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Chesney K, Stylli J, Elsouri M, Phelps E, Fayed I, Anaizi A, Voyadzis JM, Sandhu FA. Minimally Invasive Surgical Decompression without Fusion for the Treatment of Lumbar Synovial Cysts: Feasibility and Long-Term Outcomes. World Neurosurg 2022; 167:e323-e332. [PMID: 35961590 DOI: 10.1016/j.wneu.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Lumbar synovial cysts (LSCs) can cause painful radiculopathy and sensory and/or motor deficits. Historically, first-line surgical treatment has been decompression with fusion. Recently, minimally invasive laminectomy without fusion has shown equal or superior results to traditional decompression and fusion methods. OBJECTIVE This study investigates the long-term efficacy of minimally invasive laminectomy without fusion in the treatment of LSC as it relates to the rate of subsequent fusion surgery. METHODS A retrospective review was performed over a 10-year period of patients undergoing minimally invasive laminectomy for symptomatic LSCs. The primary end point was the rate of revision surgery requiring fusion. RESULTS Eighty-five patients with symptomatic LSCs underwent minimally invasive laminectomy alone January 2010-August 2020 at our institution. The most common location was L4-5 (72%). Preoperative imaging identified spondylolisthesis (grade 1) in 43 patients (57%), none of which was unstable on available dynamic radiographs. Average procedure duration was 93 minutes, with 78% of patients discharged home on the same day of surgery. Over 46 months of mean follow-up, 17 patients (20%) required 19 revision operations. Of those operations, 16 were spinal fusions (17.6%). Median time to fusion surgery was 36 months. There were no identifiable risk factors on multivariate regression analysis that predicted the need for fusion. CONCLUSIONS Minimally invasive laminectomy is an effective first-line treatment for symptomatic LSCs and avoids the need for fusion in most treated patients. Of our patients, 18% required a fusion over 46 months, suggesting that further studies are required to guide patient selection.
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Affiliation(s)
- Kelsi Chesney
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jack Stylli
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mohamad Elsouri
- Georgetown University School of Medicine, Washington, DC, USA
| | - Emily Phelps
- Georgetown University School of Medicine, Washington, DC, USA
| | - Islam Fayed
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Amjad Anaizi
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
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Khalid SI, Nie JW, Thomson KB, Nie JZ, Patil SN, Zakrzewski V, Souter J, Smith JS, Mehta AI. Five-Year Outcomes After Decompression and Fusion Versus Decompression Alone in the Treatment of Lumbar Synovial Cysts. World Neurosurg 2022; 166:e23-e33. [PMID: 35691521 DOI: 10.1016/j.wneu.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spinal synovial cysts are acquired, fluid-filled lesions of the facet joint that most commonly occur in the lumbar spine. They are thought to arise from degenerative changes and to result from segmental instability. Although the treatment of these lesions has been studied, the long-term implications and effects of the different strategies for surgical intervention (i.e., decompression and fusion vs. decompression alone) have not yet been elucidated or established. METHODS Using an all-payer database with 53 million patient records (MARINER-53), patients with a diagnosis of lumbar synovial cysts were identified. Patients who had undergone lumbar fusion versus laminectomy were matched 1:1 using binomial and gaussian logistic regression models to evaluate the need for future lumbar surgery within 5 years after their index procedure. RESULTS No statistically significant differences were noted between the 5-year rates of subsequent intervention, additional laminectomy, or fusion among patients who had undergone index decompression and fusion (n = 51; 10.5%) versus decompression alone (n = 43; 8.8%; P = 0.39). Furthermore, no significant differences were found in the odds of intervention type after index decompression and fusion versus decompression alone (subsequent laminectomy: odds ratio, 0.59; 95% confidence interval, 0.32-1.09; subsequent fusion: odds ratio, 1.14; 95% confidence interval, 0.64-2.02). CONCLUSIONS Patient-specific factors and surgeon-patient-shared decision-making should be used when planning interventions for these lesions. However, synovial cysts might not require a fusion procedure for presumed instability. Further investigation is required, using randomized and prospective studies, to further evaluate the effective treatment of this entity.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - James W Nie
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Jeffrey Z Nie
- School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Shashank N Patil
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Victoria Zakrzewski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - John Souter
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jennifer S Smith
