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Choi JB, Koh JC, Jo D, Kim JH, Chang WS, Lim KT, Lee HG, Moon HS, Kim E, Lee SY, Park K, Choi YH, Park SJ, Oh J, Lee SY, Park B, Jun EK, Ko YS, Kim JS, Ha E, Kim TK, Choi GB, Cho RY, Kim NE. A Comparative Study of Endoscopic versus Percutaneous Epidural Neuroplasty in Lower Back Pain: Outcomes at Six-Month Follow Up. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:839. [PMID: 38793022 PMCID: PMC11122715 DOI: 10.3390/medicina60050839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Endoscopic epidural neuroplasty (EEN) facilitates adhesiolysis through direct epiduroscopic visualization, offering more precise neural decompression than that exhibited by percutaneous epidural neuroplasty (PEN). We aimed to compare the effects of EEN and PEN for 6 months after treatment with lower back and radicular pain in patients. Methods: This retrospective study compared the visual analog scale (VAS) and Oswestry disability index (ODI) scores in patients with low back and radicular pain who underwent EEN or PEN with a steering catheter. The medical records of 107 patients were analyzed, with 73 and 34 undergoing EEN and PEN, respectively. Results: The VAS and ODI scores decreased at all time points after EEN and PEN. VAS and ODI scores decreased more in the EEN group than those in the PEN group at 1 day and 1- and 6-months post-procedure, indicating superior pain relief for both lower back and radicular pain through EEN. Conclusions: EEN is a superior treatment of pain control than PEN in lower back and radicular pain patients.
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Affiliation(s)
- Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.B.C.); (S.Y.L.); (T.K.K.)
| | - Jae Chul Koh
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea;
| | - Daehyun Jo
- Jodaehyun Pain Center, Jeonju 55149, Republic of Korea;
| | - Jae Hyung Kim
- Department of Anesthesiology and Pain Medicine, Hallym University School of Medicine, Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea;
| | - Won Sok Chang
- Department of Anesthesiology and Pain Medicine, Chungdam Wooridul Spine Hospital, Seoul 06068, Republic of Korea
| | - Kang Taek Lim
- Department of Neurosurgery, AIN Hospital, Incheon 22148, Republic of Korea;
| | - Hyung Gon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea;
| | - Ho Sik Moon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan 50612, Republic of Korea;
| | - Sun Yeul Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea;
| | - Kibeom Park
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea;
| | - Yi Hwa Choi
- Department of Anesthesiology and Pain Medicine, Hallym University School of Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea;
| | - Sang Jun Park
- Department of Anesthesiology and Pain Medicine, Yonsei University School of Medicine, Severance Hospital, Seoul 03722, Republic of Korea;
| | - Jinyoung Oh
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu 41944, Republic of Korea;
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.B.C.); (S.Y.L.); (T.K.K.)
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon 16499, Republic of Korea
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon 16499, Republic of Korea;
| | - Eun Kyung Jun
- Department of Anesthesiology and Pain Medicine, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea
| | - Yeong Seung Ko
- Department of Anesthesiology and Pain Medicine, Inha University School of Medicine, Incheon 22332, Republic of Korea;
| | - Ji Su Kim
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon 16499, Republic of Korea;
| | - Eunji Ha
- Department of Anesthesiology and Pain Medicine, Beomeo First Orthopedic Clinic, Daegu 42087, Republic of Korea
| | - Tae Kwang Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.B.C.); (S.Y.L.); (T.K.K.)
| | - Gyu Bin Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.B.C.); (S.Y.L.); (T.K.K.)
| | - Ra Yoon Cho
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.B.C.); (S.Y.L.); (T.K.K.)
| | - Na Eun Kim
- Department of Anesthesiology and Pain Medicine, Inha University School of Medicine, Incheon 22332, Republic of Korea;
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Hwang SM, Lee MK, Kim S. Management of symptomatic cervical facet cyst with cervical interlaminar epidural block: A case report. World J Clin Cases 2022; 10:11936-11941. [PMID: 36405267 PMCID: PMC9669865 DOI: 10.12998/wjcc.v10.i32.11936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/07/2022] [Accepted: 10/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region. These cysts are usually located in the 7th cervical and 1st thoracic vertebral (C7/T1) area, and surgical excision is performed in most cases. However, facet cysts are associated with degenerative conditions, and elderly patients are often ineligible for surgical procedures. Cervical interlaminar epidural block has been used in patients with cervical radiating symptoms and achieved good results. Therefore, cervical interlaminar epidural block may be the first-choice treatment for symptomatic cervical facet cysts.
CASE SUMMARY A 70-year-old man complained of a tingling sensation in the left hand, focused on the 4th and 5th fingers, for 1 year, and posterior neck pain for over 5 mo. The patient’s numeric rating scale (NRS) score was 5/10. The patient was diagnosed with symptomatic cervical facet cyst at the left C7/T1 facet joint. Fluoroscopy-guided cervical interlaminar epidural block at the C7/T1 level with 20 mg triamcinolone and 5 mL of 0.5% lidocaine was administered. The patient's symptoms improved immediately after the block, with an NRS score of 3 points. After 3 mo, his left posterior neck pain and tingling along the left 8th cervical dermatome were relieved, with an NRS score of 2.
