1
|
Chen Y, Yu P, Li Z, Xu H, Li S, Wang Q, Ji F, Lan Q. Outcomes and adverse events for spinal synovial cysts surgical treatment: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:3275-3289. [PMID: 39039314 DOI: 10.1007/s00402-024-05460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Spinal synovial cysts (SSCs) are a rare cause of nerve root and spinal cord compression. Surgical excision of SSCs remains the mainstay of treatment in the presence of unremitting symptoms or neurological deficits, but the choice of the surgical approach remains controversial. The goal of this study was to compare clinical outcomes and adverse events associated with traditional approaches (interlaminar or laminectomy/hemilaminectomy) and minimally invasive approaches (microsurgical tubular approaches or endoscopic approaches) for SSCs. METHODS Studies reporting surgical management of SSCs were searched in three online databases (PubMed, the Cochrane Library, and Web of Science). This meta-analysis was reported following the PRISMA Statement. It was registered at the International Prospective Register of Systematic Reviews (CRD42021288992). The Cochrane Collaboration's Risk of Bias in Nonrandomised Studies-of Interventions (ROBINS-I) was used to evaluate bias. Extracted research data were statistically analyzed using Stata 16 and SPSS statistics 25. RESULTS A total of 22 related relevant studies were included. Meta-analysis revealed no statistically significant difference in dural tear, residual cyst, recurrence, reoperation, and operation time between minimally invasive approaches and traditional approaches (p > 0.05), but minimally invasive approaches had a good functional improvement (p = 0.004). Postoperative length of hospital stays and intraoperative bleeding in traditional approaches were also higher than in minimally invasive approaches (p < 0.05). CONCLUSION Based on the available evidence, minimally invasive approaches may be better than traditional approaches in the treatment of SSCs. Minimally invasive approaches had the advantages of improving clinical satisfaction, with a similar complication rate to traditional approaches. Moreover, endoscopic and microsurgical tubular approaches had similar outcomes.
Collapse
Affiliation(s)
- Ying Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Pei Yu
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Zhaoliang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Hui Xu
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Shenggang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Qing Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Fufu Ji
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Qing Lan
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China.
| |
Collapse
|
2
|
Heo J, Park HK, Baek JH, Ahn HS, Lee SC. Percutaneous Epidural Neuroplasty for Symptomatic Lumbar Juxtafacet Cysts. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1042. [PMID: 39064470 PMCID: PMC11278696 DOI: 10.3390/medicina60071042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: The term "Juxtafacet cyst" refers to both synovial cysts and ganglion pseudocysts associated with the lumbar facet joint. As conservative treatment for the juxtafacet cyst has a minimal effect, complete excision through surgery is considered the first choice of treatment. In this study, we retrospectively reviewed the clinical outcomes of percutaneous epidural neuroplasty for symptomatic lumbar juxtafacet cysts. Materials and Methods: We conducted a retrospective review of 34 patients with symptomatic juxtafacet cysts who visited a single institute from January 2010 to September 2023. Patients who received conservative treatment for at least 6 weeks but experienced no or insufficient effects were eligible for this study. After neuroplasty, a medical history check and neurological examination were performed during follow-up at 2 weeks, 1 month, 2 months, 3 months, 6 months, and once a year thereafter. Results: The pain improved for all patients to a VAS score of 3 or less immediately after neuroplasty; however, four of those patients (11%) had pain that worsened eventually to the same level as before the procedure and required surgery. The results showed that, regardless of cyst size, in cases with severe stenosis of the spinal canal, the outcome of neuroplasty was poor and often eventually required surgery. The cyst size was not associated with the procedure results. In addition, if the cyst was present at the L4-L5 level, or if diabetes mellitus was present, the likelihood of future surgery was significant (p-value = 0.003). Conclusions: Percutaneous neuroplasty showed a better success rate than other non-surgical treatments. In addition, severe spinal stenosis (Schizas grade C or higher), L4-L5 level, or diabetes mellitus produced a high possibility of surgery due to recurrence.
Collapse
Affiliation(s)
- Juneyoung Heo
- Joint & Arthritis Research, Department of Neurosurgery, Himchan Hospital, Seoul 21337, Republic of Korea;
| | - Hyung-Ki Park
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Seoul 31538, Republic of Korea;
| | - Ji-Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (H.-S.A.)
| | - Hye-Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (H.-S.A.)
| | - Su-Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (H.-S.A.)
| |
Collapse
|
3
|
Mercer RW, Vicentini JRT, Staffa SJ, Habib U, Cho R, Chang CY. CT-guided lumbar facet cyst rupture and corticosteroid injection: technique, approach, and procedural and clinical success rates. Skeletal Radiol 2024; 53:1135-1144. [PMID: 38097764 DOI: 10.1007/s00256-023-04544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 04/10/2024]
Abstract
PURPOSE To evaluate success rates of computed tomography (CT)-guided lumbar facet synovial cyst (LFC) rupture. MATERIALS AND METHODS We retrospectively reviewed all LFC ruptures performed by a single musculoskeletal radiologist with > 10 years of experience, using posterior facet approach and/or direct puncture by ipsilateral/contralateral interlaminar, or transforaminal approach. All patients also received a corticosteroid injection. Rupture rates were calculated, and clinical success rate was determined through medical record review. Pre-procedure magnetic resonance imaging (MRI) images and CT procedure images were also reviewed for LFC and facet joint imaging features that may predict rupture. RESULTS There were 37 patients, 17 (46%) female and 20 (54%) male, ages 62 ± 12 (range 39-87) years. Thirty-four (92%) of LFC were successfully ruptured, 17 (50%) by facet approach and 17 (50%) by direct cyst puncture. At least one direct puncture approach was possible in 35 (95%) patients. No MRI or CT LFC or facet joint features predicted cyst rupture. Thirty-one (91%) of patients reported immediate pain relief, and 19 (53%) did not have further intervention for LFC-related pain. Sixteen (84%) of these patients remained pain-free for an average follow-up time period of 28 months. Fourteen (39%) of patients required surgical intervention. There were no complications. CONCLUSION Our systematic approach to CT-guided LFC rupture is safe and has high technical and clinical success rates similar to prior studies. Since there are no definitive imaging features that determine rupture success, this procedure can almost always be attempted as a first-line treatment for LFC.
Collapse
Affiliation(s)
- Ronald W Mercer
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joao R T Vicentini
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Ukasha Habib
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Rosa Cho
- Department of Physical Medicine and Rehabilition, Division of Spine Care and Pain Management, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA, 02129, USA
| | - Connie Y Chang
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
| |
Collapse
|
4
|
Do Y, Lee E, Chee CG, Lee JW. [Lumbar Facet Joint Injection: A Review of Efficacy and Safety]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:54-76. [PMID: 38362388 PMCID: PMC10864157 DOI: 10.3348/jksr.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Facet joint arthrosis is a progressive degenerative disease that is frequently associated with other spinal degenerative disorders such as degenerative disc disease or spinal stenosis. Lumbar facet joint arthrosis can induce pain in the proximal lower extremities. However, symptoms and imaging findings of "facet joint syndrome" are not specific as they mimic the pain from herniated discs or nerve root compression. Currently, evidence for therapeutic intra-articular lumbar facet joint injections is still considered low, with a weak recommendation strength. Nevertheless, some studies have reported therapeutic effectiveness of facet joint injections. Moreover, the use of therapeutic facet joint injections in clinical practice has increased. This review article includes opinions based on the authors' experience with facet joint injections. This review primarily aimed to investigate the efficacy of lumbar facet joint injections and consider their associated safety aspects.
Collapse
|
5
|
Nguyen M, Saffarian M, Smith CC, Holder EK, Lee H, Marshall BJ, Mattie R, Patel J, Schneider B, McCormick ZL. FactFinders for patient safety: Understanding potential procedure-related complications: RFN/multifidus atrophy, intradiscal biologics, and facet cyst rupture. INTERVENTIONAL PAIN MEDICINE 2023; 2:100248. [PMID: 39238672 PMCID: PMC11372888 DOI: 10.1016/j.inpm.2023.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 09/07/2024]
Abstract
This series of FactFinders presents a brief summary of the evidence and outlines recommendations to improve our understanding and management of several potential procedure-related complications. The evidence in support of the following facts is presented: (1) Multifidus Atrophy After Lumbar Medial Branch Radiofrequency Neurotomy (LMBRFN) -- There is no conclusive published literature indicating that LMBRFN leads to increased multifidus atrophy relative to natural history. High-quality prospective studies with a natural history comparison group evaluating immediate pre-procedure as well as post-procedure longitudinal cross-sectional imaging are needed to accurately assess for any possible influence of LMBRFN on multifidus atrophy as well as the clinical relevance. (2) Intradiscal Biologics -- Although the available evidence on intradiscal biologic interventions is limited, it nonetheless shows a non-zero risk of complications. Until larger sample sizes are reported, the actual magnitude of the risk cannot be ascertained. In the meantime, physicians who perform intradiscal injections of biologics should conscientiously consider the risk-benefit of these procedures. (3) Lumbar Facet Synovial Cyst Rupture -- There have been few reports of complications secondary to lumbar facet synovial cyst rupture. Risks of may include increased pain, infection, and nerve root compression.
