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Federico VP, Forlenza EM, Acuna AJ, Vucicevic RS, Conaway WK, Nie JW, Butler AJ, Gabriel S, Lopez GD, An HS, Colman MW, Phillips FM. Risk of Subsequent Fusion After Isolated Decompression of Lumbar Facet Cysts. J Am Acad Orthop Surg 2024; 32:339-345. [PMID: 38320287 DOI: 10.5435/jaaos-d-23-00765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Lumbar facet cysts represent a potential source of nerve root compression in elderly patients. Isolated decompression without fusion has proven to be a reasonable treatment option in properly indicated patients. However, the risk of lumbar fusion after isolated decompression and facet cyst excision has yet to be elucidated. METHODS The PearlDiver database was reviewed for patients undergoing isolated laminectomy for lumbar facet cyst from January 2015 to December 2018 using Current Procedural Terminology coding. Patients undergoing concomitant fusion or additional decompression, as well as those diagnosed with preexisting spondylolisthesis or without a minimum of 5-year follow-up, were excluded. Rates of subsequent lumbar fusion and potential risk factors for subsequent fusion were identified. Statistical analysis included descriptive statistics, chi square test, and multivariate logistic regression. Results were considered significant at P < 0.05. RESULTS In total, 10,707 patients were ultimately included for analysis. At 5-year follow-up, 727 (6.79%) of patients underwent subsequent lumbar fusion after initial isolated decompression. Of these, 301 (2.81% of total patients, 41.4% of fusion patients) underwent fusion within the first year after decompression. Multivariate analysis identified chronic kidney disease, hypertension, and osteoarthritis as risk factors for requiring subsequent lumbar fusion at 5 years following the index decompression procedure ( P < 0.033; all). CONCLUSION Patients undergoing isolated decompression for lumbar facet cysts undergo subsequent lumbar fusion at a 5-year rate of 6.79%. Risk factors for subsequent decompression include chronic kidney disease, hypertension, and osteoarthritis. This study will assist spine surgeons in appropriately counseling patients on expected postoperative course and potential risks of isolated decompression.
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Affiliation(s)
- Vincent P Federico
- From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Federico, Forlenza, Acuna, Vucicevic, Conaway, Nie, Butler, Lopez, An, Colman, and Phillips), and the Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Gabriel)
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2
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Benato A, Menna G, Rapisarda A, Polli FM, D’Ercole M, Izzo A, D’Alessandris QG, Montano N. Decompression with or without Fusion for Lumbar Synovial Cysts—A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072664. [PMID: 37048747 PMCID: PMC10095101 DOI: 10.3390/jcm12072664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
The management of symptomatic lumbar synovial cysts (LSC) is still a matter of debate. Previous systematic reviews did not stratify data according to different treatment techniques or incompletely reported comparative data on patients treated with lumbar posterior decompression (LPD) and lumbar decompression and fusion (LDF). The aim of our study was to compare LPD and LDF via a systematic review and meta-analysis of the existing literature. The design of this study was in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review questions were as follows: among patients suffering from symptomatic lumbar synovial cysts (population) and treated with either posterior lumbar decompression or posterior decompression with fusion (intervention), who gets the best results (outcome), in terms of cyst recurrence, reoperation rates, and improvement of postoperative symptoms (comparison)? The search of the literature yielded a total of 1218 results. Duplicate records were then removed (n = 589). A total of 598 articles were screened, and 587 records were excluded via title and abstract screening; 11 studies were found to be relevant to our research question and were assessed for eligibility. Upon full-text review, 5 were excluded because they failed to report any parameter separately for both LPD and LDF. Finally, 6 studies for a total of 657 patients meeting the criteria stated above were included in the present investigation. Our analysis showed that LDF is associated with better results in terms of lower postoperative back pain and cyst recurrence compared with LPD. No differences were found in reoperation rates and complication rates between the two techniques. The impact of minimally invasive decompression techniques on the different outcomes in LSC should be assessed in the future and compared with instrumentation techniques.
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Affiliation(s)
- Alberto Benato
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Grazia Menna
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Rapisarda
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Maria Polli
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Manuela D’Ercole
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Izzo
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Quintino Giorgio D’Alessandris
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola Montano
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Morishita Y, Taniguchi R, Kawano O, Maeda T. Synovial facet joint cysts after lumbar posterior decompression surgery. J Neurosurg Spine 2021; 35:704-709. [PMID: 34416717 DOI: 10.3171/2021.2.spine201671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Numerous studies have reported on synovial facet joint cysts of the spine as a primary lesion. The exact pathogenesis of those cysts is still controversial, but degeneration and destabilization seem to be underlying mechanisms. However, only a few reports have thus far investigated synovial cysts of the spine as postoperative complications of decompression surgery. In this retrospective clinical study, the authors focused on synovial cysts of the lumbar facet joints as complications after lumbar decompression surgery, with the aim of elucidating their pathophysiology. METHODS A total of 326 patients with 384 segments treated with posterior decompression surgery without fusion were included in the study. Of these segments, 107 were surgically decompressed unilaterally and 277 were decompressed bilaterally. After surgery, 18 of the 384 segments developed a complication of symptomatic facet synovial cyst. The anatomical and morphological evaluations of these segments were performed using functional plain radiographs, CT scans, and MR images. RESULTS All of the 18 segments with postoperative lumbar facet synovial cyst were treated with bilateral lumbar posterior decompression. There was no significant radiological lumbar spinal instability in any segments, although 17 of 18 segments demonstrated facet articular spondylotic changes. Moreover, 12 of 18 patients demonstrated lumbar retrolisthesis in the neutral position. CONCLUSIONS Based on the authors' results, they propose that patients with lumbar degenerative disease who have a potential biomechanical lumbar instability such as disruption of the facet articular surface and hydrarthrosis or lumbar facet tropism might have a high risk for formation of lumbar facet synovial cyst after bilateral posterior decompression surgery.
