1
|
Gonzalez GA, Corso K, Kothari P, Franco D, Porto G, Miao J, Wainwright JV, O'Leary M, Hines K, Mahtabfar A, Vanderkarr M, Thalheimer S, Sharan A, Jallo J, Harrop J. Lumbar Synovial Cysts-Should You Fuse or Not? Neurosurgery 2022; 92:1013-1020. [PMID: 36700698 DOI: 10.1227/neu.0000000000002314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown. OBJECTIVE To test the hypothesis that select patients who underwent decompression with instrumented fusion for lumbar synovial cysts would be less likely to have subsequent surgery (SS) in a 2-year period than patients treated with laminectomy alone. METHODS This retrospective cohort study was performed using IBM MarketScan Commercial Claims and Encounters Database. Patients who had a lumbar synovial cyst diagnosis and laminectomy surgery with or without fusion surgery were included in this study. Patients were tracked for SS 2 years after surgery. Laminectomy patients were propensity score-matched to laminectomy with fusion (LF) patients using a 2:1 ratio. The log-rank test and Cox regression were used to compare the cumulative incidence of SS between groups. RESULTS There were 7664 and 1631 patients treated with laminectomy and LF before matching. After matching, there were 2212 laminectomy and 1631 LF patients and patient characteristics were balanced. The 2-year incidence of recurrent SS was 3.1% ([CI]: 2.2%, 4.0%) and 1.7% (95% CI: 0.9%, 2.5%) laminectomy and LF, respectively. Compared with laminectomy, LF had a statistically significant lower risk of recurrent SS (hazard ratio: 0.56 [95% CI: 0.32-0.97]; P -value: .04). CONCLUSION All patients who had concomitant lumbar fusion showed decreased chance of having a cyst- or noncyst-related recurrence SS when compared with all patients undergoing laminectomy alone, regardless of diagnosis at the time of SS.
Collapse
Affiliation(s)
- Glenn A Gonzalez
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Katherine Corso
- Real World Data Sciences, Medical Device Epidemiology, Johnson & Johnson, New Brunswick, New Jersey, USA
| | | | - Daniel Franco
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Guilherme Porto
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Jingya Miao
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - John V Wainwright
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Matthew O'Leary
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Aria Mahtabfar
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Mari Vanderkarr
- Real World Data Sciences, Medical Device Epidemiology, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - Sara Thalheimer
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Chang SY, Kim J, Kim Y, Im BE, Chang BS, Lee CK, Kim H. The Fate of Lumbar Facet Cyst After Indirect Decompression Using Oblique Lateral Interbody Fusion in Degenerative Spondylolisthesis. Orthopedics 2021; 44:306-312. [PMID: 34590958 DOI: 10.3928/01477447-20210819-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Favorable clinical outcomes have been reported for oblique lateral interbody fusion (OLIF) for various lumbar degenerative diseases. However, there is only limited evidence on the safety and effectiveness of OLIF in degenerative spondylolisthesis with lumbar facet cyst (LFC), and OLIF is often regarded as a relative contraindication for these patients. The authors prospectively enrolled patients who underwent a single-level OLIF for degenerative spondylolisthesis with LFC to evaluate the morphological changes of LFC and their clinical significance following OLIF. Twenty patients with a mean age of 69.6 years (range, 65-86 years) were enrolled. At 1 week postoperative, 5 (25%) patients had a residual cyst, whereas 15 (75%) patients had completely resolved cysts on magnetic resonance imaging (MRI). No patient had a residual cyst on the 1-year postoperative MRI. Patients with cyst resolution (n=15) on the 1-week postoperative MRI had a larger slip percentage difference on the preoperative dynamic radiograph when compared with patients with no cyst resolution (n=5) (4.7%±2.8% vs 1.3%±0.3%, P=.002). The group with cyst resolution also showed a greater expansion of facet fluid width following OLIF, although this was not statistically significant (1.2±0.7 mm vs 0.7±0.5 mm, P=.098). For both groups, all preoperative clinical scores showed a significant improvement at 1 year after OLIF, but there was no significant difference between the groups at all time points. Preliminary 1-year follow-up results from this prospective series suggest that OLIF can be a useful option for fusion surgery in LFC patients with apparent segmental instability. [Orthopedics. 2021;44(5):306-312.].
Collapse
|