Collapse
Affiliation(s)
- Minh Nguyen
- University of Texas Southwestern, Department of Physical Medicine and Rehabilitation, Dallas, TX, USA
| | - Mathew Saffarian
- Michigan State University, Department of Physical Medicine and Rehabilitation, East Lansing, MI, USA
| | - Clark C Smith
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, NY, USA
| | - Eric K Holder
- Yale University School of Medicine, Department of Orthopedics and Rehabilitation, New Haven, CT, USA
| | - Haewon Lee
- University of California, San Diego, Department of Orthopedic Surgery, San Diego, CA, USA
| | - Benjamin J Marshall
- Department of Physical Medicine and Rehabilitation, University of Colorado, School of Medicine, Denver, CO, USA
| | - Ryan Mattie
- Providence Cedars-Sinai Tarzana Medical Center, Department of Interventional Pain & Spine, Los Angeles, CA, USA
| | - Jaymin Patel
- Emory University, Department of Orthopaedics, Atlanta, GA, USA
| | - Byron Schneider
- Vanderbilt University Medical Center, Dept of Physical Medicine & Rehabilitation, Nashville, TN, USA
- Vanderbilt University Medical Center, Center for Musculoskeletal Research, Nashville, TN, USA
| | - Zachary L McCormick
- University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| |
Collapse
|
6
|
Strohm A, Braun M, Kloth C, Sollmann N, Ozpeynirci Y, Pala A, Beer M, Schmitz BL, Rosskopf J. Effectiveness and Safety of CT-Guided Facet Joint Cyst Rupture for Radicular Pain as First Choice Therapy: A Retrospective Analysis. PAIN MEDICINE 2023; 24:158-164. [PMID: 35944225 DOI: 10.1093/pm/pnac116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate effectiveness and safety of computed tomography (CT)-guided cyst rupture with intraarticular contrast-enhanced injection of steroid and local anesthetic as first choice therapy in patients with facet joint cyst-induced radicular pain. DESIGN Retrospective data set analysis. SETTING University hospital. SUBJECTS One hundred and twenty-one patients suffering from radicular pain attributable to facet joint cysts were included. METHODS The rate of patients without following surgery was assessed and defined as surrogate to measure effectiveness. Patients' characteristics, procedure-associated complications, technical aspects, and imaging findings on magnetic resonance imaging (MRI) were analyzed. A subgroup of 65 patients (54%) underwent telephone interview to assess pain relief and clinical outcome measured by Numeric Rating Scale and Oswestry Disability Index. Analyses between the groups with and without surgery were performed by Fisher exact test and two-sample unpaired t-test, respectively. RESULTS The effectiveness of CT-guided cyst rupture was found to be 66.1%. Procedure-induced pain yielded in premature abort in two cases (1.7%). The detection of epidural contrast agent was statistically significantly associated with no need for surgery (P = .010). The cyst level was associated with the status of following surgery (P = .026), that is, cysts at lower lumbar spine were easier to rupture than cysts at other locations (cervical, thoracic, or upper lumbar spine). No further significant association was found. CONCLUSIONS CT-guided cyst rupture as the first-choice therapy in patients with cyst-induced radicular pain was safe and effective. Successful cyst rupture was associated with no need for surgery. Cysts at lower lumbar spine revealed the highest success rate.
Collapse
Affiliation(s)
- Alexa Strohm
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| | - Michael Braun
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, Ludwig-Maximilian-University, Munich, Germany
| | - Andrej Pala
- Department of Neurosurgery, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Bernd L Schmitz
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| | - Johannes Rosskopf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| |
Collapse
|
7
|
Ishihara Y, Morishita M, Kanzaki K. Efficacy of Percutaneous Image-Guided Rupture of Lumbar Facet Cysts: A Retrospective Study. Adv Orthop 2023; 2023:5591496. [PMID: 36950325 PMCID: PMC10027461 DOI: 10.1155/2023/5591496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/07/2023] [Accepted: 03/04/2023] [Indexed: 03/24/2023] Open
Abstract
Background Percutaneous rupture of lumbar facet cysts (LFC) is the only nonsurgical treatment which is effective in directly reducing cysts. However, this is not yet a common procedure, and its effectiveness, including the associated complications, remains unclear. Therefore, this study aimed to evaluate the clinical outcomes of percutaneous rupture for LFC and elucidate whether this minimally invasive procedure could become an alternative to surgeries for cases resistant to conservative treatments. Methods This study investigated 57 symptomatic patients with LFC for whom conservative treatments were ineffective and underwent percutaneous rupture of the LFC. All patients were followed up for >2 years posttreatment. Clinical evaluations (visual analogue scale (VAS) and recovery rate calculated using the Japanese Orthopedic Association (JOA) scores) and radiographic evaluations (size of LFC based on magnetic resonance imaging (MRI)) were performed from pretreatment to the final follow-up examination. Results Successful LFC rupture, without hospitalization and general anesthesia, was achieved in 48 patients. No severe complications occurred during treatment through the last observation. Satisfactory clinical results with significant improvements in the VAS and JOA scores were obtained (VAS: pre/posttreatment: 80.7 mm/11.2 mm, JOA: pre/posttreatment: 15.6 points/26.7 points, and recovery rate: 82.3%). A significant reduction in the LFC was also observed in all cases based on the posttreatment MRI findings. No successful rupture cases required subsequent surgical treatments, although four cases of LFC recurrence required additional percutaneous rupture treatment. Conclusions Percutaneous rupture for LFC is not only a safe and minimally invasive procedure without any severe complications or requirements for hospitalization and general anesthesia but also a beneficial procedure that can eliminate the need for surgery in cases resistant to conservative treatments.
Collapse
Affiliation(s)
- Yohei Ishihara
- 1Asao General Hospital Spine Center, 6-25-1, Kamiasao, Asao-ku, Kawasaki, Kanagawa 215-0021, Japan
| | - Masutaro Morishita
- 1Asao General Hospital Spine Center, 6-25-1, Kamiasao, Asao-ku, Kawasaki, Kanagawa 215-0021, Japan
| | - Koji Kanzaki
- 2Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-8501, Japan
| |
Collapse
|
8
|
Wockner RS, Seethala RR, Emeto TI, McCaul JA, Subramaniam SS. Epithelial-myoepithelial carcinoma of the maxillofacial and sinonasal region: a systematic review of presenting characteristics, treatment modalities, and associated outcomes. Int J Oral Maxillofac Surg 2023; 52:1-12. [PMID: 35667947 PMCID: PMC11227655 DOI: 10.1016/j.ijom.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland malignancy. Controversy exists in the literature regarding the effectiveness of treatment modalities employed in the management of EMC. This systematic review was undertaken to understand the presenting characteristics of EMC and identify the most common treatment modalities and their associated outcomes, in order to help guide an evidenced-based approach to the algorithm of care. The MEDLINE (PubMed) and Embase databases were searched (up to February 23, 2022), and the review was performed in accordance with the PRISMA statement. Fifty-seven studies (51 case reports and six case series) describing 91 cases of EMC were included in this review. In the included studies, a slow-growing painless mass was the most common presenting clinical feature. EMC was most frequently treated with surgery alone (65%). Local disease recurrence occurred in 24% of the cases and metastatic disease in 11%. A positive surgical margin was found to be associated with a higher risk of recurrence (P < 0.001), while adjuvant radiotherapy was associated with a decreased risk of local disease recurrence (P = 0.034). Metastatic disease and multimodal therapy were found to be associated with decreased disease-free and overall survival (all P < 0.05). The current literature supports surgery with clear margins as the mainstay of treatment for EMC of the salivary and seromucous glands of the head and neck. In certain situations, radiotherapy may improve disease-free survival.