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Boody BS, Smucker JD, Sasso RC, Segar AH, Protopsaltis TS. Does the Decompression of Symptomatic Lumbar Facet Cysts Without Instability Require Fusion? Clin Spine Surg 2021; 34:39-42. [PMID: 33633054 DOI: 10.1097/bsd.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/17/2019] [Indexed: 12/25/2022]
Affiliation(s)
| | | | | | - Anand H Segar
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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5
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Connolly M, Rotstein AH, Roebert J, Grabinski R, Malara F, O'Shea T, Wood T, Omizzolo M, Kovalchik S, Reid M. Lumbar spine abnormalities and facet joint angles in asymptomatic elite junior tennis players. SPORTS MEDICINE-OPEN 2020; 6:57. [PMID: 33237502 PMCID: PMC7688834 DOI: 10.1186/s40798-020-00285-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lumbar spine abnormalities, in particular stress fractures to the pars interarticularis, are common in elite junior tennis players, though the difference in prevalence between males and females remains unclear. Further, facet joint orientation appears to be a possible option for recognizing which players might go on to present with a pars stress fracture. Given the link between pars stress fractures and low back pain in tennis players, it appears logical to explore the link between facet joint angle and pars abnormalities. Thus, the purpose of this study was to describe the prevalence of lumbar spine abnormalities and explore the relationship between facet joint orientation and pars abnormalities in elite adolescent tennis players. METHODOLOGY Lumbar spine MRI images of 25 elite junior tennis players were obtained and distributed between five radiologists for analysis. Descriptive comparisons and confidence intervals were used to describe the prevalence of the abnormalities. A generalized linear regression model was conducted to investigate the relationship between lumbar pars abnormalities and lumbar facet joint angles. RESULTS Sixteen (64%) of 25 players were found to have at least one lumbar spine abnormality. Pars abnormalities affected 36% of players while bone marrow edema was found in 24% of players. Disc herniation, disc degeneration, and facet joint degeneration were diagnosed in 20%, 44%, and 24% of players respectively. Lastly, one player (4%) was diagnosed with spondylolisthesis. Females had significantly larger facet joint angles across L3/4 L5/S1 compared to males (p < 0.01). Further, those who had pars abnormalities had larger facet joint angles compared to those who did not (p < 0.001). CONCLUSION Disc degeneration, pars abnormalities, including bone marrow edema, and facet joint degeneration were common findings among elite adolescent tennis players. Additionally, this study is the first to discover that pars abnormalities are linked to facet joint angle in elite adolescent tennis players. This finding might assist in identifying tennis players at a greater risk of developing lumbar spine pars abnormalities in the future.
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Affiliation(s)
- Molly Connolly
- Institute for Health and Sport, Victoria University, Melbourne, Australia. .,Performance, Tennis Australia, Melbourne, Australia.
| | - Andrew H Rotstein
- Victoria House Medical Imaging, 435 Malvern Rd, South Yarra, Melbourne, Australia
| | - Justin Roebert
- Victoria House Medical Imaging, 435 Malvern Rd, South Yarra, Melbourne, Australia
| | - Rafal Grabinski
- Victoria House Medical Imaging, 435 Malvern Rd, South Yarra, Melbourne, Australia
| | - Frank Malara
- Victoria House Medical Imaging, 435 Malvern Rd, South Yarra, Melbourne, Australia
| | - Tomas O'Shea
- Victoria House Medical Imaging, 435 Malvern Rd, South Yarra, Melbourne, Australia
| | - Tim Wood
- Glenferrie Private Hospital, Melbourne, Australia
| | | | - Stephanie Kovalchik
- Institute for Health and Sport, Victoria University, Melbourne, Australia.,Game Insight Group, Tennis Australia, Melbourne, Australia
| | - Machar Reid
- Game Insight Group, Tennis Australia, Melbourne, Australia
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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.
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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
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Kalidindi KKV, Bhat MR, Gupta M, Mannem A, Chhabra HS. Ligamentum Flavum Cyst With Acute Onset Motor Deficit: A Literature Review and Case Series. Int J Spine Surg 2020; 14:544-551. [PMID: 32986576 DOI: 10.14444/7072] [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: 11/20/2022] Open
Abstract
BACKGROUND Ligamentum flavum cysts have been rarely described in the literature and are one of the rare causes of neural compression and canal stenosis. Very few cases of their association with neurologic deficits are reported to date, and association with acute onset weakness is even rarer. CLINICAL PRESENTATION We report our experience with 3 cases of ligamentum flavum cyst that presented with acute onset weakness and also present a comprehensive literature review on lumbar ligamentum flavum cysts reported to date. All 3 patients had symptoms of severe neurogenic claudication and presented to us with acute onset of motor weakness in lower limbs. Ligamentum flavum cyst was located in the midline in 2 cases and laterally in 1 case. We performed excision of the cyst and decompression with fusion in 2 cases and decompression alone in 1 case. All 3 cases had significant improvement in their neurologic status postoperatively. Histopathological examination confirmed ligamentum flavum cyst in all 3 cases. We performed a PUBMED and EMBASE database search using the MeSH (Medical Subject Headings) terms "ligamentum flavum" and "cysts" for articles published to April 2019. We could identify 7 studies describing 20 cases of lumbar ligamentum flavum cysts with motor weakness in the literature. Only 1 case had been described with an acute onset of weakness. CONCLUSIONS Ligamentum flavum cysts should remain in the differential diagnosis of a patient who has symptoms of lumbar canal stenosis and presents with acute onset of neurological deficits. Such patients have a good improvement with surgery.
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Affiliation(s)
| | - Mohd Rafiq Bhat
- Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
| | - Mayank Gupta
- Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
| | - Abhishek Mannem
- Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
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8
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Robins JMW, Selvanathan SK, Ismail A, Derham C, Pal D. Rapid Growth of a Facet Joint Cyst Mimicking an Aggressive Tumor in the Lumbar Spine. J Neurosci Rural Pract 2020; 11:646-650. [PMID: 33144806 PMCID: PMC7595784 DOI: 10.1055/s-0040-1715079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 67-year-old patient with a history of fully treated bowel carcinoma presented with a short history of unilateral lumbosacral radiculopathy. No neurological deficit was found on examination. Magnetic resonance imaging (MRI) demonstrated initially L4/5 foraminal narrowing that was believed to be the cause for the patient’s symptoms; however, a nerve root block led to no improvement in symptoms. MRI was repeated at 5 months and demonstrated a mass causing compression of the S1 nerve. However, the patient declined surgical decompression. MRI at 14 months subsequently showed rapid growth of the lesion suggestive of an aggressive process such as a metastatic lesion or even a nerve sheath tumor such as a Schwannoma. Open biopsy and decompression revealed the lesion to be a facet joint cyst and the patient recovered well and had satisfactory postoperative imaging at 3 months follow-up. There are no reports in the literature of facet joint cysts growing this quickly and thus mimicking other forms of lesion.
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Affiliation(s)
- James M W Robins
- Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom
| | | | - Azzam Ismail
- Deparment of Pathology, St James' University Hospital, Leeds, United Kingdom
| | - Chris Derham
- Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom
| | - Deb Pal
- Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom
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Hellinger S, Lewandrowski KU. Clinical outcomes with endoscopic resection of lumbar extradural cysts. JOURNAL OF SPINE SURGERY 2020; 6:S133-S144. [PMID: 32195422 DOI: 10.21037/jss.2019.08.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Lumbar extradural cysts may be associated with sciatica-type back and leg pain. The symptoms of clinical pain syndrome from synovial cysts are sometimes difficult to differentiate from those of lumbar disc herniation or spinal canal stenosis and may be identified to be a pain source when visualized endoscopically. The authors analyzed the clinical outcomes with their endoscopic resection to better establish clinical indications and prognosticators of favorable results. Methods Two-year Macnab outcomes, VAS scores, and complications were analyzed in a series of 48 patients treated with the endoscopic removal of extradural cyst encountered during routine transforaminal and interlaminar decompression for foraminal and lateral recess stenosis causing lumbar radiculopathy. Results There were 26 female and 22 male patients. The extradural cysts were most commonly encountered at L4/5 level in 26 patients (72.2%) followed by the L5/S1 level in 8 patients (22.2%), and in 2 patients (5.6%) at the L3/4 level, respectively. One patient underwent T9/10 decompression. At minimum 2-year follow-up, all patients were improved. Excellent results according to the Macnab criteria were obtained in 19/48 (39.6%) patients, good in 18/48 (37.5%), and fair in 11/48 (22.9%), respectively. The average preoperative VAS score for leg pain was 8.06±1.57 and reduced at a statistically significant level (P<0.000) postoperatively to 1.92±1.49, and 1.77±1.32 at final follow-up, respectively. The percentage of patients with unlimited walking endurance had improved at a statistically significant level (P<0.0001) from 33.3% preoperatively (16/48) to 81.3% (39/48) postoperatively. One patient had a recurrent disc herniation, and another patient did not improve. Two patients underwent fusion during the follow-up period. Patients with Fair outcomes had a statistically significant association (P<0.001) with facet instability as suggested by axial T2-weighted magnetic resonance imaging (MRI) findings of thickened ligamentum flavum, facet joint hypertrophy, and bright white fluid-filled joint gap of >2 mm. Conclusions Endoscopic resection of extradural spinal cysts during routine decompression for symptomatic foraminal and lateral recess stenosis is feasible with favorable clinical outcomes in the majority of patients. Fair outcomes were associated with advanced instability of the involved lumbar facet joint complex.
