1089/acu.2009.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Edwin Yong Miao
- M. Modern Traditional Chinese Medical Clinic—Acupuncture, Melbourne, Victoria, Australia
| |
Collapse
|
93
|
Removal of discal cyst using percutaneous working channel endoscope via transforaminal route. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 18 Suppl 2:201-5. [PMID: 19034535 DOI: 10.1007/s00586-008-0815-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 04/30/2008] [Accepted: 10/12/2008] [Indexed: 10/21/2022]
Abstract
Discal cyst is a very rare lesion that can cause refractory low back pain and radiating leg pain. Although there are some reports to remove this lesion, there has been no report of discal cyst removed by percutaneous endoscopic transforaminal approach. Two young patients manifested left gluteal and leg pain due to a discal cyst at L5-S1 level and L4-5 level, respectively. Percutaneous endoscopic transforaminal approach was performed to remove the discal cyst, achieving complete decompression of the nerve root. The symptom was relieved and the patient was discharged the next day. Percutaneous endoscopic transforaminal approach could be a good alternative option in selected cases for the treatment of lumbar discal cyst.
Collapse
|
94
|
Heran MKS, Smith AD, Legiehn GM. Spinal injection procedures: a review of concepts, controversies, and complications. Radiol Clin North Am 2008; 46:487-514, v-vi. [PMID: 18707959 DOI: 10.1016/j.rcl.2008.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The field of spinal injection procedures is growing at a tremendous rate. Many disciplines are involved, including radiology, anesthesiology, orthopedics, physiatry and rehabilitation medicine, as well as other specialties. However, there remains tremendous variability in the assessment of patients receiving these therapies, methods for evaluation of outcome, and in the understanding of where these procedures belong in the triaging of those who require surgery. In this article, we attempt to highlight the biologic concepts on which these therapies are based, controversies that have arisen with their increasing use, and a description of complications that have been reported.
Collapse
Affiliation(s)
- Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, Canada.
| | | | | |
Collapse
|
95
|
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a case of a subacute radiculopathy resulting from a spontaneous hemorrhage into a lumbar ganglion cyst. SUMMARY OF BACKGROUND DATA Ganglion and synovial cysts of the lumbar spine are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. Few cases of hemorrhage into lumbar juxtafacet cysts after trauma or anticoagulation therapy have been described in the literature. METHODS A case of a spontaneous hemorrhage in a lumbar ganglion cyst is presented. RESULTS A 61-year-old man presented with a 2-month history of intermittent bilateral lumbar ache. Eight days before admission he had a sudden exacerbation of the lumbar pain and began to fall frequently and noticed weakness and tingling in his lower members, mainly in the right leg. Magnetic resonance imaging scan revealed a hematic collection associated with a large juxtafacet cyst at the L4-L5 level. He was submitted to surgery and the cyst was totally removed. Microscopic examination was consistent with the diagnosis of a ganglion cyst. Two days after surgery he had already an independent gait. CONCLUSION Although, there are a few descriptions of hemorrhagic lumbar justafacet cysts after trauma or anticoagulant therapy, this is the first case of a hemorrhagic ganglion cyst with no previous traumatic event or use of medication. Magnetic resonance imaging was essential for making the preoperative diagnosis. Neurosurgical cyst removal proved to be an effective treatment.
Collapse
|
96
|
Midterm results of percutaneous CT-guided aspiration of symptomatic lumbar discal cysts. AJR Am J Roentgenol 2008; 190:W310-4. [PMID: 18430817 DOI: 10.2214/ajr.07.2195] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lumbar intervertebral discal cysts are rarely reported. To our knowledge, only 12 cases have been reported in the literature. The symptoms are indistinguishable from those of typical discal herniation. Our aim is to report the imaging characteristics, method of percutaneous CT-guided aspiration, and clinical outcome after management of lumbar intervertebral discal cysts. CONCLUSION Percutaneous CT-guided aspiration is an effective method for the management of lumbar intervertebral discal cysts.