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Yu J, Zhang S, Bian L, He C, Ye M, Li G, Hu P, Sun L, Ling F, Zhang H, Hong T. Clinical features and outcomes of perimedullary arteriovenous fistulas: comparison between micro- and macro-type lesions. J Neurointerv Surg 2022:neurintsurg-2021-018412. [PMID: 35732484 DOI: 10.1136/neurintsurg-2021-018412] [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: 11/06/2021] [Accepted: 06/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although the angioarchitecture of perimedullary arteriovenous fistulas (PMAVFs) is straightforward, their size and blood flow are highly heterogeneous. This study aimed to evaluate the differences in clinical features and outcomes of PMAVFs based on lesion size and blood flow. METHODS 114 consecutive patients with PMAVFs from two institutes were retrospectively reviewed. The lesions were classified as either micro-PMAVFs (shunt point diameter <1 cm) or macro-PMAVFs (shunt point diameter ≥1 cm). RESULTS The patients with micro-PMAVFs were older at the first presentation (33.50 vs 13.50 years, p<0.001). Macro-PMAVFs were more commonly associated with spinal metameric arteriovenous shunts (6.9% vs 28.6%, p=0.003). Compared with the macro-PMAVFs, the micro-PMAVFs showed a significantly higher risk of gradual clinical deterioration after initial onset (73.6%/year vs 10.0%/year; HR 3.888, 95% CI 1.802 to 8.390, p=0.001). A total of 58.6% of the micro-PMAVFs were treated surgically, whereas 85.7% of the macro-PMAVFs were treated via endovascular approaches. Complete obliteration was 73.7% for the whole cohort, and was more common for the micro-PMAVFs than for the macro-PMAVFs (87.9% vs 58.9%, p=0.001). At the last follow-up, spinal function was significantly improved compared with the pretreatment status, and the rate of severe disability of patients with macro-PMAVFs was slightly but not significantly higher than that of patients with micro-PMAVFs (16.1% vs 8.6%, p=0.315) CONCLUSIONS: The clinical risks, treatment strategies and obliteration rates of PMAVFs differ based on their size and blood flow.
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Affiliation(s)
- Jiaxing Yu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Shiju Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | | | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Liyong Sun
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China .,China International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China .,China International Neuroscience Institute (China-INI), Beijing, China
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Garg K, Kasliwal MK. Outcomes and complications following minimally invasive excision of synovial cysts of the lumbar spine: A systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 206:106667. [PMID: 33984755 DOI: 10.1016/j.clineuro.2021.106667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Lumbar synovial cysts (LSC) are one of the manifestations of spinal degenerative cascade. Spinal stenosis or presence of instability in these patients can lead to various symptoms and surgery is indicated following failure of non-operative management for symptomatic synovial cysts. Surgery when performed consists of either decompression with resection of cyst with our without fusion. The efficacy and complications of minimally invasive techniques using tubular retractors (microscopic or endoscopic) in comparison to traditional open techniques remain to be studied. METHODS A comprehensive search of different databases was performed to retrieve studies describing the use of minimal invasive techniques using tubular retractors (both microscopic and endoscopic) in patients with LSC. Meta-analysis with subgroup analysis and metaregression was done. RESULTS Twenty articles were selected for the systematic review and meta-analysis with total of 388 patients. Eighty-six percent of patients (95% Confidence Interval (CI): 80-90%) had favorable outcome as per Macnab's criteria (excellent and good outcome) with the pooled standard mean difference between preoperative and postoperative Oswestry Disability Index (ODI) being -4.44 (95% CI -8.78 to -0.10, p-value=0.0474, I2 82%). The pooled percentage change in visual analogue scale (VAS) after surgery was 76.5% (95% CI 66.9-84%, I2 82%). The pooled proportion of incidental durotomies, cyst recurrence and patients requiring operation being 8% (95% CI 5-11%, I2 0%), 4% (95% CI 2-7%, I2 0%,) and 5% (95% CI 3-9%) respectively. Studies were homogeneous with an I2 value of 0%. Subgroup analysis revealed no significant difference in the outcome rates or complication rates between the microscopic and endoscopic subgroups. CONCLUSION Minimally invasive techniques for the resection of LSC is a safe and effective alternative to traditional surgical approaches with no difference between the microscopic and endoscopic approaches.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manish K Kasliwal