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Affiliation(s)
- Stefan Hellinger
- Department of Orthopedic Surgery, Isar Hospital, Munich, Germany
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, USA.,Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, DC, Colombia
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Abstract
CLINICAL ISSUE Spinal cysts can be classified as meningeal, not meningeal, and tumor-associated cysts. Due to the widespread availability of high-resolution computed tomography and magnet resonance imaging, spinal cysts can be detected with high sensitivity these days. Concerning the variety of potential cystic differential diagnoses, a precise classification is difficult and can often only be realized after surgical inspection or histological examination. PRACTICAL RECOMMENDATIONS Spinal cysts are generally incidental findings during a routine diagnostic workup and need no further therapy. Surgical treatment can be necessary if the spinal cyst reaches a certain size and causes neurological symptoms due to the compression of the spinal cord or the nerve root.
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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.
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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
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Siu KC, Stoodley MA. Decompressive laminectomy without fusion for lumbar facet joint cysts. J Clin Neurosci 2018; 58:113-116. [DOI: 10.1016/j.jocn.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 11/15/2022]
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Mobbs R, Campbell R, Phan K. NeuroSpine Surgery Research Group (NSURG) Classification System for Grading Lumbar Synovial Cysts. Orthop Surg 2018; 10:3-7. [PMID: 29436166 DOI: 10.1111/os.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/01/2017] [Indexed: 01/25/2023] Open
Abstract
To classify facet joint cysts (FJC) which will assist in identification of patient groups to best fit with a particular intervention. Sagittal T2 -weighted magnetic resonance images (MRI) of these patients are used to measure cyst size, while axial T2 -weighted MRI are used to determine the percentage of the vertebral canal occupied by the cyst. The degree of spondylolisthesis is also measured through standing X-rays or sagittal MRI. The proposed grading system is as follows. Grade I includes cysts that occupy less than 25% of the canal diameter that usually present with unilateral radiculopathy. Grade II includes cysts that occupy less than 50% of the canal diameter and may present with radiculopathy, with or without claudicant symptoms. Grade III cysts may present with radiculopathy and claudication with bilateral leg symptoms, along with facetogenic pain symptoms. Grades IV and V include potential instability as defined by greater than 15% spondylolisthesis in addition to either less than or greater than 50% canal stenosis. With higher grade cysts, presentation may include: facetogenic back pain, radiculopathy and claudicant pain in variable degrees of severity. The optimal classification system grades FJC from I to V on the basis of canal compression and degree of spondylolisthesis. Prospective studies are required to confirm the validity of this grading scale for long-term use.
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Affiliation(s)
- Ralph Mobbs
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ryan Campbell
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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14
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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.
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Domenicucci M, Ramieri A, Marruzzo D, Missori P, Miscusi M, Tarantino R, Delfini R. Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review. World J Orthop 2017; 8:697-704. [PMID: 28979853 PMCID: PMC5605355 DOI: 10.5312/wjo.v8.i9.697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze different terms used in literature to identify lumbar extradural cysts and propose a common scientific terminology; to elaborate a new morphological classification of this pathology, useful for clinical and surgical purposes; and to describe the best surgical approach to remove these cysts, in order to avoid iatrogenic instability or treat the pre-existing one.
METHODS We retrospectively reviewed 34 patients with symptomatic lumbar ganglion cysts treated with spinal canal decompression with or without spinal fixation. Microsurgical approach was the main procedure and spinal instrumentation was required only in case of evident pre-operative segmental instability.
RESULTS The complete cystectomy with histological examination was performed in all cases. All patients presented an improvement of clinical conditions, evaluated by Visual Analogic Scale and Japanese Orthopaedic Association scoring.
CONCLUSION Spinal ganglion cysts are generally found in the lumbar spine. The treatment of choice is the microsurgical cystectomy, which generally does not require stabilization. The need for fusion must be carefully evaluated: Pre-operative spondylolisthesis or a wide joint resection, during the operation, are the main indications for spinal instrumentation. We propose the terms “ganglion cyst” to finally identify this spinal pathology and for the first time its morphological classification, clinically useful for all specialists.
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Affiliation(s)
- Maurizio Domenicucci
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Daniele Marruzzo
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Paolo Missori
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Massimo Miscusi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
| | - Roberto Tarantino
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberto Delfini
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
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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.
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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
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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]
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Choi KC, Lee DC, Park CK. Percutaneous Endoscopic Lumbar Foraminoplasty for Resection of Synovial Cyst. ACTA ACUST UNITED AC 2016. [DOI: 10.21182/jmisst.2016.00052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Elgafy H, Peters N, Lea JE, Wetzel RM. Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection: A case report and review of the literature. World J Orthop 2016; 7:452-457. [PMID: 27458557 PMCID: PMC4945513 DOI: 10.5312/wjo.v7.i7.452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/12/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection (ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel (antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors’ knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking anti-platelet medications.
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Klessinger S. The incidence of dural tears after complete resection of lumbar synovial cysts and the relation to the outcome. Clin Neurol Neurosurg 2016; 144:14-9. [DOI: 10.1016/j.clineuro.2016.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 11/30/2022]
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Abstract
STUDY DESIGN This was a retrospective study. PURPOSE To study the surgical outcome of synovial cysts of the lumbar spine through posterior laminectomy in combination with transpedicular screw fixation. OVERVIEW OF LITERATURE Synovial cysts of the lumbar spine contribute significantly to narrowing of the spinal canal and lateral thecal sac and nerve root compression. Cysts form as a result of arthrotic disruption of the facet joint, leading to degenerative spondylolisthesis in up to 40% of patients. METHODS Retrospective data from 6 patients, treated during the period of March 2007 to February 2011, were analyzed. All preoperative and postoperative manifestations, extension/flexion radiographs, magnetic resonance imaging, and computed tomography records were reviewed. All underwent surgery for synovial cysts with excision and decompression combined with posterior fixation. The result of surgery was evaluated with Macnab's classification. An excellent or good outcome was considered as satisfactory. Japanese Orthopedic Association Scale was used for evaluation of back pain. RESULTS All patients included in this study had excellent outcomes as regarding to improvement of all preoperative manifestations and returning to normal daily activities. Only 2 cases developed postoperative transient cerebro-spinal fluid leak and were treated conservatively and improved during the follow up period. CONCLUSIONS Although this study included a small number of cases and we could not have statistically significant results, the good outcome of decompression of synovial cysts combined with posterior fixation and fusion encouraged us to recommend this approach for patients with juxtafacet synovial cysts.