Collapse
|
97
|
Prise en charge chirurgicale des kystes synoviaux lombaires : étude rétrospective concernant 52 patients. ACTA ACUST UNITED AC 2008; 94:289-96. [DOI: 10.1016/j.rco.2007.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2007] [Indexed: 11/21/2022]
|
98
|
Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:831-7. [PMID: 18389295 DOI: 10.1007/s00586-007-0563-z] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Revised: 10/07/2007] [Accepted: 11/25/2007] [Indexed: 12/12/2022]
Abstract
This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Although the relevant reports in the international literature are increasing, the controversy about conservative versus surgical treatment and the need for concomitant fusion still exists. Data from seven patients (age range 58-69 years, mean age 61 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concomitant local pathology, treatment and results of treatment were recorded. A follow-up of at least 6 months (range 6-48 months) was conducted and results were noted. All patients had back pain, while five also experienced unilateral radicular leg pain and one had bilateral leg pain. One patient had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. No fusion was performed. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. Review of the literature revealed a trend towards surgery, as this is correlated to a more favorable outcome compared with conservative treatment. Fusion should be performed on a case-by-case basis only. Surgery is a safe and effective treatment choice in this increasingly appearing ailment. A prospective, randomized trial should clarify issues under debate.
Collapse
|
99
|
KIM JU, LEE SH, LEE DY. Extraforaminal Lumbar Synovial Cyst Causing Sudden Foot Drop -Case Report-. Neurol Med Chir (Tokyo) 2008; 48:578-81. [DOI: 10.2176/nmc.48.578] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jin Uk KIM
- Department of Orthopaedic Surgery, Wooridul Spine Hospital
| | - Sang-Ho LEE
- Department of Neurosurgery, Wooridul Spine Hospital
| | | |
Collapse
|
100
|
Surgical treatment of nonrheumatoid atlantoaxial degenerative arthritis producing pain and myelopathy. Spine (Phila Pa 1976) 2007; 32:3067-73. [PMID: 18091503 DOI: 10.1097/brs.0b013e31815d004c] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review. OBJECTIVE The purpose of this study was to evaluate the clinical and pathologic findings and surgical treatment outcomes for atlantoaxial osteoarthritis. SUMMARY OF BACKGROUND DATA Nonrheumatoid atlantoaxial osteoarthritic degeneration can occur at either the atlantodental articulation or lateral mass articulations. This condition may present with neck pain or myelopathy in the setting of a compressive degenerative pannus. There is a paucity of literature on this topic with only case reports and small case series. METHODS A retrospective chart review was performed to identify patients treated for C1-C2 osteoarthritis. Patient demographics, clinical presentation, neurologic examination, visual analog pain scores, radiographic findings, surgical treatment, outcomes, and complications were recorded for each patient. RESULTS Twenty-six patients (18 with pannus at the atlantodental articulation and 8 primarily with lateral mass articulation arthritis; 10 men, 16 women; mean age 74 years) were surgically treated for atlantoaxial osteoarthritis. Eleven patients presented primarily with complaints related to myelopathy (all with a degenerative pannus) and 15 presented with cervicalgia only. All patients were treated with posterior atlantoaxial arthrodesis, and 13 patients with myelopathy or severe canal compromise from an irreducible subluxation also had transoral odontoidectomy. All myelopathic patients had improvement in neurologic function (10 of 11 improved 1 Ranawat grade). Neck pain improved in 93% of patients with preoperative neck pain complaints (mean visual analog score before surgery = 7.0, follow-up = 1.3). Fusion was demonstrated in all patients with adequate follow-up. CONCLUSION Atlantoaxial osteoarthritis can result in neck pain and myelopathy. In the setting of a degenerative pannus and myelopathy, most patients will improve neurologically after transoral decompression and arthrodesis. Patients with pannus and no myelopathy were effectively treated with posterior fusion alone, although 2 with irreducible subluxation required an initial transoral decompression to allow realignment before fusion. Posterior arthrodesis alone provided significant pain relief in most patients.
Collapse
|