- University Hospitals Cleveland Medical Centre, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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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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Splavski B, Rotim A, Brumini I, Koprek I, Gajski D, Božić B, Rotim K. LUMBAR SPINE SYNOVIAL CYST: A CASE SERIES REPORT AND REVIEW OF SURGICAL STRATEGIES. Acta Clin Croat 2019; 58:491-496. [PMID: 31969762 PMCID: PMC6971798 DOI: 10.20471/acc.2019.58.03.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Lumbar spine synovial cysts are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy and neurological deficit. However, they are not well defined concerning their origin, cause and pathology, as well as available treatment strategies. The scope of different surgical procedures includes image-guided epidural steroid injection, direct cyst puncture by percutaneous epidural needle, spinal canal decompression and cyst resection, and spinal bone fusion with/without instrumentation. Hereby, we report institutional experience and discuss surgical strategies of lumbar spine synovial cyst treatment. Presenting symptoms, imaging findings and outcomes were retrospectively analyzed in 15 patients with lumbar spine synovial cyst, operated on during a one-year period. The leading presenting symptom was lumbar radicular pain, while the most commonly involved vertebral level was L5-S1. In a great majority of patients, a single-level interlaminectomy and cyst resection were performed. Most patients recovered without postoperative neurological and functional deficit, as well as surgery-related complications. No poor outcome was noticed in our series. Concerning our results and literature review, the optimal management for patients with symptomatic lumbar synovial cyst has to be highly personalized, which is essential to achieve a favorable outcome. Nonetheless, the best treatment strategy has yet to be affirmed.
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Affiliation(s)
| | - Ante Rotim
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia; 6Department of Neurosurgery, Varaždin General Hospital, Varaždin, Croatia
| | - Ivan Brumini
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia; 6Department of Neurosurgery, Varaždin General Hospital, Varaždin, Croatia
| | - Ivan Koprek
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia; 6Department of Neurosurgery, Varaždin General Hospital, Varaždin, Croatia
| | - Domagoj Gajski
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia; 6Department of Neurosurgery, Varaždin General Hospital, Varaždin, Croatia
| | - Boris Božić
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia; 6Department of Neurosurgery, Varaždin General Hospital, Varaždin, Croatia
| | - Krešimir Rotim
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, School of Dental Medicine and Health, Osijek, Croatia; 4Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 5University of Applied Health Sciences, Zagreb, Croatia; 6Department of Neurosurgery, Varaždin General Hospital, Varaždin, Croatia
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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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Ramhmdani S, Ishida W, Perdomo-Pantoja A, Witham TF, Lo SFL, Bydon A. Synovial Cyst as a Marker for Lumbar Instability: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 122:e1059-e1068. [DOI: 10.1016/j.wneu.2018.10.228] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 01/25/2023]
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9
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Themistoklis KM, Papasilekas TI, Boviatsis KA, Giakoumettis DA, Vlachakis EN, Themistocleous MS, Sakas DE, Korfias SI. Spinal synovial cysts. A case series and current treatment options. J Clin Neurosci 2018; 57:173-177. [DOI: 10.1016/j.jocn.2018.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
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Vergara P, Akhunbay-Fudge CY, Kotter MR, Charles Laing RJ. Minimally Invasive Versus Open Surgery for Lumbar Synovial Cysts. World Neurosurg 2017; 108:555-559. [DOI: 10.1016/j.wneu.2017.09.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 01/24/2023]
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Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To analyze the various anatomical parameters that influence segmental stability in patients suffering from lumbar intra spinal cysts (LISCs) and to determine the outcome of microscopic unilateral laminotomy and cystectomy. METHODS All patients that were surgically managed for a LISC between 2007 and 2013 with more than 3 years of follow-up were reviewed. Those without associated instability were evaluated for segmental mobility, segmental angulation, facet inclination, stage of disc degeneration, and level of involvement on MRI and dynamic radiographs. Outcomes of unilateral laminotomy and cystectomy were evaluated using VAS (Visual Analogue Score), ODI (Oswestry Disability Index), and Macnabs criteria. Dynamic radiographs were performed in all cases pre- and postoperatively and at the last follow-up. RESULTS Thirty patients were operated for a LISC between 2007 and 2013. The levels involved were L4-5(23), L3-4(4) and L5-S1(3). The mean facet angle was 42.6 (± 6.1) degrees. The stage of disc degeneration was scattered haphazardly across all the cases (Gr 2[17]; Gr 3[1]; Gr 4[8]; Gr 5[4]). VAS and ODI scores improved significantly in all patients. Mean follow-up was 46.5 months (36-96 months). No patient developed postoperative instability at the last follow-up. CONCLUSIONS The coronal inclination of the facet joints, absence of radiological instability, and poor co-relation with stages of disc degeneration suggests the presence of adequate residual stability. In this study, stand-alone decompression for LISCs without instability had well sustained good/excellent outcomes. Fusion is recommended for LISCs with associated instability.
