A rare gas-containing lumbar synovial cyst treated by percutaneous transforaminal endoscopic cystectomy: A case report and literature review

Spinal synovial cysts are rare entities for which standard surgical strategies are inconsistent. Here, we present an uncommon intraspinal gas-containing synovial cyst treated by percutaneous transforaminal endoscopic cystectomy. A 52-year-old man presented with radicular pain and intermittent claudication that had persisted for one month. Computed tomography revealed an intraspinal cystic lesion anteromedial to the left L4-L5 articular joint and the center of the lesion manifested gas contents. A transforaminal endoscopic procedure was performed and confirmed as a safe and minimally invasive technique for gas-containing lumbar synovial cysts. It provides a valuable substitution and supplementation to open surgery.

Transforaminal percutaneous endoscopic discectomy for symptomatic gas-filled discal cysts-report of three cases and literature review

OBJECTIVE

The aim of this retrospective study is to review our experience in the diagnosis and role of transforaminal percutaneous endoscopic discectomy (TPED) for symptomatic gas-filled discal cysts.

METHODS

Between May 2014 and June 2017, 3 patients from Lishui Center Hospital (Lishui China), who underwent TPED for symptomatic gas-filled discal cysts, were analyzed. The clinical features, imaging findings, operative findings, and treatment outcomes are presented. In addition, relevant literature regarding gas-filled discal cysts was searched using PubMed, and their characteristics, clinical features, therapeutic strategies, and survival outcomes were reviewed.

RESULTS

The median age of the patients was 56.7 years (range, 55-60 years). In all patients, a discal cyst was located in the lumbar region, and the patients presented with backache and numbness in the lower extremities. The diagnosis was made by lumbar 3-dimensional computed tomography (3D-CT) or magnetic resonance imaging (MRI). All patients underwent TPED. All patients recovered successfully and were eventually discharged. Eighteen articles were identified from the searches of the database, and a total of 42 patients were included. There were 28 males and 14 females. The mean age was 56.8 years, ranging from 27 to 85 years. Lower back pain was the major symptom. Twenty-two patients underwent surgery, 4 patients underwent percutaneous needle aspiration, 2 patients underwent drug therapy, 13 patients received nonoperative treatment, and 1 patient was unknown.

CONCLUSION

TPED for gas-filled discal cysts is feasible, effective, and successful, although it should be performed by an experienced surgeon with awareness of the potential risk of severe nerve root injury.

Gas containing intraspinal synovial cyst in the lumbar spine: Case report and literature review

Intraspinal synovial cyst (ISC) is a well-documented pathology. It is sometimes found in the degenerative lumbar spine and can result in neurological disorders. ISC typically contains xanthochromic fluid, blood, inflammatory tissue, and/or osseous structures, enclosed by fibrous tissue. Regarding the treatment modalities, the effectiveness of both nonsurgical management, such as oral analgesics, needle aspiration, and intra-articular injection of corticosteroid drugs, and surgical management, have been reported. Previous studies have described that the ISC can contain gas, which is derived from the vacuum phenomenon of an adjacent facet joint; however, this clinical condition has never been systematically investigated because of its rarity. In the present report, we describe the case of a 68-year-old male with gas-containing ISC in the lumbar spine who was successfully treated with surgical management; additionally, we performed a literature review to discuss the decision-making process for cases of gas-containing ISC. Based on our findings and previous literature, we recommend that considering the peculiarity of the content of such lesions in addition to the ball-valve effect of a synovial cyst, prompt transition to surgical management would be pertinent when nonsurgical treatment cannot achieve satisfactory outcomes in such cases.

Symptoms of musculoskeletal disorders among ammunition factory workers in Turkey

The aim of this study was to assess the prevalence of symptoms of work-related musculoskeletal disorders (MSDs) and to determine the risk factors among ammunition factory workers in Turkey. This cross-sectional study was performed on 955 ammunition factory workers. Potential risk factors were investigated with a questionnaire and multivariate logistic regression analysis was performed. During the previous year, 39.3% of ammunition workers experienced symptoms of work-related MSDs. Logistic regression analysis showed smoking (odds ratio [OR] = 1.372), chronic diseases (OR = 1.795), body mass index (BMI; overweight) (OR = 1.631), working year (OR = 1.509), cold temperature (OR = 1.838), and work load (OR = 2.210) were significant independent risk factors for the development of symptoms of MSDs. It was found that both work-related conditions and personal and environmental factors are important for the development of occupational MSDs.

Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes

BACKGROUND CONTEXT

With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear.

PURPOSE

To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence.

STUDY DESIGN

Systematic review of the literature.

PATIENT SAMPLE

All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion.

OUTCOME MEASURES

Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales.

METHODS

We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts.

RESULTS

Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4-L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion.

CONCLUSIONS

Surgical decompression results in symptomatic resolution in the vast majority of patients; however, recurrent back pain occurs in a significant number of patients. Cyst recurrence occurs in less than 2% of patients but has never been reported after cyst excision with concomitant fusion. The lack of cyst recurrence after concomitant fusion supports the need to investigate the value of fusion of the involved motion segment in the treatment of symptomatic synovial cysts of the spine.

Factors associated with recurrent back pain and cyst recurrence after surgical resection of one hundred ninety-five spinal synovial cysts: analysis of one hundred sixty-seven consecutive cases

STUDY DESIGN

Retrospective study.

OBJECTIVE

Compare outcomes of different treatment methods for intraspinal synovial cysts.

SUMMARY OF BACKGROUND DATA

Intraspinal synovial cysts are cited as an increasing cause of back pain and radiculopathy. To date, few studies have compared outcomes of differing treatment methods in patients with synovial cysts.

METHODS

We retrospectively reviewed 167 consecutive patients undergoing surgical management of 195 symptomatic synovial cysts at a single institution over 19 years. The incidence of postoperative mechanical back pain, radiculopathy, and cyst recurrence was compared between patients undergoing unilateral hemilaminectomy (n = 51), bilateral laminectomy (n = 39), facetectomy with in situ fusion (n = 18), and facetectomy with instrumented fusion (n = 56).

RESULTS

A total of 155 (97.5%) patients presented with radiculopathy, 132(82.5%) with mechanical back pain, 31 (20%) with neurogenic claudication, and 5 (3.2%) with bladder dysfunction. Most cysts occurred in the lumbar spine. After surgery, back and radicular pain improved in 91.6% and 91.9% patients, respectively. By a mean follow-up of 16 +/- 9 months, 36 (21.6%) patients developed recurrent back pain, 20 (11.8%) recurrent leg pain, and 5 (3%) recurrent synovial cysts. Patients undergoing laminectomy had a significantly increased cyst recurrence incidence compared to fusion groups via log-rank test (P = 0.042), and this risk was decreased to baseline with instrumented fusion on reoperation. Laminectomy was also associated with the highest increased risk of recurrent back pain in both log-rank test (P = 0.018) and proportional hazards regression (HR): 1.64 (1.00-3.45), P = 0.05. Instrumented fusion had the lowest risk for back pain recurrence.

CONCLUSION

Hemilaminectomy or laminectomy remains one of the mainstay surgical treatments for symptomatic intraspinal synovial cysts. Our experience shows that the majority of patients undergoing decompression/excision of synovial cysts will have immediate improvement in back and leg pain. However, within 2 years, patients receiving hemilaminectomy or laminectomy alone have an increased incidence of back pain and cyst recurrence. Decompression with instrumented fusion appears to be associated with the lowest incidences of cyst recurrence or back pain.