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Sukkarieh HG, Hitchon PW, Awe O, Noeller J. Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases. J Neurosurg Spine 2015; 23:444-50. [DOI: 10.3171/2015.1.spine14996] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach.
METHODS
All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times.
RESULTS
There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m2. Sixty-nine percent (9 of 13) of the cysts were at L4–5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series.
CONCLUSIONS
The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.
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Haemorrhagic lumbar juxtafacet cyst with ligamentum flavum involvement. Case Rep Orthop 2015; 2014:126067. [PMID: 25580330 PMCID: PMC4279113 DOI: 10.1155/2014/126067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022] Open
Abstract
Juxtafacet cysts are an uncommon cause of radiculopathy. They occur most frequently in the lumbar region, and their distribution across the spine correlates with mobility. Haemorrhagic complications are rare and may occur in the absence of any provocation, although there is some association with anticoagulation and trauma. We present a case of acute radiculopathy due to an L5/S1 juxtafacet cyst with unprovoked haemorrhage which was found to extend into ligamentum flavum. The patient underwent uncomplicated microscope assisted decompression with excellent results. The demographics, presentation, aetiology, and management of juxtafacet cysts are discussed.
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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]
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Huang KT, Owens TR, Wang TS, Moreno JR, Bagley JH, Bagley CA. Giant, completely calcified lumbar juxtafacet cyst: report of an unusual case. Global Spine J 2014; 4:175-8. [PMID: 25083359 PMCID: PMC4111943 DOI: 10.1055/s-0033-1363591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 11/11/2013] [Indexed: 12/15/2022] Open
Abstract
Study Design Case report. Objective To report the case of one patient who developed a giant, completely calcified, juxtafacet cyst. Methods A 57-year-old woman presented with a 2-year history of progressively worsening lower back pain, left leg pain, weakness, and paresthesias. Imaging showed a giant, completely calcified mass arising from the left L5-S1 facet joint, with coexisting grade I L5 on S1 anterolisthesis. The patient was treated with laminectomy, excision of the mass, and L5-S1 fixation and fusion. Results The patient had an uncomplicated postoperative course and had complete resolution of her symptoms as of 1-year follow-up. Conclusions When presented with a solid-appearing, calcified mass arising from the facet joint, a completely calcified juxtafacet cyst should be considered as part of the differential diagnosis.
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Affiliation(s)
- Kevin T. Huang
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Timothy R. Owens
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Teresa S. Wang
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Jessica R. Moreno
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Jacob H. Bagley
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Carlos A. Bagley
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States,Address for correspondence Carlos A. Bagley, MD Division of Neurosurgery, Duke University Medical CenterBox 3807, Durham, NC 27710United States
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Seo DH, Park HR, Oh JS, Doh JW. Ligamentum flavum cyst of lumbar spine: a case report and literature review. KOREAN JOURNAL OF SPINE 2014; 11:18-21. [PMID: 24891868 PMCID: PMC4040634 DOI: 10.14245/kjs.2014.11.1.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/17/2014] [Accepted: 03/06/2014] [Indexed: 11/19/2022]
Abstract
Ligamentum flavum cysts have rarely been reported and known to be the uncommon cause of spinal compression and radiculopathy. A 63-year-old man presented right sciatica lasting for 1 month. Lumbar computerized tomography and magnetic resonance imaging demonstrated an extradural cystic mass adjacent to the L5-S1 facet joints. Partial hemilaminectomy and flavectomy at the L5-S1 space were performed, and then the cystic mass was excised. Histopathology confirmed a connective tissue cyst, which is consistent with the ligamentum flavum. Microscopic examination of the cyst wall revealed that it is closely packed collagen fibril. The symptom of patient was improved after surgery. Because of rarity of ligamentum flavum cysts and nonspecific clinical and radiologic findings, the preoperative diagnosis is not easy. The histologic features of ligamentum flavum cysts are distinct from other cystic lesion of lumbar spine. This study presents a case and literature review of ligamentum flavum cyst. We summarize the pathophysiology, occurrence, differential diagnosis of rare ligamentum flavum cyst, especially on lumbar spine.
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Affiliation(s)
- Dong-Ho Seo
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hye-Ran Park
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae-Sang Oh
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae-Won Doh
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Cheonan, Korea
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Microendoscopy-assisted muscle-preserving interlaminar decompression for lumbar spinal stenosis: clinical results of consecutive 105 cases with more than 3-year follow-up. Spine (Phila Pa 1976) 2014; 39:E318-25. [PMID: 24365896 DOI: 10.1097/brs.0000000000000160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of data collected prospectively on patients who underwent microendoscopy-assisted muscle-preserving interlaminar decompression (MILD) for lumbar spinal stenosis. OBJECTIVE To evaluate the clinical results including surgical invasiveness and reduction rate of facet joint with a follow-up of more than 3 years. SUMMARY OF BACKGROUND DATA Hatta et al reported microscopic posterior decompression procedure, MILD for lumbar spinal stenosis with reference to the cervical central approach put forth by Shiraishi. Mikami et al applied spinal microendoscopy to MILD procedure (microendoscopy-assisted MILD). METHODS One hundred five consecutive patients, who underwent microendoscopy-assisted MILD, participated in this study. Operative time, blood loss, visual analogue scale (VAS), serum creatine kinase and C-reactive protein, surgical complications, reduction rate of the facet joint, Japanese Orthopaedic Association score, and Short-Form 36 were evaluated. RESULTS The operative time was 99.3 minutes and the intraoperative bleeding was 15.7 mL on average. The mean VAS score to assess surgical site pain was 20.6 mm on postoperative day 1. The mean serum creatine kinase on postoperative day 1 and C-reactive protein on postoperative day 3 were 145.4 IU/L and 2.7 mg/dL, respectively. Surgical complications were identified in 2 cases, cauda equina injury and dural tear. The mean reduction rate of the facet joint was 3%. The follow-up rate was 83.3% and the mean follow-up period was 52.7 months. The Japanese Orthopaedic Association score improved significantly from 14.8 to 23.7 points on average. Significant improvements in Short-Form 36 were observed in all subscales except in General Health. Revision surgical procedures were performed in 8 cases at the operated level including 4 of juxtafacet cyst, 3 of disc herniation, and 1 of insufficient decompression. CONCLUSION Microendoscopy-assisted MILD is a minimally invasive procedure and favorable clinical results can be expected for lumbar spinal stenosis. LEVEL OF EVIDENCE 4.