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Affiliation(s)
- Arvind G. Kulkarni
- Bombay Hospital & Medical Research Centre, Mumbai, India
- Arvind G. Kulkarni, Department of Orthopedics, Mumbai Spine Scoliosis and Disc Replacement Centre, 2nd Floor, Room 206 New Wing, Bombay Hospital & Medical Research Centre, 12, New Marine Lines, Mumbai 400020, India.
| | - Shumayou Dutta
- Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Abhilash Dhruv
- Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Anupreet Bassi
- Bombay Hospital & Medical Research Centre, Mumbai, India
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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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14
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Endoscopic Surgical Treatment of Lumbar Synovial Cyst: Detailed Account of Surgical Technique and Report of 11 Consecutive Patients. World Neurosurg 2017; 103:122-132. [DOI: 10.1016/j.wneu.2017.02.075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/12/2017] [Accepted: 02/15/2017] [Indexed: 02/02/2023]
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15
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Jha RT, Syed HR, Catalino M, Sandhu FA. Contralateral Approach for Minimally Invasive Treatment of Upper Lumbar Intervertebral Disc Herniation: Technical Note and Case Series. World Neurosurg 2017; 100:583-589. [PMID: 28137544 DOI: 10.1016/j.wneu.2017.01.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Upper lumbar disc herniations comprise only 1%-2% of all lumbar disc herniations. Patients exhibit nonspecific signs and symptoms in comparison to predictable radiculopathies, as seen in lower lumbar disc herniations. The unique anatomic characteristics of the upper lumbar spine present several challenges for safe and effective surgical treatment of disc herniations. The authors review the anatomy of the upper lumbar spine, describe a novel approach to upper lumbar disc herniations, and present 3 cases with a focus on clinical outcome and technical pearls. METHODS Conventional techniques for upper lumbar discectomy require a near complete facetectomy and pars interarticularis resection for adequate bony exposure, possibly leading to spinal destabilization. A tubular retractor system was used to approach upper lumbar disc herniation using a contralateral minimally invasive technique, while completely preserving the facet complex and pars interarticularis. RESULTS We report 3 cases of minimally invasive discectomy from a contralateral approach. The patients experienced complete resolution of presenting symptoms, and the facet complexes were preserved. All cases were free of complications. CONCLUSION A contralateral approach to perform a minimally invasive discectomy for paracentral and central upper LDH is a safe, efficient, and effective technique. The approach that we describe in this study preserves the facet complex and may prevent future spinal instability.
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Affiliation(s)
- Ribhu T Jha
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Hasan R Syed
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Michael Catalino
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
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16
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Denis DR, Hirt D, Shah S, Lu DC, Holly LT. Minimally invasive surgery for lumbar synovial cysts with coexisting degenerative spondylolisthesis. Int J Spine Surg 2016; 10:37. [PMID: 27909658 DOI: 10.14444/3037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND About one third of lumbar synovial cysts are associated with degenerative spondylolisthesis. Segmental instability is thought to contribute to the pathogenesis and recurrence of synovial cysts and lumbar fusion has been advocated as a treatment of choice in the presence of spondylolisthesis. In patients with spondylolisthesis, minimally invasive resection of lumbar synovial cysts, without fusion, could minimize surgically induced segmental instability while providing good pain relief. METHODS Clinical and radiological outcomes of lumbar synovial cyst patients with and without spondylolisthesis were retrospectively compared. Pain outcomes were assessed with modified Macnab criteria. RESULTS Fifty-three patients (18 with grade 1 spondylolisthesis) underwent minimally invasive synovial cyst resection and all had either excellent or good pain outcome at ≤ 8 post- operative weeks (P = 1.000, n = 53). At > 8 post-operative weeks (mean (SD) follow-up of 200 (175) weeks), excellent or good outcomes were noted in 89% of patients without spondylolisthesis and in 75% of patients with spondylolisthesis (P = 0.425, n = 40). Four patients developed a new grade 1 spondylolisthesis at a mean follow-up of 2.6 ± 2.1 years. Nine patients were assessed for spondylolisthesis measurements at 1.2 ± 1.3 years of follow up and no significant difference was observed (5 ± 0 vs 5 ± 1 mm; P = 0.791). Two patients without spondylolisthesis and none of the patients with spondylolisthesis had a synovial cyst recurrence. CONCLUSION Patients with concomitant lumbar degenerative spondylolisthesis and synovial cyst can have good short- and long-term clinical outcomes with minimally invasive surgery without fusion. Post-operative segmental instability does not appear to be significant in patients with spondylolisthesis. All patients included in this article signed an informed consent for the use of their medical information for research.
