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Scrofani R, De Simone M, Migliorini F, Amoroso E, Maffulli N, Narciso N, Iaconetta G. Spontaneous Resolution of Symptomatic Synovial Cysts of the Lumbar Spine: A Comprehensive Review with Two Illustrative Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1115. [PMID: 39064544 PMCID: PMC11278635 DOI: 10.3390/medicina60071115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
Although lumbar synovial cysts (LSCs) are frequently described in the literature, they are a relatively uncommon cause of low back and radicular leg pain. Furthermore, their spontaneous resolution is an even rarer event. The standard treatment of the lumbar synovial cyst is surgical excision. Spontaneous resolution in the literature is a sporadic event. In our experience, we have had two cases where the lumbar synovial cyst disappeared spontaneously. To date, only nine cases of spontaneous resolution of synovial cysts have been documented in the literature. In this discussion, we highlight a pathology that typically suggests surgical intervention, yet conservative treatment can be a viable alternative. We present two cases of large synovial cysts that were initially scheduled for surgery but ultimately resolved spontaneously without any treatment. While the spontaneous resolution of lumbar synovial cysts is extremely rare, conservative strategies are an option that should not be overlooked. Our cases contribute to the growing body of evidence on the spontaneous regression of symptomatic LSC, potentially enhancing the understanding of the disease's natural progression in the future.
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Affiliation(s)
- Raffaele Scrofani
- Department of Clinical Neurosurgery, AOU San Giovanni di Dio e Ruggi D′Aragona, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy; (R.S.); (E.A.); (N.N.)
| | - Matteo De Simone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
- BrainLab s.r.l., Mercato San Severino, 84085 Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany;
| | - Ettore Amoroso
- Department of Clinical Neurosurgery, AOU San Giovanni di Dio e Ruggi D′Aragona, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy; (R.S.); (E.A.); (N.N.)
| | - Nicola Maffulli
- Department of Orthopaedics, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, 00185 Rome, Italy;
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST5 5BG, UK
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
| | - Nicola Narciso
- Department of Clinical Neurosurgery, AOU San Giovanni di Dio e Ruggi D′Aragona, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy; (R.S.); (E.A.); (N.N.)
| | - Giorgio Iaconetta
- Department of Clinical Neurosurgery, AOU San Giovanni di Dio e Ruggi D′Aragona, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy; (R.S.); (E.A.); (N.N.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
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Lazarescu AE, Hogea BG, Andor BC, Totorean A, Cojocaru DG, Negru M, Bolintineanu LA, Patrascu Jnr JM, Misca LC, Sandesc MA, Patrascu Snr JM. Using a Double Syringe Sterile System for MSK Aspiration/Injection Procedures Eliminates Risk of Iatrogenic Infection. Ther Clin Risk Manag 2022; 18:1029-1036. [PMID: 36339728 PMCID: PMC9628697 DOI: 10.2147/tcrm.s372676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Diverse musculo-skeletal pathology can be treated conservatively by different types of injections and in most cases, results are significantly better if the existing inflammatory fluid is aspirated prior to injection of medication solutions. The present study analyses an original technique which uses infusion therapy accessories to create two types of closed sterile double syringe systems, and compares the benefits of using such a system in aspiration/injection procedures to classic aspiration injection technique that implies changing and connecting multiple syringes to the same needle, thus increasing the risk for septic complications. The aim of the present study is to minimize therapeutic risk of iatrogenic septic complications during aspiration/injection procedures. Methods 1024 patients underwent aspiration/injection procedures in our clinic using the double syringe system between 2015 and 2020. During the early stages of the study, the second type of assembly was rendered impractical so the study continued with analyzing a single type of double syringe system using a three way infusion therapy device which is readily available, and allows the assembly of a closed sterile system with a single, two-step procedure technique. Iatrogenic local septic complications were followed by means of a six week clinical follow-up evaluation with additional investigations only if necessary. Results In 1024 procedures we report 0% incidence of iatrogenic septic complications, or other types of complications and recommend this technique in a vast array of rheumatic, orthopedic or traumatic conditions that require aspiration/injection procedures. Discussion The double syringe system is practical, easy to use, it completely eliminates the risk of iatrogenic infection due to manipulation errors, and significantly simplifies the technique for sonography guided aspiration/injection procedures for musculo-skeletal pathology.