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Lumbar L4-L5 ganglion cyst with hemicauda equina syndrome. Report of a case and review of the literature. ROMANIAN NEUROSURGERY 2013. [DOI: 10.2478/romneu-2013-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Mostly associated with degenerative facet joints and spondylolisthesis, symptomatic lumbar juxta facet cysts - ganglion and synovial cysts are uncommon lesions of the spine. They can mimic herniated discs, causing low back pain, radiculopathy or even cauda equina syndrome; also some of them are associated with spinal instability. Referring to a case with hemicauda equina syndrome where microsurgical decompression was performed with very good result; alternative treatment solutions are discussed: conservative therapy for symptomatic lesions is often unsuccessful, spinal fusion should be made for those cases with spinal instability, although there are reports of spontaneous resolution of these cysts as well as the symptoms associated with them.
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Kato M, Konishi S, Matsumura A, Hayashi K, Tamai K, Shintani K, Kazuki K, Nakamura H. Clinical characteristics of intraspinal facet cysts following microsurgical bilateral decompression via a unilateral approach for treatment of degenerative lumbar disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1750-7. [PMID: 23543390 DOI: 10.1007/s00586-013-2763-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 01/24/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary intraspinal facet cysts in the lumbar spine are uncommon, but it is unclear whether cyst incidence increases following decompression surgery and if these cysts negatively impact clinical outcome. We examined the prevalence, clinical characteristics, and the risk factors associated with intraspinal facet cysts after microsurgical bilateral decompression via a unilateral approach (MBDU). METHODS We studied 230 patients treated using MBDU for lumbar degenerative disease (133 men and 97 women; mean age 70.3 years). Clinical status, as assessed by the Japanese Orthopedic Association (JOA) score and findings on X-ray and magnetic resonance images, was evaluated prior to surgery and at both 3 months and 1 year after surgery. The prevalence of intraspinal facet cysts was determined and preoperative risk factors were defined by comparing presurgical findings with clinical outcomes. RESULTS Thirty-eight patients (16.5%) developed intraspinal facet cysts within 1 year postoperatively, and 24 exhibited cysts within 3 months. In 10 patients, the cysts resolved spontaneously 1 year postoperatively. In total, 28 patients (12.2%) had facet cysts 1 year postoperatively. The mean JOA score of patients with cysts 1 year postoperatively was significantly lower than that of patients without cysts. This poor clinical outcome resulted from low back pain that was not improved by conservative treatment. Most cases with spontaneous cyst disappearance were symptom-free 1 year later. The preoperative risk factors for postoperative intraspinal facet cyst formation were instability (OR 2.47, P = 0.26), scoliotic disc wedging (OR 2.23, P = 0.048), and sagittal imbalance (OR 2.22, P = 0.045). CONCLUSIONS Postoperative intraspinal facet cyst formation is a common cause of poor clinical outcome in patients treated using MBDU.
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Affiliation(s)
- Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, Japan.
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Abstract
BACKGROUND AND PURPOSE Synovial cysts of the spine occur most frequently in the lumbosacral region. Methods of treatment vary, but in cases of chronic pain or neurological deficits surgical intervention is undertaken. The aim of this paper is to present indications, surgical technique and efficacy of surgical treatment in patients with synovial cyst of the spinal canal. MATERIAL AND METHODS The retrospective analysis included 11 patients, aged from 47 to 72 years, treated at the Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, between 2004 and 2009. The length of medical history ranged from 2 months to 6 years. Conservative treatment applied before surgery was not effective. Neurological examination revealed unilateral or bilateral sciatica, superficial sensory disturbance or lower limb paresis. RESULTS Synovial cysts were located mainly at the L4-L5 level (9 cases). Magnetic resonance imaging (MRI) of the spine was performed in all patients and showed the cystic lesion attached to the intervertebral joint. Surgical treatment consisted of a unilateral fenestration using microsurgical techniques in most cases. Back pain relief was observed in 9 cases. In 10 patients, symptoms of sciatica disappeared. Neurological deficits disappeared in 5 patients. CONCLUSIONS Surgical treatment of spinal synovial cysts is safe, effective and ensures a long-lasting effect. Surgical treatment is indicated in patients in whom the clinical symptoms correlate with the presence of synovial cyst in imaging studies and do not resolve after conservative treatment.
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Bahuleyan B, Groff MW. Management Strategies for Patients with Spinal Synovial Cysts. World Neurosurg 2013; 79:277-80. [DOI: 10.1016/j.wneu.2012.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 11/09/2012] [Indexed: 12/11/2022]
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Bydon M, Papadimitriou K, Witham T, Wolinsky JP, Sciubba D, Gokaslan Z, Bydon A. Treatment of Spinal Synovial Cysts. World Neurosurg 2013; 79:375-80. [DOI: 10.1016/j.wneu.2012.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/26/2012] [Accepted: 08/17/2012] [Indexed: 01/24/2023]
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GANAU M, ENNAS F, BELLISANO G, GANAU L, AMBU R, FAA G, MALECI A. Synovial Cysts of the Lumbar Spine. Neurol Med Chir (Tokyo) 2013; 53:95-102. [DOI: 10.2176/nmc.53.95] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mario GANAU
- Chair of Neurosurgery, University of Cagliari
| | | | | | - Laura GANAU
- Chair of Neurosurgery, University of Cagliari
| | - Rossano AMBU
- Institute of Anatomic Pathology, University of Cagliari
| | - Gavino FAA
- Institute of Anatomic Pathology, University of Cagliari
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Park HS, Sim HB, Kwon SC, Park JB. Hemorrhagic lumbar synovial cyst. J Korean Neurosurg Soc 2012; 52:567-9. [PMID: 23346333 PMCID: PMC3550429 DOI: 10.3340/jkns.2012.52.6.567] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/28/2012] [Accepted: 12/14/2012] [Indexed: 11/27/2022] Open
Abstract
Synovial cysts of the lumbar spine are an uncommon cause of back and radicular pain. These cysts most frequently present as back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms secondary to spinal canal compromise. Although less common, they can also present with acute spinal cord or root compression symptoms. We report of a case in which hemorrhaging into a right L2-3 facet synovial cyst caused an acute onset of back pain and radiculopathy, requiring surgical excision.
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Affiliation(s)
- Hyun Seok Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Rhee J, Anaizi AN, Sandhu FA, Voyadzis JM. Minimally invasive resection of lumbar synovial cysts from a contralateral approach. J Neurosurg Spine 2012; 17:453-8. [DOI: 10.3171/2012.8.spine12101] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Synovial cysts of the lumbar spine result from degeneration of the facet capsule and often mimic symptoms commonly seen with herniated intervertebral discs. In symptomatic patients, the prevalence of synovial cysts may be as high as 10%. Although conservative management is possible, the majority of patients will require resection. Traditional procedures for lumbar synovial cyst resection use an ipsilateral approach requiring partial or complete resection of the ipsilateral facet complex, possibly leading to further destabilization. A contralateral technique using minimally invasive tubular retractors for synovial cyst resection avoids facet disruption. The authors report 2 cases of a minimally invasive synovial cyst resection via a contralateral laminotomy. In both cases, complete resection of the cyst was achieved while sparing the facet joint.