CONCLUSION A cervical interlaminar epidural block is a good alternative for managing symptomatic cervical facet cysts.
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Affiliation(s)
- Seong Min Hwang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Min Kyu Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Saeyoung Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
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Kim HT, Choi JH, Shin YD, Kim TY, Lee JY. Successful treatment of symptomatic facet joint synovial cysts using C-arm fluoroscopy-guided percutaneous aspiration: report of two cases. Am J Transl Res 2022; 14:3547-3553. [PMID: 35702115 PMCID: PMC9185068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Lumbar facet-joint synovial cysts are an important cause of back pain and radiculopathy. Treatment options for facet-joint synovial cysts include surgical excision, facet-joint steroid injections, and facet-joint cyst aspiration. Although percutaneous facet-joint synovial cyst aspiration is an effective and minimally invasive procedure for treating patients with symptomatic facet-joint synovial cysts, its success rate is known to be low. Here, we report out experience with treating two men using this approach. The men presented with back pain or radiculopathy. In both cases, magnetic resonance imaging showed facet-joint synovial cysts in the lumbar spine at various locations. Depending on the location of the cysts, 2-3 needles and various needle approaches were required for treatment. The facet-joint synovial cysts were aspirated using the intra-articular, interlaminar, or safe triangle approach. After aspiration, both patients experienced immediate improvement in their symptoms, and neither of them relapsed during more than 12 months of follow-up. Percutaneous aspiration of symptomatic facet-joint synovial cysts under fluoroscopic guidance is a treatment option worth considering in patients with facet-joint synovial cysts.
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Cianci F, Ferraccioli G, Ferraccioli ES, Gremese E. Comprehensive review on intravertebral intraspinal, intrajoint, and intradiscal vacuum phenomenon: From anatomy and physiology to pathology. Mod Rheumatol 2020; 31:303-311. [PMID: 32374204 DOI: 10.1080/14397595.2020.1764744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The term 'vacuum phenomenon' (VP), is characterized by gas-like density areas due to a rapid increase in the joint space volume ('acute VP') or represent a chronic gas collection. It can occur within a collapsed vertebral body, the spinal canal, joints but mainly the intervertebral disc. Studies support that VP is originated by a dynamic process involving the balance between tissues' liquid and gaseous components, influenced by the duration and the depth of mechanical and metabolic alterations, by the nature of neighboring tissues and the variability in both pressure and permeability of disc or vertebral or joint structures. Prevalence of VP in the general population is about 2%, reaching 20% in the elderly with disc degeneration. Although it's often a random finding in asymptomatic patients, VP is an eventually painful expression of disc degeneration, or disc or vertebral fracture, or bone lesions. In sporadic cases, intradiscal gas can be expelled (all-in-one or gradually), resulting in a gaseous cyst, causing pain and neurological symptoms. Considering that spontaneous resolution and recurrence after surgery are both possible, most of the authors recommend conservative treatment in patients with intradiscal and intravertebral VP; occasionally percutaneous CT(computed tomography) -guided aspiration or vertebral stabilization.
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Affiliation(s)
- Francesco Cianci
- Istitute of Rheumatology, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Elisa Gremese
- Istitute of Rheumatology, Università Cattolica del Sacro Cuore, Roma, Italy
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Jeong S, Nahm FS, Lee JS, Han WK, Choi E, Lee PB, Lee HJ. Epiduroscopic decompression of a symptomatic perineural cyst: A case report. Medicine (Baltimore) 2019; 98:e17564. [PMID: 31689762 PMCID: PMC6946280 DOI: 10.1097/md.0000000000017564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Perineural cysts in the spinal canal are usually asymptomatic. However, symptoms can occur when the cyst becomes large enough to compress a nerve root. There are still no established treatment options for this disease. In this report, we describe a case of successful decompression of the large symptomatic perineural cyst using epiduroscope. PATIENT CONCERNS A 42-year-old male patient visited our pain center complaining of discomfort and pain in his right posterior thigh. Magnetic resonance imaging of the patient showed a large perineural cyst (53 × 31 × 21 mm) compressing the right S1 nerve. No other abnormalities that would explain the patient's symptoms were identified. DIAGNOSIS Perineural cyst at the right S1 nerve. INTERVENTIONS We performed an epiduroscopic decompression of the perineural cyst. After advancing the epiduroscope and locating the cyst, we used the laser to make a hole in the cyst wall. Then, the epiduroscope was advanced into the cyst, and the cystic fluid was aspirated. OUTCOMES The symptoms of the patient were relieved after the procedure, without any complications. There was no recurrence of symptoms until 6 months after the procedure. LESSONS The epiduroscope is a minimally invasive method which can be used safely for decompression of symptomatic perineural cysts in the spinal canal.