Collapse
Affiliation(s)
- R S Wockner
- University of Otago, School of Medicine, Wellington, New Zealand.
| | - R R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - T I Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - J A McCaul
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - S S Subramaniam
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Victoria, Australia; Department of Oral and Maxillofacial Surgery, Townsville University Hospital, Queensland, Australia
| |
Collapse
|
9
|
Lalanne LB, Carmona RL, Cirillo Totera JI, Lemos FA, Wilson JTM, Beaulieu Montoya AM. Surgically managed symptomatic intraspinal lumbar facet synovial cyst outcome of surgical treatment with resection and instrumented posterolateral fusion, a case series. BMC Surg 2022; 22:277. [PMID: 35841087 PMCID: PMC9287942 DOI: 10.1186/s12893-022-01712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background There is controversy regarding the treatment of symptomatic synovial cysts, specifically, the need for a concomitant fusion when surgical resection of the synovial cysts is required. We present a retrospective review of a series of patients treated for symptomatic synovial cysts of the lumbar region during the last 20 years by a single surgeon, analyzing the current available literature. Methods Retrospective review. The same surgical technique was applied to all patients. Demographic, clinical, surgical data and synovial cyst recurrence rate were recorded. Postoperative results reported by patients were documented according to the McNab score. Results Sixty nine subjects, with mean follow-up of 7.4 years. 62% (43) were female, with a mean 57.8 years at the time of surgery. In 91.3% (63), the primary management was conservative for a minimum period of 3 months. All subjects underwent surgery due to the failure of conservative treatment. The segment most operated on was L4–L5 (63.77%). 91.3% (63) of the sample reported excellent and good and 6 subjects (8.6%) fair or poor results. There was no evidence of synovial cysts recurrence at the operated level. Conclusion In symptomatic synovial cysts, it seems that conservative treatment is only effective in a limited number of patients and in the short term. Thus, the recommendation of a surgical indication should proceed as soon as the conservative management fails to result in significant symptom relief. Based on our results, we recommend, together with the resection of the cyst, the instrumentation of the segment to avoid its recurrence and the management of axial pain.
Collapse
Affiliation(s)
- Lyonel Beaulieu Lalanne
- Orthopaedic Spine Surgeon, Head of Spine Center, Clínica Universidad de los Andes, Santiago, Chile
| | | | - Juan I Cirillo Totera
- Orthopaedic Spine Surgeon, Clínica Universidad de los Andes, Santiago, Chile.,Orthopaedic Spine Surgeon, Hospital del trabajador, Santiago, Chile
| | - Facundo Alvarez Lemos
- Orthopaedic Spine Surgeon, Clínica Universidad de los Andes, Santiago, Chile. .,Las Condes, Los Trigales 7887, dep: 508, Santiago, RM, Chile.
| | | | | |
Collapse
|
10
|
Su S, Mitsuya Y, Schirmer D, Levin J. Attempted aspiration of a symptomatic lumbar juxtafacet cyst resulting in improvement of acute onset radiculopathy with progressive motor weakness. INTERVENTIONAL PAIN MEDICINE 2022; 1:100101. [PMID: 39239377 PMCID: PMC11372890 DOI: 10.1016/j.inpm.2022.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 09/07/2024]
Affiliation(s)
- Sharlene Su
- Department of Orthopedic Surgery, Stanford University, USA
| | - Yumi Mitsuya
- University of California San Francisco Benioff Children's Hospitals, USA
| | - Derek Schirmer
- Department of Orthopedic Surgery, Stanford University, USA
| | - Josh Levin
- Department of Orthopedic Surgery, Stanford University, USA
- Department of Neurosurgery, Stanford University, USA
| |
Collapse
|
11
|
Kim HJ, Lee E, Lee JW, Kang Y, Ahn JM. Efficacy of Fluoroscopy-Guided Lumbar Facet Joint Synovial Cyst Rupture with Intra-Articular Steroid Injection after Laminectomy. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:162-172. [PMID: 36237472 PMCID: PMC9432400 DOI: 10.3348/jksr.2019.0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/11/2020] [Accepted: 07/15/2020] [Indexed: 06/16/2023]
Abstract
PURPOSE We retrospectively evaluated the technical success rate and long-term efficacy of fluoroscopy-guided synovial cyst rupture followed by an intra-articular steroid injection at the post-laminectomy lumbar facet. MATERIALS AND METHODS We selected subjects who had undergone a fluoroscopy-guided synovial cyst rupture with simultaneous intra-articular steroid injection within 6 months of MRI and demonstrated a symptomatic facet joint synovial cyst at the level of a previous lumbar laminectomy. Fourteen patients were enrolled, and we determined whether cyst rupture and symptom improvement were achieved after each procedure. The degrees of symptom improvement were categorized into 4: 1) symptoms improved (30% or more reduction, based on pre-procedural and post-procedural Numerical Pain Rating Scale scores), 2) symptoms not improved, 3) patient underwent surgery after injection, and 4) loss of follow-up. RESULTS The success rate of percutaneous synovial cyst rupture decreased with repeated procedures (62.5% for the first procedure and 0% to 33.3% for additional procedures). However, 80% of the patients had symptom improvement with the procedures, overall. The surgery rate was 14.3% in 14 patients. CONCLUSION For patients with post-laminectomy symptomatic lumbar facet joint synovial cysts, fluoroscopy-guided synovial cyst rupture with intra-articular steroid injection may be an effective and less invasive treatment before considering a surgical approach.
Collapse
|
12
|
Fujibayashi S, Otsuki B, Tanida S, Nagahara R, Ito H, Matsuda S. Rapid Spontaneous Resolution of Lumbar Intraspinal Facet Cyst after Lateral Lumbar Interbody Fusion. Spine Surg Relat Res 2020; 4:328-332. [PMID: 33195857 PMCID: PMC7661029 DOI: 10.22603/ssrr.2020-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/22/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Intraspinal facet cysts resistant to conservative treatment are treated surgically. Surgical treatment was generally resection and decompression, but complications of dural tear and recurrence sometimes occurred. We present good clinical results and rapid spontaneous resolution following treatment of five cases of lumbar intraspinal facet cyst after lateral lumbar interbody fusion (LLIF). Methods Multicenter series of five cases of lumbar intraspinal facet cyst with segmental instability treated with LLIF. The cross-sectional area (CSA) of the thecal sac and facet cyst on T2-weighted axial magnetic resonance imaging and the distance of facet joint (FJ) gap on axial computed tomography were measured preoperatively and postoperatively. Patient data and clinical and radiographic results were described. Results Of five patients, one was male and four were female, with an average age of 72.6 (61-76) years. The mean preoperative CSA of facet cyst was 40.09 mm2. In all cases, intraspinal facet cyst resolved within two weeks after LLIF and good clinical results were obtained. The mean CSA of the thecal sac increased from 64.18 mm2 preoperatively to 95.72 mm2 postoperatively. The mean distance of FJ gap increased from 0.8 (0-1.5) mm preoperatively to 3.1 (0.5-6.0) mm postoperatively. Conclusions LLIF may be indicated for intraspinal facet cysts with segmental instability.
Collapse
Affiliation(s)
- Shunsuke Fujibayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shimei Tanida
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryoichi Nagahara
- Department of Orthopedic Surgery, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Hideo Ito
- Department of Orthopedic Surgery, Kyoto Shimogamo Hospital, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
13
|
Soriano E, Bellinger E. Adult degenerative lumbar spondylolisthesis: Nonoperative treatment. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.semss.2020.100805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
14
|
Akbary K, Kim JS, Park CW, Jun SG, Hwang IC. The Feasibility and Perioperative Results of Bi-Portal Endoscopic Resection of a Facet Cyst Along With Minimizing Facet Joint Resection in the Degenerative Lumbar Spine. Oper Neurosurg (Hagerstown) 2020; 18:621-628. [PMID: 31550357 DOI: 10.1093/ons/opz262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/07/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Presentation of degenerative facet cysts (FC) as radicular pain in patients is well established. The traditional treatment of FCs has been decompressive laminectomy with a medial facetectomy and cyst excision. A major disadvantage of open procedures with medial facetectomy is predisposition to further instability. OBJECTIVE To describe a contralateral bi-portal endoscopic excision of FC along with minimizing facet joint resection. METHODS Thirteen patients between March 2016 and December 2017 were evaluated retrospectively for clinical, radiological, and morphometric outcomes. Patients with complaints of unilateral radiculopathy with associated neurogenic claudication from degenerative lumbar FC were included. Clinical evaluation was by NRS leg pain and ODI scores, radiological evaluation was by MRI. For morphometric analysis, cross-sectional area of facet joint (CSA-FJ) was measured on MRI in square millimeters. RESULTS Thirteen FCs were decompressed (no adverse events) NRS leg pain and ODI improved from 6.85 ± 0.69 and 65.08 ± 7.95 preoperatively to 1 ± 0.91 and 13.46 ± 5.19 at 1-yr follow-up, respectively. CSA-FJ remained relatively well preserved from 212.83 ± 58.05 to 189.77 ± 62.93 post decompression (statistically insignificant, P = .3412). CONCLUSION Bi-portal endoscopic decompression of FC can be performed with good clinical and radiological outcomes. This surgical technique may be recommended for further evaluation as an addition in the armamentarium of a spine surgeon for treatment of degenerative lumbar FC.