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Juxtafacet cyst infection. 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 2012; 22 Suppl 3:S388-93. [PMID: 22996596 DOI: 10.1007/s00586-012-2503-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 09/09/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE In the realm of spinal surgery, infections have multiple etiologies and sites of origin. In this case series, we describe a juxtafacet cyst spinal infection that can often be missed or attributed to common symptomology of benign processes despite florid infection. METHODS In rare instances, the juxtafacet cyst may become infected and require direct intervention. This case report attempts to describe the prodrome leading to such a diagnosis and two different ways to manage an infected facet cyst. RESULTS Management of spinal infections varies due to the multiplicity of causes and location of infections. The juxtafacet cyst infection should remain a part of the differential diagnosis for low back pain as their presentation often mimics more common presenting complaints. CONCLUSIONS In our two patient presentations, both were diabetics and had remote histories of cancer that necessitated chemotherapy or radiation therapy. They also seemingly had de novo onset of infected juxtafacet cyst. The variety of causes and presentations of spinal infections should heighten the astute surgeon to be suspicious of these entities and thus intervene early with appropriate management.
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Bashir EF, Ajani O. Management of lumbar spine juxtafacet cysts. World Neurosurg 2012; 77:141-6. [PMID: 22405394 DOI: 10.1016/j.wneu.2011.06.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 05/14/2011] [Accepted: 06/23/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We review a series of 21 patients with lumbar juxtafacet cysts (LJFCs) treated in two institutions. METHODS The charts of 21 patients with a diagnosis of LJFCs during a 6- year period, January 2001 to December 2006, treated at Hamad Hospital, Doha, Qatar, and El Ribat University Hospital, Khartoum, Sudan, were reviewed. Demographic data, clinical and imaging findings, management, and outcome were reviewed. RESULTS Twenty-one patients with 23 LJFCs were identified (14 men, 7 women) with a mean age of 54 years. All presented with back pain and radicular symptoms. Ten patients presented with neurogenic claudication due to spinal canal stenosis. All had magnetic resonance imaging and dynamic spine radiographs. Fourteen LJFCs were found at L4-5 level, 8 at L5-S1 level, and 1 at L3-4 level. Three patients had sustained improvement with conservative treatment and 17 patients underwent surgical management, mainly through a microsurgical approach. Nine of 10 patients with lumbar canal stenosis underwent decompressive laminectomy; one patient refused treatment. One patient with bilateral LJFCs and mobile spondylolisthesis underwent spinal fusion. All patients, except one, were followed up for a period of 12-72 months. CONCLUSIONS LJFCs may lead to symptoms similar to degenerative disc disease. Surgery is reserved for symptomatic patients who do not improve satisfactorily with conservative treatment. The microsurgical approach is our preferred surgical method and spinal fusion should be reserved for patients with spinal instability. Long-term outcome with surgical treatment appears satisfactory.
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Affiliation(s)
- El Fatih Bashir
- Neuro Spine Center, El Ribat University Hospital, Khartoum, Sudan.
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Landi A, Marotta N, Tarantino R, Ruggeri AG, Cappelletti M, Ramieri A, Domenicucci M, Delfini R. Microsurgical excision without fusion as a safe option for resection of synovial cyst of the lumbar spine: long-term follow-up in mono-institutional experience. Neurosurg Rev 2012; 35:245-53; discussion 253. [PMID: 22009492 DOI: 10.1007/s10143-011-0356-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 06/01/2011] [Accepted: 09/03/2011] [Indexed: 02/07/2023]
Abstract
Spinal synovial cysts are cystic dilatations of the synovial membrane that may arise at all levels of the spine. We describe our experience, paying attention to diagnosis, surgical treatment, and long-term follow-up. Between 1995 and 2007, 18 patients were surgically treated. Of these, three patients were excluded from the study because they presented spinal instability at pre-operative assessment. All patients were evaluated pre-operatively with CT, MRI, and dynamic X-rays, and underwent surgery for removal of the cyst by hemilaminectomy and partial arthrectomy. All patients were evaluated with early MRI and had a minimum 2-year follow-up by dynamic X-rays. None of the patients required instrumented fusion due to the absence of radiological signs of instability on the pre-operative dynamic tests. In all patients, there was an immediate resolution of the symptoms, with evidence of complete removal of the cysts on post-operative MRI. At 2-year follow-up, all patients underwent dynamic X-rays and responded to a questionnaire for evaluation of outcome. None of them showed signs of relapse. The gold standard for treatment is surgery, even though other conservative treatment regimens have been proposed. Correct surgical strategy relies on pre-operative assessment of biomechanical stability for deciding whether patients need instrumented fusion during cyst removal. Patients with no instability signs are suitable for hemilaminectomy with partial arthrectomy, preserving 2/3 of the medial portion of the articular facet, because this represents a valid option of treatment with a low risk of complications and a low rate of relapse.
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Affiliation(s)
- A Landi
- Division of Neurosurgery, Department of Neurology and Psychiatry, University of Rome Sapienza, Rome, Italy.
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Xu R, Solakoglu C, Maleki Z, McGirt MJ, Gokaslan ZL, Bydon A. Hemorrhagic synovial cyst: the possible role of initial trauma and subsequent microtrauma in its pathogenesis: case report. Neurosurgery 2011; 68:E858-65; discussion E865. [PMID: 21311282 DOI: 10.1227/neu.0b013e3182080127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Intraspinal synovial cysts are uncommon causes of back and radicular leg pain. Usually associated with degenerative spinal disease, these juxtafacet cysts are usually located in the lumbar spine and may rarely undergo intracystic hemorrhage. The pathogenesis of these cysts are unclear, and risk factors that may contribute to hemorrhagic complications are largely unknown. CLINICAL PRESENTATION A 68-year-old man presented to the clinic 4 months after a fall on ice with persistent back pain and lumbar radiculopathy. A week after the initial clinic consultation, the patient presented to the emergency room with increased pain and worsening weakness in the left foot. An emergent magnetic resonance image showed thecal sac compression secondary to a large, juxtafacet cyst that was hyperintense on T1-weighted and hypointense on T2-weighted images. Lumbar decompressive laminectomies were performed at L3 and L4 with cyst removal and stabilization. CONCLUSION We present the eighth reported case of a hemorrhagic juxtafacet cyst secondary to physical trauma, the second in which the patient's symptoms acutely worsened several months after the initial insult without new trauma. We also present summary statistics of the 31 cases of hemorrhagic juxtafacet cysts reported in the literature and propose a putative mechanism that may account for the development and progression of symptoms in some patients.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Bydon A, Xu R, Parker SL, McGirt MJ, Bydon M, Gokaslan ZL, Witham TF. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. Spine J 2010; 10:820-6. [PMID: 20488765 DOI: 10.1016/j.spinee.2010.04.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 03/14/2010] [Accepted: 04/08/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear. PURPOSE To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence. STUDY DESIGN Systematic review of the literature. PATIENT SAMPLE All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion. OUTCOME MEASURES Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales. METHODS We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts. RESULTS Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4-L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion. CONCLUSIONS Surgical decompression results in symptomatic resolution in the vast majority of patients; however, recurrent back pain occurs in a significant number of patients. Cyst recurrence occurs in less than 2% of patients but has never been reported after cyst excision with concomitant fusion. The lack of cyst recurrence after concomitant fusion supports the need to investigate the value of fusion of the involved motion segment in the treatment of symptomatic synovial cysts of the spine.