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Affiliation(s)
- Sangmin Jeong
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University
| | - Jae-Sung Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Woong Ki Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
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Kim HS, Damani N, Singh R, Adsul NM, Oh SW, Noh JH, Jang IT, Oh SH. Endoscopic Resection of Symptomatic Cervical Facet Cyst in Ankylosing Spondylitis. World Neurosurg 2019; 127:99-102. [PMID: 30930316 DOI: 10.1016/j.wneu.2019.03.220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extradural benign cysts located in close proximity to the facet joints are called juxtafacetal cysts. Only about 3.5% of such cysts occur in the cervical spine. To our knowledge, there has been no published article on the endoscopic resection of a cervical facet cyst, and this is the first report. CASE DESCRIPTION A 48-year-old male presented with a chief complaint of severe axial neck pain (visual analog scale score 9) and right scapular pain. The patient had no related radiculopathy or myelopathy, and neurologic status was intact. There was severe limitation of cervical spine movements. Plain radiographs indicated age-related degenerative changes with typical features of ankylosing spondylitis with a bamboo spine appearance and gross fusion of all the vertebrae. The only mobile cervical spinal level was C6-C7. Axial magnetic resonance imaging revealed a right-sided juxtafacetal lesion at C6-C7 level that was hyperintense on T2 and hypointense on T1 imaging. A percutaneous endoscopic posterior cervical foraminotomy at right-sided C7-T1 was performed under general anesthesia. The cyst was removed, and adequate decompression of the C7 root was achieved. Postoperative magnetic resonance imaging and computed tomography scan showed adequate foraminotomy and decompression of the neural structures. The patient had gross relief of neck pain (visual analog scale score 2). CONCLUSIONS The findings suggest that ankylosing spondylitis may cause formation of a juxtafacetal cyst at the mobile levels in a relatively less mobile cervical spine. The endoscopic resection of such cysts is a minimally invasive novel procedure that can cure such patients successfully without unwanted fusion surgery.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea.
| | - Neelesh Damani
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Nitin Maruti Adsul
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Hospital, Incheon, Seoul, Republic of Korea
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Abstract
One of the major causes of lumbar spinal canal stenosis (LSCS) has been considered facet joint hypertrophy (FJH). However, a previous study asserted that "FJH" is a misnomer because common facet joints are no smaller than degenerative facet joints; however, this hypothesis has not been effectively demonstrated. Therefore, in order to verify that FJH is a misnomer in patients with LSCS, we devised new morphological parameters that we called facet joint thickness (FJT) and facet joint cross-sectional area (FJA).We collected FJT and FJA data from 114 patients with LSCS. A total of 86 control subjects underwent lumbar magnetic resonance imaging (MRI) as part of routine medical examinations, and axial T2-weighted MRI images were obtained from all participants. We measured FJT by drawing a line along the facet area and then measuring the narrowest point at L4-L5. We measured FJA as the whole cross-sectional area of the facet joint at the stenotic L4-L5 level.The average FJT was 1.60 ± 0.36 mm in the control group and 1.11 ± 0.32 mm in the LSCS group. The average FJA was 14.46 ± 5.17 mm in the control group and 9.31 ± 3.47 mm in the LSCS group. Patients with LSCS had significantly lower FJTs (P < .001) and FJAs (P < .001).FJH, a misnomer, should be renamed facet joint area narrowing. Using this terminology would eliminate confusion in descriptions of the facet joint.
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Affiliation(s)
| | - Mi Sook Seo
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Soo Il Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Tae-Ha Lim
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine
| | - So Jin Shin
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
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Optimal Cut-Off Value of the Superior Articular Process Area as a Morphological Parameter to Predict Lumbar Foraminal Stenosis. Pain Res Manag 2017; 2017:7914836. [PMID: 28163566 PMCID: PMC5253487 DOI: 10.1155/2017/7914836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/21/2016] [Indexed: 11/17/2022]
Abstract
Background. We devised a new morphological parameter called the superior articular process area (SAPA) to evaluate the connection between lumbar foraminal stenosis (LFS) and the superior articular process. Objective. We hypothesized that the SAPA is an important morphologic parameter in the diagnosis of LFS. Methods. All patients over 60 years of age were included. Data regarding the SAPA were collected from 137 patients with LFS. A total of 167 control subjects underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. We analyzed the cross-sectional area of the bone margin of the superior articular process at the level of L4-L5 facet joint in the axial plane. Results. The average SAPA was 96.3 ± 13.6 mm2 in the control group and 128.1 ± 17.2 mm2 in the LFS group. The LFS group was found to have significantly higher levels of SAPA (p < 0.001) in comparison to the control group. In the LFS group, the optimal cut-off value was 112.1 mm2, with 84.4% sensitivity, 83.9% specificity, and AUC of 0.94 (95% CI: 0.91-0.96). Conclusions. Higher SAPA values were associated with a higher possibility of LFS. These results are important in the evaluation of patients with LFS.
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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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