Collapse
Affiliation(s)
- Kutbuddin Akbary
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea.,Seoul St. Mary'
- 's Hospital, Spine Centre, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Seoul St. Mary'
- 's Hospital, Spine Centre, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Cheul Woong Park
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea
| | - Su Gi Jun
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea
| | - In Chang Hwang
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea
| |
Collapse
|
15
|
Fletcher-Sandersjöö A, Edström E, Kuntze Söderqvist Å, Grane P, Elmi-Terander A. Long-term pain relief following percutaneous steroid treatment of spinal synovial cysts: a population-based cohort study. J Neurointerv Surg 2020; 12:874-878. [PMID: 32354843 DOI: 10.1136/neurintsurg-2020-015890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Spinal synovial cysts are fluid-filled sacs that develop after facet joint degeneration and can give rise to radicular pain. If resistant to conservative management, surgical decompression or percutaneous steroid treatment is usually recommended. Percutaneous treatment minimizes the risk of spinal instability, but it has been uncertain whether it provides any long-term symptom relief. Moreover, it is unclear whether cyst rupture provides any added benefit. OBJECTIVE To assess long-term pain relief in patients with spinal synovial cysts who were treated with percutaneous intra-articular steroid treatment without cyst rupture. METHODS A population-based cohort-study was conducted of all patients with symptomatic synovial cysts who were treated with percutaneous intra-articular steroid treatment without cyst rupture between 1995 and 2014. RESULTS Thirty-eight patients were included. All patients had variations of lower back and radicular pain. Intra-articular access was achieved in 35 (92%) patients, and there were no treatment-related complications. At short-term assessment, 30 (79%) had pain relief. During the median follow-up of 11 years, 12 (32%) patients showed sustained pain relief without the need for decompressive surgery. CONCLUSIONS Percutaneous intra-articular steroid treatment without cyst rupture is a safe treatment for symptomatic spinal synovial cysts and eliminates the need for surgery in a substantial number of patients. It can be suggested as a first line of treatment.
Collapse
Affiliation(s)
- Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden .,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Åsa Kuntze Söderqvist
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Grane
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
16
|
New classification of facet joint synovial cysts. Acta Neurochir (Wien) 2020; 162:929-936. [PMID: 32086604 DOI: 10.1007/s00701-020-04264-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/10/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE Facet cysts develop due to degeneration of the zygapophyseal joints and can lead to radiculopathy and neurogenic claudication. Various surgical options are available for facet cyst excision. The aim was to facilitate surgical treatment of lumbar facet cysts based on a new classification. METHODS We retrospectively analyzed all patients of the last 10 years in whom a facet cyst was surgically removed (ipsilateral laminotomy, contralateral laminotomy, and segmental fusion). Several radiological parameters were analyzed and correlated with the patients' outcome (residual symptoms, perioperative complications, need for re-operation, need for secondary fusion, facet cyst recurrence). RESULTS One hundred eleven patients (55 women; median age 64 years) could be identified. Thirty-three (48%) of 69 cases, for which MRI data were available, were classified as medial facet cyst (compressing the spinal canal), 6 facet cysts were localized intraforaminal (9%) and 30 cases (43%) mediolateral (combination of both). The contralateral approach had the lowest rate for revision surgery (7.5%, p = .038) and the lowest prevalence of residual complaints (7.5%, p = .109). A spondylolisthesis and a higher/steeper angle of the facet joints were associated with poorer patient outcome. CONCLUSIONS Lateral facet joint cysts are best resected by a contralateral approach offering the best outcome while medial cysts are suitable for removal by an ipsilateral laminotomy. The approach of mediolateral cysts can be determined by the width of the lamina and the angle of the joint. Segmental fusion should be considered in cases with detected spondylolisthesis and/or steep facet joints.
Collapse
|
17
|
The Variability of Lumbar Facet Joint Synovial Cyst Recurrence Requiring Revision Surgery After Decompression-only and Decompression/Fusion. Clin Spine Surg 2019; 32:E457-E461. [PMID: 31453836 DOI: 10.1097/bsd.0000000000000870] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
Collapse
|
18
|
Xie T, Xiu P, Yang Z, Wang D, Zeng J, Song Y. OLIF Combined with Anterior Fixation for Lumbar Synovial Cysts with Instability. World Neurosurg 2019; 135:76-79. [PMID: 31765867 DOI: 10.1016/j.wneu.2019.11.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The optimal management of lumbar synovial cysts (LSCs) has always been controversial. Open or minimally invasive partial hemilaminotomy as a direct decompression approach has been widely studied, whereas to our knowledge, there has been no report of an indirect decompression method for LSC. CASE DESCRIPTION A 60-year-old male complained of chronic low back pain for 2 years. He reported that the pain had been getting worse and started radiating to the bilateral posterior thighs and right lateral calf for 6 months. An ovoid lesion with a hyperintense center attached to the medial side of the right facet joint at the L4-5 level, as well as L4-5 dynamic instability, were found with magnetic resonance imaging and lumbar x-ray examinations, respectively. L4-5 oblique lumbar interbody fusion combined with anterior fixation was performed. After surgery, the patient felt distinct pain relief and was discharged on the third day postoperatively. Three months later, lumbar magnetic resonance imaging and 3-dimensional computed tomography were performed again. The L4-5 disk height and foraminal height recovered from 7.1-12.3 mm and 14.8-18.5 mm, respectively. No evidence of a cyst was disclosed. The patient did not complain of any low back pain or radicular pain during the 12-month follow-up. CONCLUSIONS Indirect decompression surgery may be a new option for the management of LSC, especially in those with lumbar instability and that communicate with the facet joint. Further research with a larger and more comprehensive sample population is required.
Collapse
Affiliation(s)
- Tianhang Xie
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Peng Xiu
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Zhiqiang Yang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Duan Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Jiancheng Zeng
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China.
| | - Yueming Song
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| |
Collapse
|
19
|
Landriel F, Hem S, Rasmussen J, Vecchi E, Yampolsky C. [Minimally invasive resection of spinal synovial cysts: Technical note]. Surg Neurol Int 2019; 10:S12-S20. [PMID: 31123636 PMCID: PMC6416767 DOI: 10.4103/sni.sni_416_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Indexed: 11/05/2022] Open
Abstract
Objetivo: Presentar el algoritmo de tratamiento, técnica quirúrgica y resultados de una serie de pacientes con quistes sinoviales espinales resecados con técnica mínimamente invasiva (MIS). Introducción: Los quistes sinoviales espinales se originan a partir de la dilatación y potencial ruptura de la vaina sinovial de una articulación facetaria, la resección quirúrgica es considerada el tratamiento de elección en pacientes sintomáticos. La utilización de técnicas MIS podrían disminuir la disrupción de la faceta articular comprometida reduciendo el riesgo de inestabilidad postoperatoria. Material y métodos: Se evaluaron retrospectivamente 21 pacientes con quistes sinoviales espinales operados mediante abordaje y descompresión MIS, se analizaron los signos, síntomas, tiempo quirúrgico, estadía hospitalaria, evolución y complicaciones. Se utilizó la escala visual analógica (EVA), para evaluar el dolor y la escala de Weiner y los criterios de Macnab modificados para medir la satisfacción posoperatoria del paciente. Resultados: Se trataron quirúrgicamente 21 pacientes (13 mujeres, 8 hombres), el 76,2% (n = 16) de los pacientes de la serie no requirió artrodesis, el 23,8% (n = 5) restante fue fusionado. Realizamos 13 (61,9%) hemilaminectomías contralaterales, 7 hemilaminectomías ipsilaterales (33,3%) y una laminectomía en el QS S1-S2 con técnica MIS. El seguimiento promedio fue de 26 meses, el tiempo de cirugía fue de 150,33 ± 63,31 min., con una estadía hospitalaria de 2,5 ± 1,78 días. La EVA disminuyó de 8,3 preoperatoria a 2,3 postoperatoria. Siguiendo la escala de Macnab; 16 pacientes refirieron resultados excelentes, 4 buenos y 1 regular, el 95,2% de los pacientes percibió que el procedimiento tuvo mucho/bastante éxito según la escala de Weiner. Conclusión: El abordaje mínimamente invasivo es un procedimiento seguro y eficaz para la resección completa de quistes sinoviales espinales. Proporciona resultados clínico-funcionales excelentes preservando músculos, ligamentos y facetas articulares.