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Affiliation(s)
- Adrian Emil Lazarescu
- Department of Anatomy and Embriology, University of Medicine and Pharmacy “victor Babes” Timișoara, Timisoara, Romania
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Bogdan Gheorghe Hogea
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Correspondence: Bogdan Gheorghe Hogea, Tel +40744363188, Email
| | - Bogdan Corneliu Andor
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Alina Totorean
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Department of Medical Recovery, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Dan Grigore Cojocaru
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Marius Negru
- Department of Pediatric Surgery, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Laura A Bolintineanu
- Department of Pathophysiology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Jenel Marian Patrascu Jnr
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Liviu C Misca
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Mihai A Sandesc
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
| | - Jenel Marian Patrascu Snr
- 2nd Clinic of Orthopedics and Traumatology, County Emergency Hospital “Pius Branzeu” Timisoara, Timisoara, Romania
- Profesor Teodor Sora’ Research Center, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timisoara, Romania
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Bruder M, Gessler F, Cattani A, Droste C, Seifert V, Setzer M, Marquardt G. Surgical Treatment of Spinal Synovial Cysts in Elderly Patients: Symptoms, Treatment Course, and Outcome in Patients >75 Years of Age. World Neurosurg 2017; 110:e520-e525. [PMID: 29155111 DOI: 10.1016/j.wneu.2017.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the aging of our society comes a rising number of elderly patients with progressive degeneration of the spine associated with synovial cysts. Surgical treatment may be particularly challenging in elderly patients because of comorbidities. METHODS Patients treated in our department between 1999 and 2014 for spinal synovial cysts were screened. The 28 patients ≥75 years old were classified as elderly and were compared with 96 patients 50-74 years old. No patient underwent fusion as part of cyst resection. RESULTS Despite a significantly higher frequency of muscle reflex changes in elderly patients at presentation, symptoms, cyst levels, rate of complications, and surgical method were not different between groups. Cyst adherence to the dura and subtotal resection were observed significantly more often in the elderly group (18% vs. 3%; P < 0.05). Outcome according to the Oswestry Disability Index was classified as no disability or minimal disability in 85% of the elderly group and in 82% of the control group. Recurrent cyst and delayed fusion rates were lower in the elderly group (4% and 4%) compared with the control group (7% and 8%). CONCLUSIONS The clinical course of elderly patients with surgical treatment of spinal synovial cysts did not differ compared with younger patients. Good or excellent results could be achieved and persisted for a long time in most cases. Fusion should be performed only in cases of severe instability. Nonaggressive cyst removal in cases of dural attachment enables low cerebrospinal fluid fistula rates without increasing cyst recurrence rates.
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Affiliation(s)
- Markus Bruder
- Department of Neurosurgery, Goethe University, Frankfurt, Germany.
| | - Florian Gessler
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Christian Droste
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
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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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Lista-Martínez O, Moreno-Barrueco V, Castro-Castro J, Varela-Rois P, Pastor-Zapata A. Lumbar synovial cysts: Presentation of a series of 10 cases and literature review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Lista-Martínez O, Moreno-Barrueco VM, Castro-Castro J, Varela-Rois P, Pastor-Zapata A. Lumbar synovial cysts: presentation of a series of 10 cases and literature review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 61:28-34. [PMID: 27717625 DOI: 10.1016/j.recot.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/23/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Although they are freqqently described in the literature, lumbar synovial cysts are a relative uncommon cause of low back and radicular leg pain. OBJECTIVE To evaluate the treatment and surgical outcomes of the lumbar synovial cysts operated on in our hospital during a 5 year period. MATERIAL AND METHODS A retrospective study was conducted on patients surgically treated in our department from August 2009 to September 2014, using a visual analogue scale for the clinical follow-up in the first year after surgery. RESULTS After the surgical treatment (surgical removal of the synovial cyst with or without instrumented arthrodesis with transpedicular screws) of 10 patients (5 female and 5 male) with a mean age of 70.2 years (range 50-80), the clinical outcome was satisfactory in 80% of the patients, with the resolving of their symptoms. CONCLUSIONS Lumbar synovial cysts have to be considered in the differential diagnosis in patients with low back and radicular leg pain. The majority of the patients are in their sixties and have lumbar degenerative spondylopathy. Nowadays, surgical resection of the lumbar synovial cysts and spinal fusion are the recommended treatment, because it is thought that the increased movement of the spine is one to the causes of the cyst formation. More studies are still needed, hence the relevance of this article.
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Affiliation(s)
- O Lista-Martínez
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Orense, Orense, España.
| | - V M Moreno-Barrueco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital HM Modelo, A Coruña, España
| | - J Castro-Castro
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Orense, Orense, España
| | - P Varela-Rois
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Orense, Orense, España
| | - A Pastor-Zapata
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Orense, Orense, España
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Shuang F, Hou SX, Zhu JL, Ren DF, Cao Z, Tang JG. Percutaneous resolution of lumbar facet joint cysts as an alternative treatment to surgery: a meta-analysis. PLoS One 2014; 9:e111695. [PMID: 25389771 PMCID: PMC4229115 DOI: 10.1371/journal.pone.0111695] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/19/2014] [Indexed: 12/11/2022] Open
Abstract
PURPOSE A comprehensive review of the literature in order to analyze data about the success rate of percutaneous resolution of the lumbar facet joint cysts as a conservative management strategy. METHODS A systematic search for relevant articles published during 1980 to May 2014 was performed in several electronic databases by using the specific MeSH terms and keywords. Most relevant data was captured and pooled for the meta-analysis to achieve overall effect size of treatment along with 95% confidence intervals. RESULTS 29 studies were included in the meta-analysis. Follow-up duration as mean ± sd (range) was 16±10.2 (5 days to 5.7 years). Overall the satisfactory results (after short- or long-term follow-up) were achieved in 55.8 [49.5, 62.08] % (pooled mean and 95% CI) of the 544 patients subjected to percutaneous lumbar facet joint cyst resolution procedures. 38.67 [33.3, 43.95] % of this population underwent surgery subsequently to achieve durable relief. There existed no linear relationship between the increasing average duration of follow-up period of individual studies and percent satisfaction from the percutaneous resolutions procedure. CONCLUSION Results shows that the percutaneous cyst resolution procedures have potential to be an alternative to surgical interventions but identification of suitable subjects requires further research.
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Affiliation(s)
- Feng Shuang
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- Department of Orthopedics, The 94th Hospital of Chinese PLA, Nanchang, China
| | - Shu-Xun Hou
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- * E-mail: (JGT); (SXH)
| | - Jia-Liang Zhu
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Dong-Feng Ren
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Zheng Cao
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Jia-Guang Tang
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- * E-mail: (JGT); (SXH)
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