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Affiliation(s)
- Daniel R Denis
- Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Daniel Hirt
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Saumya Shah
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Langston T Holly
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
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Birch BD, Aoun RJN, Elbert GA, Patel NP, Krishna C, Lyons MK. Minimally Invasive Tubular Resection of Lumbar Synovial Cysts: Report of 40 Consecutive Cases. World Neurosurg 2016; 94:188-196. [DOI: 10.1016/j.wneu.2016.06.125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 01/24/2023]
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18
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Torres Campa-Santamarina J, Towne S, Alimi M, Navarro-Ramirez R, Härtl R. Minimally Invasive Approach For Extraforaminal Synovial Cyst L5-S1. Cureus 2015; 7:e362. [PMID: 26623217 PMCID: PMC4659579 DOI: 10.7759/cureus.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Symptoms from synovial cysts are produced by neural compression in the spinal canal or the foramen. Few cases of extraforaminal synovial cyst have been published in the literature. This is a case report of a 65-year-old female who presented with a three-month history of sciatic pain and no relief with conservative treatment. MRI showed a left-sided extraforaminal synovial cyst at L5-S1 with compression of the L5 nerve root at the lateral portion of the foramen. Minimally invasive surgery for resection was performed using an extraforaminal tubular microscopic endoscopy-assisted approach. The patient improved clinically and remained symptom-free for the entire follow-up of 30 months.
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Affiliation(s)
| | - Sara Towne
- Department of Neurosurgery, Weill-Cornell/New York Presbyterian Hospital
| | - Marjan Alimi
- Department of Neurosurgery, Weill-Cornell/New York Presbyterian Hospital
| | | | - Roger Härtl
- Department of Neurosurgery, Weill-Cornell/New York Presbyterian Hospital
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19
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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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Ganau M, Ennas F, Ambu R, Faa G, Maleci A. Letters to the Editor: Excision of synovial cysts: pathology matters. J Neurosurg Spine 2013; 19:266-7. [DOI: 10.3171/2013.4.spine13299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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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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22
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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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Treatment of synovial cysts: a matter of debate. World Neurosurg 2012; 79:281-2. [PMID: 23111218 DOI: 10.1016/j.wneu.2012.10.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/23/2012] [Indexed: 11/24/2022]
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25
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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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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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27
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Long-term resolution of symptoms from percutaneous lumbar synovial cyst aspiration: a visual vignette. Am J Phys Med Rehabil 2010; 89:695-6. [PMID: 19730359 DOI: 10.1097/phm.0b013e3181b71e02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Shah M, Kaminsky J, Vougioukas VI. Minimally invasive removal of an extradural intraradicular lumbar schwannoma. Acta Neurochir (Wien) 2008; 150:691-3; discussion 693-4. [PMID: 18548188 DOI: 10.1007/s00701-008-1607-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 04/21/2008] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Surgical exposure of peripheral lumbar schwannomas often requires extensive muscle mobilization which results in significant postoperative pain. We describe an alternative minimally invasive surgical technique for the treatment of such lesions. METHODS We report the case of a patient with an extradural intraradicular schwannoma of the L4 root that was treated with a minimally invasive transmuscular approach by using tubular retractors. RESULTS Muscle trauma and intraoperative blood loss were negligible. The postoperative course was uneventfull. There was no additional morbidity associated with the approach. The patient was discharged 72 h after the procedure. CONCLUSIONS In selected cases extradural intraradicular lumbar schwannomas can be treated adequately with a minimally invasive transmuscular approach.
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Affiliation(s)
- M Shah
- Department of Neurosurgery, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
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29
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Prise en charge chirurgicale des kystes synoviaux lombaires : étude rétrospective concernant 52 patients. ACTA ACUST UNITED AC 2008; 94:289-96. [DOI: 10.1016/j.rco.2007.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2007] [Indexed: 11/21/2022]
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