Collapse
Affiliation(s)
- Federico Landriel
- Departmento de Neurocirugía - Hospital Italiano de Buenos Aires, Argentina
| | - Santiago Hem
- Departmento de Neurocirugía - Hospital Italiano de Buenos Aires, Argentina
| | - Jorge Rasmussen
- Departmento de Neurocirugía - Hospital Italiano de Buenos Aires, Argentina
| | - Eduardo Vecchi
- Departmento de Neurocirugía - Hospital Italiano de Buenos Aires, Argentina
| | - Claudio Yampolsky
- Departmento de Neurocirugía - Hospital Italiano de Buenos Aires, Argentina
| |
Collapse
|
20
|
Anand A, Pfiffner TJ, Mechtler L. The Role of Imaging in the Management of Cystic Formations of the Mobile Spine (CYFMOS). Curr Pain Headache Rep 2018; 22:70. [PMID: 30145776 DOI: 10.1007/s11916-018-0723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to give a better understanding of the pathogenesis of cystic formations of the mobile spine (CYFMOS) and the correlating imaging findings. This would help with medical decision-making, given the plethora of conservative, interventional, and surgical treatment options. RECENT FINDINGS There has been a general understanding that CYFMOS are associated with degenerative spine changes. More recent articles however have suggested that identifying detailed imaging characteristics can assist in determining outcomes when CYFMOS are treated with interventional percutaneous methods or surgical decompression with or without concomitant fusion. CYFMOS although uncommon are not a rare finding seen in the spine when there is a background of degenerative spine changes. These cystic lesions are generally symptomatic by exhibiting mass effect on adjacent structure. Most treatments are aimed at decompression by interventional percutaneous or surgical means. Various imaging characteristics of these CYFMOS described in this article including their signal intensity, presence of spinal instability, particular patterns of adjacent degenerative changes, and imaging changes following interventional treatments can help guide physicians when managing these cases.
Collapse
Affiliation(s)
- Amar Anand
- DENT Neurologic Institute, 3980 Sheridan Dr, Buffalo, NY, 14226, USA.
| | | | | |
Collapse
|
21
|
Wu HH, Chu L, Zhu Y, Cheng CY, Chen CM. Percutaneous Endoscopic Lumbar Surgery via the Transfacet Approach for Lumbar Synovial Cyst. World Neurosurg 2018; 116:35-39. [DOI: 10.1016/j.wneu.2018.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 01/23/2023]
|
22
|
Kim SK, Lee BH, Song MB, Lee SC. A novel technique for managing symptomatic spinal cysts using epiduroscopic neural laser decompression: technical note and preliminary results. J Orthop Surg Res 2018; 13:136. [PMID: 29866183 PMCID: PMC5987393 DOI: 10.1186/s13018-018-0849-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benign spinal cysts are relatively common, but can cause significant pain. However, consensus regarding the best method for treating these cysts has not been established. We aimed to examine the usefulness of epiduroscopic neural laser decompression (ENLD), a novel percutaneous treatment, for treating lumbo-sacral cysts. METHODS Ten patients (6 men, 4 women; mean age 45.5 years) with benign lumbo-sacral cysts underwent ENLD. The lumbo-sacral cysts were caused by multiple pathophysiologies and displayed different characteristics. Cysts were evaluated using a recorded epiduroscopic procedure video, magnetic resonance imaging (MRI), and electronic medical records. In all patients, MRI identified cysts with well-defined margins that were compressing the nerves in the lumbo-sacral region and were associated with the pain symptoms of the patients. Retrospectively, we reviewed a series of consecutive patients who underwent surgery (two with discal cysts, four with facet cysts, and four with Tarlov cysts). Low back/leg pain was evaluated using a 1-10 visual analog scale. Functional improvement was evaluated using Oswestry Disability Index scores. Outcomes were evaluated pre- and post-operatively and 1 year post-surgery. RESULTS Patients were examined between May 2016 and August 2017. Average pain scores improved from 4.7 pre-surgery to 1.8 post-surgery (low back; p < .001) and from 5.8 pre-surgery to 1.6 post-surgery (leg; p < .001). Disability scores decreased from 27.2% pre-surgery to 14.6% post-surgery. CONCLUSION Currently, no standard treatment strategy for symptomatic spinal cysts exists. These results show that ENLD using a Holmium: YAG laser can be useful in treating symptomatic benign spinal cysts. TRIAL REGISTRATION Not applicable as this is a retrospective chart review.
Collapse
Affiliation(s)
- Seung-Kook Kim
- Department of Neurosurgery, Spine Center, Himchan Hospital, 118 Yongdam-ro, Yunsoo-gu, Incheon, 21927, South Korea. .,Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul, South Korea.
| | - Byoung-Hoi Lee
- Department of Neurosurgery, Spine Center, Himchan Hospital, 118 Yongdam-ro, Yunsoo-gu, Incheon, 21927, South Korea.,Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul, South Korea
| | - Moon-Bok Song
- Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul, South Korea.,Department of Orthopedic Surgery, Himchan Hospital, 118 Yongdam-ro, Yunsoo-gu, Incheon, 21927, South Korea
| | - Su-Chan Lee
- Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul, South Korea
| |
Collapse
|
23
|
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVE To compare (1) recurrence of radiculopathy and (2) back pain after decompression with and without fusion for patients with a symptomatic synovial cyst. BACKGROUND Previous work described favorable outcomes following cyst excision with and without fusion. Because of the association of facet cysts with spinal instability it is hypothesized that a decompression with fusion will lead to better outcomes. However, previous studies present contradicting results. METHODS We included 314 consecutive patients that underwent operative treatment for a facet cyst between 2003 and 2013 at 2 tertiary spine referral centers: 224 (71%) underwent decompression without fusion (35% spondylolisthesis), 90 (29%) underwent decompression with fusion (63% spondylolisthesis). Baseline data were compared between the groups. Bivariate log-rank analysis was used to compare outcomes between groups, followed by multivariable Cox regression analysis accounting for differences in baseline characteristics. RESULTS Patients undergoing decompression with fusion presented with a higher incidence of back pain (P=0.004) and spondylolisthesis (P<0.001), had more often bilateral decompressions (P<0.001), more facetectomies (P<0.001), and more levels of decompression (P=0.004) than those who underwent decompression alone. We found a difference in recurrence of radiculopathy (no fusion: 25% vs. fusion: 9.4%, P=0.029) in bivariate analysis. However, this difference did not hold when accounting for confounders (hazard ratio, 0.50, 95% confidence interval, 0.19-1.31, P=0.16). There was no difference in recurrence of back pain in bivariate (no fusion: 29% vs. fusion: 22%, P=0.51) and multivariable analysis (hazard ratio 0.51, 95% confidence interval, 0.23-1.14, P=0.10). CONCLUSIONS We found, with the numbers evaluated, no difference in recurrence of radiculopathy or back pain between patients undergoing decompression with or without fusion after accounting for confounders. The decision for fusion should be considered in light of the extent of decompression and the existence of other pathology. LEVEL OF EVIDENCE Level III-therapeutic study.
Collapse
|
24
|
Shah VN, von Fischer ND, Chin CT, Yuh EL, Amans MR, Dillon WP, Hess CP. Long-Term Effectiveness of Direct CT-Guided Aspiration and Fenestration of Symptomatic Lumbar Facet Synovial Cysts. AJNR Am J Neuroradiol 2017; 39:193-198. [PMID: 29122762 DOI: 10.3174/ajnr.a5428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/19/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar facet synovial cysts are commonly seen in facet degenerative arthropathy and may be symptomatic when narrowing the spinal canal or compressing nerve roots. The purpose of this study was to analyze the safety, effectiveness, and long-term outcomes of direct CT-guided lumbar facet synovial cyst aspiration and fenestration for symptom relief and for obviating an operation. MATERIALS AND METHODS We retrospectively reviewed the medical records and imaging studies of 64 consecutive patients between 2006 and 2016 who underwent 85 CT-guided lumbar facet synovial cyst fenestration procedures in our department. We recorded patient demographics, lumbar facet synovial cyst imaging characteristics, presenting symptoms, change in symptoms after the procedure, and whether they underwent a subsequent operation. We also assessed long-term outcomes from the medical records and via follow-up telephone surveys with patients. RESULTS Direct CT-guided lumbar facet synovial cyst puncture was technically successful in 98% of procedures. At first postprocedural follow-up, 86% of patients had a complete or partial symptomatic response. During a mean follow-up of 49 months, 56% of patients had partial or complete long-term relief without the need for an operation; 44% of patients underwent an operation. Patients with calcified, thick-rimmed, or low T2 signal intensity cysts were less likely to respond to the procedure and more likely to need an operation. CONCLUSIONS CT-guided direct lumbar facet synovial cyst aspiration and fenestration procedures are safe, effective, and minimally invasive for symptomatic treatment of lumbar synovial facet cysts. This procedure obviates an operation in a substantial number of patients, even at long-term follow-up, and should be considered before surgical intervention.