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Affiliation(s)
- Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Factors associated with recurrent back pain and cyst recurrence after surgical resection of one hundred ninety-five spinal synovial cysts: analysis of one hundred sixty-seven consecutive cases. Spine (Phila Pa 1976) 2010; 35:1044-53. [PMID: 20173680 DOI: 10.1097/brs.0b013e3181bdafed] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Compare outcomes of different treatment methods for intraspinal synovial cysts. SUMMARY OF BACKGROUND DATA Intraspinal synovial cysts are cited as an increasing cause of back pain and radiculopathy. To date, few studies have compared outcomes of differing treatment methods in patients with synovial cysts. METHODS We retrospectively reviewed 167 consecutive patients undergoing surgical management of 195 symptomatic synovial cysts at a single institution over 19 years. The incidence of postoperative mechanical back pain, radiculopathy, and cyst recurrence was compared between patients undergoing unilateral hemilaminectomy (n = 51), bilateral laminectomy (n = 39), facetectomy with in situ fusion (n = 18), and facetectomy with instrumented fusion (n = 56). RESULTS A total of 155 (97.5%) patients presented with radiculopathy, 132(82.5%) with mechanical back pain, 31 (20%) with neurogenic claudication, and 5 (3.2%) with bladder dysfunction. Most cysts occurred in the lumbar spine. After surgery, back and radicular pain improved in 91.6% and 91.9% patients, respectively. By a mean follow-up of 16 +/- 9 months, 36 (21.6%) patients developed recurrent back pain, 20 (11.8%) recurrent leg pain, and 5 (3%) recurrent synovial cysts. Patients undergoing laminectomy had a significantly increased cyst recurrence incidence compared to fusion groups via log-rank test (P = 0.042), and this risk was decreased to baseline with instrumented fusion on reoperation. Laminectomy was also associated with the highest increased risk of recurrent back pain in both log-rank test (P = 0.018) and proportional hazards regression (HR): 1.64 (1.00-3.45), P = 0.05. Instrumented fusion had the lowest risk for back pain recurrence. CONCLUSION Hemilaminectomy or laminectomy remains one of the mainstay surgical treatments for symptomatic intraspinal synovial cysts. Our experience shows that the majority of patients undergoing decompression/excision of synovial cysts will have immediate improvement in back and leg pain. However, within 2 years, patients receiving hemilaminectomy or laminectomy alone have an increased incidence of back pain and cyst recurrence. Decompression with instrumented fusion appears to be associated with the lowest incidences of cyst recurrence or back pain.
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Freedman BA, Bui TL, Yoon ST. Diagnostic challenge: bilateral infected lumbar facet cysts--a rare cause of acute lumbar spinal stenosis and back pain. J Orthop Surg Res 2010; 5:14. [PMID: 20205727 PMCID: PMC2845560 DOI: 10.1186/1749-799x-5-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 03/05/2010] [Indexed: 12/31/2022] Open
Abstract
Symptomatic synovial lumbar facet cysts are a relatively rare cause of radiculopathy and spinal stenosis. This case and brief review of the literature, details a patient who presented with acutely symptomatic bilateral spontaneously infected synovial facet (L4/5) cysts. This report highlights diagnostic clues for identifying infection of a facet cyst.
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Affiliation(s)
- Brett A Freedman
- Department of Orthopaedic Surgery, Emory University School of Medicine, Emory Spine Center, Altanta, GA 30329, USA.
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Spinner RJ, Hébert-Blouin MN, Maus TP, Atkinson JLD, Desy NM, Amrami KK. Evidence that atypical juxtafacet cysts are joint derived. J Neurosurg Spine 2010; 12:96-102. [PMID: 20043771 DOI: 10.3171/2009.7.spine09257] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Juxtafacet cysts (JFCs) in usual locations have recently been shown to have joint connections. The pathogenesis of JFCs in unusual locations has remained obscure. The authors hypothesize that all JFCs, including atypical ones, are joint derived. METHODS In this study the authors sought to explain the occurrence and formation of clinical outliers of spinal JFCs. In Part I, they performed an extensive literature search to identify case reports of spinal intraneural cysts that have been unappreciated despite the fact that they should occur. In Part II, they studied far-lateral (extraforaminal) cysts treated at their institution and reported in the literature. The presence of a joint connection was specifically looked for since this finding has not been widely appreciated. RESULTS In Part I, 3 isolated case reports of spinal intraneural JFCs without reported joint connections were identified: 2 involving L-5 and 1, C-8. In Part II, 6 cases involving patients with far-lateral JFCs treated at the authors' institution were reviewed and all 6 had joint connections. Two of these cases had been previously published, although their joint connections were not appreciated. In 2 of the newly reported cases, arthrography confirmed a communication between the facet and the cyst. Only 1 of 5 cases in the literature had a recognized joint connection. CONCLUSIONS The authors believe that all JFCs are joint derived. This explanation for intraneural and extraneural JFCs in typical locations would be consistent with the unified articular (synovial) theory and the pathogenesis for intraneural and extraneural ganglion cyst formation in the limbs. Facet joints appear no different from other synovial joints occurring elsewhere. Understanding the pathogenesis of these cysts will help target treatment to the joint, improve surgical outcomes, and decrease recurrences.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Martha JF, Swaim B, Wang DA, Kim DH, Hill J, Bode R, Schwartz CE. Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients. Spine J 2009; 9:899-904. [PMID: 19664971 DOI: 10.1016/j.spinee.2009.06.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 03/17/2009] [Accepted: 06/18/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar facet joint synovial cysts are benign degenerative abnormalities of the lumbar spine. Previous reports have supported operative and nonoperative management. Facet joint steroid injection with cyst rupture is occasionally performed, but there has been no systematic evaluation of this treatment option. PURPOSE To profile the role of facet joint steroid injections with cyst rupture in the treatment of lumbar facet joint synovial cysts. STUDY DESIGN/SETTING Retrospective chart review and long-term follow-up of patients treated for lumbar facet joint synovial cysts. PATIENT SAMPLE One hundred one patients treated for lumbar facet joint synovial cysts with fluoroscopically guided corticosteroid facet joint injection and attempted cyst rupture. OUTCOME MEASURES Oswestry Disability Index and numeric rating scale score for back and leg pain. METHODS A retrospective review and a subsequent interview were conducted to collect pretreatment and posttreatment pain and disability scores along with details of subsequent treatment interventions. Group differences in pain and disability scores were assessed using paired t test. Multiple clinical factors were analyzed in terms of risk for surgical intervention using logistic regression modeling and Cox proportional hazards modeling. RESULTS Successful cyst rupture was confirmed fluoroscopically in 81% of cases. Fifty-five patients (54%) required subsequent surgery over a period averaging 8.4 months because of inadequate symptom relief. All patients reported significant improvement in back pain, leg pain, and disability at 3.2 years postinjection, regardless of their subsequent treatment course (p<.0001 in all groups). There was no significant difference in current pain between patients who received injections only and those who underwent subsequent surgery. CONCLUSIONS This study presents the largest clinical series of nonsurgical treatment for lumbar facet joint synovial cysts. Lumbar facet joint steroid injection with attempted cyst rupture is correlated with avoiding subsequent surgery in half of treated patients. Successful cyst rupture does not appear to have added benefit, and it was associated with worse disability 3 years postinjection. Long-term outcomes are similar, regardless of subsequent surgery.