Collapse
Affiliation(s)
- V N Shah
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
| | - N D von Fischer
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - C T Chin
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - E L Yuh
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - M R Amans
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - W P Dillon
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - C P Hess
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| |
Collapse
|
25
|
Chazen JL, Leeman K, Singh JR, Schweitzer A. Percutaneous CT-guided facet joint synovial cyst rupture: Success with refractory cases and technical considerations. Clin Imaging 2017; 49:7-11. [PMID: 29120814 DOI: 10.1016/j.clinimag.2017.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/11/2017] [Accepted: 10/23/2017] [Indexed: 01/23/2023]
Abstract
Percutaneous image-guided rupture of lumbar facet synovial cysts can improve clinical outcomes and obviate the need for open surgery. This series describes eleven patients who had successful CT-guided lumbar facet synovial cyst ruptures, 82% of which experienced excellent pain relief at a minimum of one-year follow-up. Of the five patients who failed prior fluoroscopic-guided synovial cyst rupture, 80% had a successful CT-guided rupture and one-year sustained pain relief. These findings reinforce minimally invasive CT-guided treatment as an excellent option to improve patient symptoms and potentially avoid open surgery.
Collapse
Affiliation(s)
- J Levi Chazen
- Weill Cornell Medicine, Department of Radiology, United States.
| | - Kristen Leeman
- Weill Cornell Medicine, Department of Radiology, United States
| | - Jaspal R Singh
- Weill Cornell Medicine, Department of Rehabilitation Medicine, United States
| | | |
Collapse
|
26
|
Spinner D, Aner M, Paul G, Simopoulos T, Gill J. Percutaneous Translaminar Facet Cyst Rupture and Epidural Access-Description of a Novel Technique. PAIN MEDICINE 2017; 18:410-413. [PMID: 28395102 DOI: 10.1093/pm/pnw141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Synovial cysts of the lumbar zygapophysial joints can be treated by percutaneous injection of corticosteroids, with distension and rupture of the cyst. Some cysts can be difficult to access, particularly when they lie deep in relation to the lamina. This technical report describes a fluoroscopy-guided technique for accessing sublaminar pathology. Crucial to the safety of the technique is visualization of the ventral margin of the lamina using a contralateral oblique view, and controlling and limiting the insertion of the needle such that only its tip passes the lamina.
Collapse
Affiliation(s)
- David Spinner
- Department of Rehabilitation Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Moris Aner
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Geet Paul
- Department of Rehabilitation Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Thomas Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jatinder Gill
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To analyze the various anatomical parameters that influence segmental stability in patients suffering from lumbar intra spinal cysts (LISCs) and to determine the outcome of microscopic unilateral laminotomy and cystectomy. METHODS All patients that were surgically managed for a LISC between 2007 and 2013 with more than 3 years of follow-up were reviewed. Those without associated instability were evaluated for segmental mobility, segmental angulation, facet inclination, stage of disc degeneration, and level of involvement on MRI and dynamic radiographs. Outcomes of unilateral laminotomy and cystectomy were evaluated using VAS (Visual Analogue Score), ODI (Oswestry Disability Index), and Macnabs criteria. Dynamic radiographs were performed in all cases pre- and postoperatively and at the last follow-up. RESULTS Thirty patients were operated for a LISC between 2007 and 2013. The levels involved were L4-5(23), L3-4(4) and L5-S1(3). The mean facet angle was 42.6 (± 6.1) degrees. The stage of disc degeneration was scattered haphazardly across all the cases (Gr 2[17]; Gr 3[1]; Gr 4[8]; Gr 5[4]). VAS and ODI scores improved significantly in all patients. Mean follow-up was 46.5 months (36-96 months). No patient developed postoperative instability at the last follow-up. CONCLUSIONS The coronal inclination of the facet joints, absence of radiological instability, and poor co-relation with stages of disc degeneration suggests the presence of adequate residual stability. In this study, stand-alone decompression for LISCs without instability had well sustained good/excellent outcomes. Fusion is recommended for LISCs with associated instability.
Collapse
Affiliation(s)
- Arvind G. Kulkarni
- Bombay Hospital & Medical Research Centre, Mumbai, India
- Arvind G. Kulkarni, Department of Orthopedics, Mumbai Spine Scoliosis and Disc Replacement Centre, 2nd Floor, Room 206 New Wing, Bombay Hospital & Medical Research Centre, 12, New Marine Lines, Mumbai 400020, India.
| | - Shumayou Dutta
- Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Abhilash Dhruv
- Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Anupreet Bassi
- Bombay Hospital & Medical Research Centre, Mumbai, India
| |
Collapse
|
28
|
Lutz GE, Nicoletti MR, Cyril GE, Harrison JR, Lutz C, Solomon JL, Cooke PM, Wyss JF, Herzog RJ, Moley PJ. Percutaneous Rupture of Zygapophyseal Joint Synovial Cysts: A Prospective Assessment of Nonsurgical Management. PM R 2017; 10:245-253. [DOI: 10.1016/j.pmrj.2017.07.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/19/2017] [Accepted: 07/30/2017] [Indexed: 10/19/2022]
|
29
|
Haider SJ, Na NR, Eskey CJ, Fried JG, Ring NY, Bao MH, Pastel DA. Symptomatic Lumbar Facet Synovial Cysts: Clinical Outcomes Following Percutaneous CT–Guided Cyst Rupture with Intra-articular Steroid Injection. J Vasc Interv Radiol 2017; 28:1083-1089. [PMID: 28549711 DOI: 10.1016/j.jvir.2017.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022] Open
|
30
|
Bruder M, Cattani A, Gessler F, Droste C, Setzer M, Seifert V, Marquardt G. 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. J Neurosurg Spine 2017; 27:256-267. [PMID: 28686146 DOI: 10.3171/2016.12.spine16756] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Markus Bruder
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Christian Droste
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | | |
Collapse
|
31
|
Hatgis J, Granville M, Berti A, Jacobson RE. Targeted Radiofrequency Ablation as an Adjunct in Treatment of Lumbar Facet Cysts. Cureus 2017; 9:e1318. [PMID: 28690952 PMCID: PMC5499940 DOI: 10.7759/cureus.1318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lumbar facet cysts are frequently found in patients with facet degeneration and segmental instability. When the facet cyst is localized in the neural foramina and lateral recess or becomes large, it can cause radiculopathy or neurogenic claudication. These symptomatic cysts are typically treated interventionally with drainage and a corticosteroid injection or attempts via overinflation to rupture the cyst; however, these procedures have a significant recurrence rate (up to 50%) and often need to be repeated or lead to lumbar surgery if unsuccessful. This is the first report of using targeted radiofrequency (RF) current as an adjunct to cyst drainage. Although RF has been used for years to treat facet pain indirectly by targeting the medial facet nerve branches, with this technique, under image guidance, the actual cyst is percutaneously drained and then cauterized along with the associated facet capsule, where the original cyst developed. This has improved overall results with less cyst recurrence than previous percutaneous methods and was documented with both intermediate and long-term followup clinically and with magnetic resonance imaging (MRI) scans. This report reviews the underlying anatomy and pathology of the facet joint relating to the development of facet cysts and how current percutaneous treatments for lumbar facet cysts can be supplemented and improved by adding targeted RF ablation to the percutaneous options available to treat a lumbar facet cyst.
Collapse
Affiliation(s)
- Jesse Hatgis
- Larkin Hospital, Nova Southeastern University School of Osteopathic Medicine
| | | | - Aldo Berti
- Miami Neurosurgical Center, University of Miami Hospital
| | | |
Collapse
|
32
|
Saiwai H, Okada S, Miyazaki K, Nakano R, Iwamoto Y, Tsuchiya K. Clinical features and surgical management of rare cases of thoracic intraspinal cysts: Report of 3 cases. J Orthop Sci 2017; 22:578-582. [PMID: 26740453 DOI: 10.1016/j.jos.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/16/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Hirokazu Saiwai
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Japan.
| | - Seiji Okada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kosei Miyazaki
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Japan
| | - Ryuji Nakano
- Department of Pathology, Japan Community Health Care Organization, Kyushu Hospital, Japan
| | - Yukihide Iwamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kuniyoshi Tsuchiya
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Japan
| |
Collapse
|
33
|
Interventions for Lumbar Synovial Facet Joint Cysts: A Comparison of Percutaneous, Surgical Decompression and Fusion Approaches. World Neurosurg 2017; 98:492-502. [DOI: 10.1016/j.wneu.2016.11.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023]
|
34
|
Scholz C, Hubbe U, Kogias E, Roelz R, Klingler JH. Microsurgical resection of juxtafacet cysts without concomitant fusion—Long-term follow-up of 74 patients. Clin Neurol Neurosurg 2017; 153:35-40. [DOI: 10.1016/j.clineuro.2016.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/10/2016] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
|
35
|
Huang AJ, Bos SA, Torriani M, Simeone FJ, Chang CY, Pomerantz SR, Bredella MA. Long-term outcomes of percutaneous lumbar facet synovial cyst rupture. Skeletal Radiol 2017; 46:75-80. [PMID: 27771754 DOI: 10.1007/s00256-016-2513-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/02/2016] [Accepted: 10/05/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the therapeutic value, safety, and long-term clinical outcomes of percutaneous lumbar facet synovial cyst (LFSC) rupture. MATERIALS AND METHODS Our study was institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant. The study group comprised 71 patients (44 women, mean age: 65 ± 17 years) who underwent CT- or fluoroscopy-guided percutaneous LFSC rupture. The technical success of LFSC rupture, the long-term clinical outcome, including repeat procedures or surgery, and imaging findings on MRI and CT were recorded. RESULTS Seventy-nine LFSC ruptures were performed in 71 patients. CT guidance was used in 57 cases and fluoroscopy guidance in 22 cases. LFSC rupture was technically successful in 58 out of 79 cases (73 %). Mean injection volume for cyst rupture was 3.6 ± 2.2 mL and a combination of steroid and anesthetic was injected in all cases. Over a mean follow-up time of 44 months, 12 % of patients underwent repeat cyst rupture, and 46 % eventually underwent surgery, whereas the majority of patients (55 %) experienced symptomatic relief and did not undergo surgery. There was no significant association between a successful outcome and age, sex, level, or size of LFSC (p > 0.1). LFSCs with T2 hypointensity were more likely to require surgery (p = 0.02). There was one complication, a bacterial skin infection that completely resolved following antibiotic therapy. CONCLUSION Percutaneous LFSC rupture is an effective and safe nonsurgical treatment option for LFSC. More than half of treated patients were able to avoid subsequent surgery. Therefore, percutaneous LFSC rupture should be considered before surgical intervention.
Collapse
Affiliation(s)
- Ambrose J Huang
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Stijn A Bos
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - F Joseph Simeone
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Connie Y Chang
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Stuart R Pomerantz
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
| |
Collapse
|
36
|
Abstract
Lumbar facet cysts are a rare but increasingly common cause of symptomatic nerve root compression and can lead to radiculopathy, neurogenic claudication, and cauda equina syndrome. The cysts arise from the zygapophyseal joints of the lumbar spine and commonly demonstrate synovial herniation with mucinous degeneration of the facet joint capsule. Lumbar facet cysts are most common at the L4-L5 level and often are associated with spondylosis and degenerative spondylolisthesis. Advanced imaging studies have increased diagnosis of the cysts; however, optimal treatment of the cysts remains controversial. First-line treatment is nonsurgical management consisting of oral NSAIDs, physical therapy, bracing, epidural steroid injections, and/or cyst aspiration. Given the high rate of recurrence and the relatively low satisfaction with nonsurgical management, surgical options, including hemilaminectomy or laminotomy to excise the cyst and decompress the neural elements, are typically performed. Recent studies suggest that segmental fusion of the involved levels may decrease the risks of cyst recurrence and radiculopathy.
Collapse
|
37
|
Denis DR, Hirt D, Shah S, Lu DC, Holly LT. Minimally invasive surgery for lumbar synovial cysts with coexisting degenerative spondylolisthesis. Int J Spine Surg 2016; 10:37. [PMID: 27909658 DOI: 10.14444/3037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND About one third of lumbar synovial cysts are associated with degenerative spondylolisthesis. Segmental instability is thought to contribute to the pathogenesis and recurrence of synovial cysts and lumbar fusion has been advocated as a treatment of choice in the presence of spondylolisthesis. In patients with spondylolisthesis, minimally invasive resection of lumbar synovial cysts, without fusion, could minimize surgically induced segmental instability while providing good pain relief. METHODS Clinical and radiological outcomes of lumbar synovial cyst patients with and without spondylolisthesis were retrospectively compared. Pain outcomes were assessed with modified Macnab criteria. RESULTS Fifty-three patients (18 with grade 1 spondylolisthesis) underwent minimally invasive synovial cyst resection and all had either excellent or good pain outcome at ≤ 8 post- operative weeks (P = 1.000, n = 53). At > 8 post-operative weeks (mean (SD) follow-up of 200 (175) weeks), excellent or good outcomes were noted in 89% of patients without spondylolisthesis and in 75% of patients with spondylolisthesis (P = 0.425, n = 40). Four patients developed a new grade 1 spondylolisthesis at a mean follow-up of 2.6 ± 2.1 years. Nine patients were assessed for spondylolisthesis measurements at 1.2 ± 1.3 years of follow up and no significant difference was observed (5 ± 0 vs 5 ± 1 mm; P = 0.791). Two patients without spondylolisthesis and none of the patients with spondylolisthesis had a synovial cyst recurrence. CONCLUSION Patients with concomitant lumbar degenerative spondylolisthesis and synovial cyst can have good short- and long-term clinical outcomes with minimally invasive surgery without fusion. Post-operative segmental instability does not appear to be significant in patients with spondylolisthesis. All patients included in this article signed an informed consent for the use of their medical information for research.
Collapse
Affiliation(s)
- Daniel R Denis
- Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Daniel Hirt
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Saumya Shah
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Langston T Holly
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| |
Collapse
|
38
|
Birch BD, Aoun RJN, Elbert GA, Patel NP, Krishna C, Lyons MK. Minimally Invasive Tubular Resection of Lumbar Synovial Cysts: Report of 40 Consecutive Cases. World Neurosurg 2016; 94:188-196. [DOI: 10.1016/j.wneu.2016.06.125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 01/24/2023]
|
39
|
Wang DJ, Lownie SP, Pelz D, Pandey S. A novel approach to symptomatic lumbar facet joint synovial cyst injection and rupture using iGuide navigational software: A case report and review. Interv Neuroradiol 2016; 22:596-9. [PMID: 27298012 DOI: 10.1177/1591019916653253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/06/2016] [Indexed: 11/15/2022] Open
Abstract
Spinal synovial cysts are benign protrusions of facet joint capsules caused by degenerative spondylosis, most frequently involving the L4-5 level, and commonly lead to symptoms of back pain, radiculopathy and neurogenic claudication. Although percutaneous treatment via facet joint steroid injection with cyst rupture can provide significant symptom relief, cyst rupture is not always achievable via an indirect trans-facet approach due to limited access from severe degenerative changes. In this case, we describe a successful approach to direct cyst access using a laser-guided navigational software in a patient with severe facet joint osteophytosis. We provide a brief review of literature.
Collapse
Affiliation(s)
- David J Wang
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Stephen P Lownie
- Department of Clinical Neuroscience, Western University, London, Ontario, Canada
| | - David Pelz
- Department of Medical Imaging, Western University, London, Ontario, Canada Department of Clinical Neuroscience, Western University, London, Ontario, Canada
| | - Sachin Pandey
- Department of Medical Imaging, Western University, London, Ontario, Canada Department of Clinical Neuroscience, Western University, London, Ontario, Canada
| |
Collapse
|
40
|
Surgical management of Juxtafacet cysts in the lumbar spine. Int J Surg 2016; 29:9-11. [PMID: 26971829 DOI: 10.1016/j.ijsu.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/22/2016] [Accepted: 03/05/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Juxtafacet cysts of the lumbar spine are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic juxta facet cysts in the Neurosurgical Department of our hospital and review of the literature. METHODS Data from seven patients (age range 58-68 years, mean age 63 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concominant local pathology, treatment and results of treatment were recorded. After surgery there was no case of a recurrent cyst during the follow-up period. The mean follow-up period of patients at the time of this study was 4 years. RESULTS All patients had back pain, while five also experienced unilateral radicular leg pain and two had bilateral leg pain. Four patients had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. CONCLUSION Surgery is a safe and effective treatment for lumbar juxtafacet cysts.
Collapse
|
41
|
Spectrum of MRI features of ganglion and synovial cysts. Insights Imaging 2016; 7:179-86. [PMID: 26911967 PMCID: PMC4805620 DOI: 10.1007/s13244-016-0463-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/17/2022] Open
Abstract
Ganglion and synovial cysts occur mainly, but not necessarily, in association with osteoarthritis. Presentation varies widely, ranging from small, incidentally detected, asymptomatic lesions to giant ones that might be the source of symptoms, either due to their compressive effect on adjacent structures or due to complications, such as rupture. On magnetic resonance imaging they are typically presented as smooth, well-circumscribed, thin-walled, unilocular, and homogeneously T2-hyperintense lesions. An identifiable thin stalk communicating to the joint space is not infrequent. Nevertheless, depending on their age, anatomic location, and eventual complication, they might have many distinct appearances, including septae and internal debris, which the radiologist must be familiar with in order to accurately differentiate them from worrisome cystic-like lesions. With regard to this diversity, some illustrative cases are presented.