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Affiliation(s)
- Julia F Martha
- Department of Orthopedics, New England Baptist Hospital, Boston, MA 02120, USA
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Ikuta K, Tono O, Oga M. Prevalence and clinical features of intraspinal facet cysts after decompression surgery for lumbar spinal stenosis. J Neurosurg Spine 2009; 10:617-22. [DOI: 10.3171/2009.2.spine08769] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Object
Although many cases of primary intraspinal facet cysts in the lumbar spine have been reported, there have only been a few reports of postoperative intraspinal facet cysts in the lumbar spine. The purpose of this study was to investigate the prevalence and clinical features of postoperative intraspinal facet cysts in the lumbar spine.
Methods
Data from 81 patients undergoing microendoscopic posterior decompression to treat lumbar spinal stenosis were reviewed. The development of a postoperative intraspinal facet cyst was observed using MR imaging during 1 year after surgery. If the patient demonstrated a postoperative intraspinal facet cyst, additional MR imaging was performed to evaluate the natural course of the cyst. Furthermore, the authors conducted a comparative evaluation to identify the factors associated with the causes of cyst development.
Results
A postoperative intraspinal facet cyst developed in 7 patients (8.6%) during 1 year after surgery. Spondylotic spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis were revealed before surgery in 2, 4, and 1 patient, respectively. In 5 patients, the cysts developed within 3 months after surgery. Although 3 patients exhibited symptoms caused by cyst development, all symptoms were relieved by conservative treatment. On radiographic evaluations, postoperative segmental spinal instability, including a progression of spondylolisthesis and disc degeneration, was revealed in 6 (86%) of the 7 patients. Spontaneous regression of the cysts was observed in 5 (71%) of these 7 patients. On comparative evaluation of patients with and without postoperative intraspinal facet cysts, the presence of segmental spinal instability before surgery (including degenerative spondylolisthesis) and the appearance of postoperative segmental spinal instability were related to the development of the cysts.
Conclusions
The prevalence of postoperative intraspinal facet cysts, including asymptomatic cysts, was 8.6% during 1 year after decompression surgery for lumbar spinal stenosis. The development of postoperative intraspinal facet cysts was related to the presence of segmental spinal instability before surgery (including degenerative spondylolisthesis) and postoperative segmental spinal instability, including a progression of spondylolisthesis and disc degeneration after surgery. A postoperative intraspinal facet cyst, which can be expected to regress spontaneously with a probability > 50%, should be recognized as one of the postoperative complications of decompression surgery for lumbar spinal stenosis.
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Affiliation(s)
- Ko Ikuta
- 1Department of Orthopedic Surgery, Karatsu Red Cross Hospital, Karatsu City; and
| | - Osamu Tono
- 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Masayoshi Oga
- 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
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Miao EY. Synovial Cyst of the Lumbar Spine Treated With Electroacupuncture. Med Acupunct 2009. [DOI: 10.1089/acu.2009.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Edwin Yong Miao
- M. Modern Traditional Chinese Medical Clinic—Acupuncture, Melbourne, Victoria, Australia
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Heran MKS, Smith AD, Legiehn GM. Spinal injection procedures: a review of concepts, controversies, and complications. Radiol Clin North Am 2008; 46:487-514, v-vi. [PMID: 18707959 DOI: 10.1016/j.rcl.2008.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The field of spinal injection procedures is growing at a tremendous rate. Many disciplines are involved, including radiology, anesthesiology, orthopedics, physiatry and rehabilitation medicine, as well as other specialties. However, there remains tremendous variability in the assessment of patients receiving these therapies, methods for evaluation of outcome, and in the understanding of where these procedures belong in the triaging of those who require surgery. In this article, we attempt to highlight the biologic concepts on which these therapies are based, controversies that have arisen with their increasing use, and a description of complications that have been reported.
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Affiliation(s)
- Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, Canada.
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a case of spinal epidural hematoma arising from the synovial joint due to anticoagulation therapy. SUMMARY OF BACKGROUND DATA Spontaneous spinal epidural hematoma is a rarity in the literature with a variety of etiologies. In 1 study, it was reported to originate from a synovial joint due to osteoarthritis of the joint. METHODS A case of hematoma of the lumber synovial joint is presented. RESULTS A 67-year-old man who was on anticoagulation therapy presented with progressive neurologic symptoms in the right lower limb. Magnetic resonance imaging scan revealed what was thought to be a L4-L5 synovial joint cyst. During surgery, it was proven to be an epidural hematoma originating from the synovial joint. Microscopic examination confirmed the diagnosis and excluded the possibility of spinal synovial cyst. After spinal decompression, neurologic symptoms improved completely in 2 weeks. CONCLUSIONS This is the first report of a synovial cyst hematoma due to anticoagulation therapy. Its magnetic resonance imaging features can be similar to synovial cyst, especially when it is hemorrhagic. Spinal decompression was the definitive treatment.
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Affiliation(s)
- Ali Nourbakhsh
- Division of Spine Surgery, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX 77555-0165, USA
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Terao T, Takahashi H, Taniguchi M, Ide K, Shinozaki M, Nakauchi J, Kubota M. Clinical Characteristics and Surgical Management for Juxtafacet Cysts of the Lumbar Spine. Neurol Med Chir (Tokyo) 2007; 47:250-7; discussion 257. [PMID: 17587776 DOI: 10.2176/nmc.47.250] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Retrospective analysis of 10 cases of resection of symptomatic lumbar juxtafacet cysts in nine patients (mean age 65.4 years) investigated the relationship between surgical method and progression of spinal spondylolisthesis or cyst recurrence. Patient characteristics, surgical methods, and postoperative course were reviewed. The most common preoperative symptom, painful radiculopathy, occurred in all cases, followed by motor weakness in five, sensory loss in four, and intermittent claudication in four. All patients underwent bilateral total (n = 6) or partial laminectomy (n = 4), with minimal (n = 3) or no (n = 7) facetectomy. Cysts were gross totally resected in eight cases and partially resected in two. Concomitant fixation was not performed. Painful radiculopathy, motor weakness, and sensory disturbance all resolved, resulting in good or excellent outcome in all patients. Postoperative symptomatic spondylolisthesis had not been noted at mean 52.1 months postoperatively. However, new juxtafacet cysts were later detected on the contralateral side to the initial lesion in two patients. Surgical removal of juxtafacet cysts is recommended for immediate symptomatic relief. Concomitant spinal fixation to prevent progression of spinal spondylolisthesis or cyst recurrence depends on cyst size, involvement of surrounding structures, degree of preoperative spondylolisthesis, and facet joint destruction.
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Affiliation(s)
- Tohru Terao
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan.
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