Collapse
|
42
|
Torres Campa-Santamarina J, Towne S, Alimi M, Navarro-Ramirez R, Härtl R. Minimally Invasive Approach For Extraforaminal Synovial Cyst L5-S1. Cureus 2015; 7:e362. [PMID: 26623217 PMCID: PMC4659579 DOI: 10.7759/cureus.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Symptoms from synovial cysts are produced by neural compression in the spinal canal or the foramen. Few cases of extraforaminal synovial cyst have been published in the literature. This is a case report of a 65-year-old female who presented with a three-month history of sciatic pain and no relief with conservative treatment. MRI showed a left-sided extraforaminal synovial cyst at L5-S1 with compression of the L5 nerve root at the lateral portion of the foramen. Minimally invasive surgery for resection was performed using an extraforaminal tubular microscopic endoscopy-assisted approach. The patient improved clinically and remained symptom-free for the entire follow-up of 30 months.
Collapse
Affiliation(s)
| | - Sara Towne
- Department of Neurosurgery, Weill-Cornell/New York Presbyterian Hospital
| | - Marjan Alimi
- Department of Neurosurgery, Weill-Cornell/New York Presbyterian Hospital
| | | | - Roger Härtl
- Department of Neurosurgery, Weill-Cornell/New York Presbyterian Hospital
| |
Collapse
|
43
|
Jin HS, Bae JY, In CB, Choi EJ, Lee PB, Nahm FS. Epiduroscopic Removal of a Lumbar Facet Joint Cyst. Korean J Pain 2015; 28:275-9. [PMID: 26495082 PMCID: PMC4610941 DOI: 10.3344/kjp.2015.28.4.275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 01/07/2023] Open
Abstract
Facet joint synovial cysts are usually associated with osteoarthritis of the adjacent facet joint and/or spondylolisthesis. In between the conservative and operative ends of the treatment spectrum lie minimally invasive techniques such as cyst rupture using epiduroscopy. In this report, we describe an 82-year-old male patient presenting with low back pain radiating to his lower left extremity and associated paresthesia. Magnetic resonance imaging of the lumbar spine revealed a synovial cyst at left L4/5 facet joint. Using epiduroscopy, the cyst was mechanically ruptured by popping it with the tip of the scope. The patient remained symptom-free at his successive visits until 12 months after the procedure, and was opened for desired follow up.
Collapse
Affiliation(s)
- Hyun Seung Jin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jun Yeol Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chi Bum In
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pyung Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
44
|
Scholz C, Hubbe U, Kogias E, Klingler JH. Incomplete resection of lumbar synovial cysts – Evaluating the risk of recurrence. Clin Neurol Neurosurg 2015; 136:29-32. [DOI: 10.1016/j.clineuro.2015.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/06/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
|
45
|
|
46
|
Percutaneous Rupture of a Symptomatic Facet Joint Synovial Cyst Using 2-Needle Distention. Reg Anesth Pain Med 2015; 40:635-8. [PMID: 26110442 DOI: 10.1097/aap.0000000000000278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This case report calls attention to an alternative approach for management of a symptomatic facet joint synovial cyst. We describe a patient with a symptomatic facet joint synovial cyst who failed an attempted percutaneous rupture using a single-needle technique. This patient was subsequently successfully managed with percutaneous rupture using a 2-needle technique. CASE REPORT A 60-year-old woman presented with low back pain, right lower extremity pain, and paresthesias. Magnetic resonance imaging revealed a right L5-S1 facet joint cyst, which compressed the right L5 nerve root. Before presentation, the patient failed an attempted single-needle percutaneous rupture. The decision was made to proceed with percutaneous rupture using a 2-needle technique. A 22-gauge needle was inserted into the right L5-S1 facet joint, and a Tuohy needle was inserted directly into the cyst through an interlaminar approach. A solution of methylprednisolone and hyaluronidase was simultaneously injected through both needles, and the cyst was continuously distended until rupture was achieved. Rupture was confirmed by injecting contrast into the facet joint and visualizing a normal epidurogram. The patient reported significant pain relief immediately after the procedure. At 4-month follow-up, the patient reported continued pain relief and denied any radicular symptoms. CONCLUSIONS Percutaneous rupture of a symptomatic facet joint synovial cyst using a single-needle technique has been validated as an efficacious form of management. In a select group of patients who fail single-needle percutaneous rupture, a 2-needle approach for percutaneous facet cyst rupture may be considered as an option for management.
Collapse
|
47
|
Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique. Cardiovasc Intervent Radiol 2015; 39:127-31. [PMID: 25944146 DOI: 10.1007/s00270-015-1106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/27/2015] [Indexed: 11/15/2022]
Abstract
We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4-L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.
Collapse
|
48
|
Shuang F, Hou SX, Zhu JL, Ren DF, Cao Z, Tang JG. Percutaneous resolution of lumbar facet joint cysts as an alternative treatment to surgery: a meta-analysis. PLoS One 2014; 9:e111695. [PMID: 25389771 PMCID: PMC4229115 DOI: 10.1371/journal.pone.0111695] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/19/2014] [Indexed: 12/11/2022] Open
Abstract
PURPOSE A comprehensive review of the literature in order to analyze data about the success rate of percutaneous resolution of the lumbar facet joint cysts as a conservative management strategy. METHODS A systematic search for relevant articles published during 1980 to May 2014 was performed in several electronic databases by using the specific MeSH terms and keywords. Most relevant data was captured and pooled for the meta-analysis to achieve overall effect size of treatment along with 95% confidence intervals. RESULTS 29 studies were included in the meta-analysis. Follow-up duration as mean ± sd (range) was 16±10.2 (5 days to 5.7 years). Overall the satisfactory results (after short- or long-term follow-up) were achieved in 55.8 [49.5, 62.08] % (pooled mean and 95% CI) of the 544 patients subjected to percutaneous lumbar facet joint cyst resolution procedures. 38.67 [33.3, 43.95] % of this population underwent surgery subsequently to achieve durable relief. There existed no linear relationship between the increasing average duration of follow-up period of individual studies and percent satisfaction from the percutaneous resolutions procedure. CONCLUSION Results shows that the percutaneous cyst resolution procedures have potential to be an alternative to surgical interventions but identification of suitable subjects requires further research.
Collapse
Affiliation(s)
- Feng Shuang
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- Department of Orthopedics, The 94th Hospital of Chinese PLA, Nanchang, China
| | - Shu-Xun Hou
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- * E-mail: (JGT); (SXH)
| | - Jia-Liang Zhu
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Dong-Feng Ren
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Zheng Cao
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Jia-Guang Tang
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- * E-mail: (JGT); (SXH)
| |
Collapse
|
49
|
Zhenbo Z, Huanting L, Jin W, Haifeng G, Yuan F, Ming L. Hemilaminoplasty for the treatment of lumbar intraspinal synovial cysts (LISCs) 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 2014; 25:3393-3402. [DOI: 10.1007/s00586-014-3570-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 01/17/2023]
|
50
|
Clinical significance of postdecompression facet joint effusion after minimally invasive decompression for degenerative lumbar spinal stenosis. ACTA ACUST UNITED AC 2014; 27:E318-23. [PMID: 25075985 DOI: 10.1097/bsd.0000000000000126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective case series study. OBJECTIVE To investigate the clinical significance of postdecompression facet effusion (PDFE) after microendoscopic decompressive laminotomy (MEDL). SUMMARY OF BACKGROUND DATA The facet joint effusion noted on magnetic resonance imaging was considered as an indicator of degeneration of the facet joints and segmental instability. PDFE occurring after MEDL might imply postdecompression segmental instability. Its clinical significance has not yet been clarified. MATERIALS AND METHODS From 2005 to 2010, 165 patients with degenerative lumbar spinal stenosis (average age: 64.5, average follow-up: 25.8 mo) who received MEDL were reviewed. We investigated the incidence of PDFE with preoperative and repetitive magnetic resonance imaging at 6 months postoperatively. The clinical data and treatment courses were reviewed. The treatment outcomes were evaluated with Oswestry Disability Index and Japanese Orthopedic Association scores. RESULTS The incidence of PDFE was 17.0% (n=28), which was significantly higher in patients receiving multilevel decompression and patients with scoliosis or spondylolisthesis. The intensity of low back pain was similar between patients with and without PDFE, but "mechanical" low back pain was only noted in patients with PDFE. Of the 28 patients with PDFE, only 9 symptomatic patients required invasive treatment (5 facet joint steroid injection, 3 revision MEDL, and 1 spinal fusion). Although the postoperative Oswestry Disability Index and Japanese Orthopedic Association scores were significantly worse these 9 patients, the final outcomes were good. Progression of spondylolisthesis was noted in 2 patients without PDFE but no patients with PDFE during the follow-up period. CONCLUSIONS The relatively high incidence of PDFE after MEDL suggests that injury to the integrity of facet joint is inevitable during decompression of the stenosis, even using minimally invasive techniques. However, the overall stability is well preserved with very rare progression of spondylolisthesis. Most patients with PDFE are asymptomatic. The prognosis of PDFE is very good. Spinal fusion is rarely indicated.
Collapse
|