Christophis Petros, Asamoto Shunji, Kuchelmeister Klaus, Schachenmayr Walter
Department of Neurosurgery, University Hospital of Giessen, Klinikstrasse 29, 35385 Giessen, Hessen, Germany.
Eur Spine J. 2007 Sep;16(9):1499-505. doi: 10.1007/s00586-006-0287-5. Epub 2007 Jan 4.
To present 58 cystic space-occupying formations of the spinal canal in 53 cases; these formations are called "juxtafacet cysts". Fifty-Three patients (33 women and 20 men, with an average age of 60.8 years) were evaluated retrospectively by neurosurgery. All of the patients had received simple X-P, computed tomography (CT) and magnetic resonance imaging (MRI) before surgery. The neurological findings were evaluated on admission and in a follow-up review. Surgical intervention was performed on all patients and they underwent gross-total cyst removal. During surgery, the origin of a cyst was well observed. Follow-up data ranged from 6 to 46 months. Patient outcome was graded on a scale of excellent, good, or poor. Histological findings were evaluated. In 53 patients 58 cysts were identified. Four of the patients had multiple cysts. All cysts were associated with mobile spine. Fifty-five cysts were found in the lumbo-sacral region, two cysts were found in the cervico-thoracic region and one cyst in the thoracic region. Forty-two patients presented back pain and 52 patients presented radicular pain. Four patients had a cauda equina syndrome. Sensory disturbance was observed in 24 cases and motor weakness was observed in 21 cases. Claudication was observed in 19 cases. All cases with cervico-thoracic or thoracic cysts presented myelopathy. The duration of these clinical symptoms ranged from 10 days to 10 years. After surgery there was no case of a recurrent cyst during the follow-up period. Thirty-four cases had an excellent outcome, 18 a good outcome, and one a poor outcome. Out of 58 cysts 32 were joint cysts (11 synovial cysts, 21 ganglion cysts). A further 19 were flavum cysts, one was a posterior longitudinal ligament (PLL) cyst and six others were unknown pseudo cysts. In 34 of the cysts we found hemosiderin deposits and in eight amyloid deposits. Present investigation and findings in literature show a clear comparison of these cystic formations and the mobile part of the spine. An anatomical relation to a vertebral joint ("facet") is only found in some of the cases (32 of 58). Further to that, the name "cyst" is not correct either, because most of the cystic formations are presented without a cell lining on their internal wall and therefore they are pseudo-cystic. We think that these cystic formations should be called "cystic formations of mobile spine" (CYFMOS) rather than "juxtafacet cysts". A surgical intervention is the best treatment for these cysts if they cause a compression of nerve roots or/and of the spinal cord.
呈现53例患者椎管内的58个囊性占位性病变;这些病变被称为“关节突旁囊肿”。对53例患者(33名女性和20名男性,平均年龄60.8岁)进行了神经外科回顾性评估。所有患者在手术前均接受了普通X线、计算机断层扫描(CT)和磁共振成像(MRI)检查。对入院时及随访复查时的神经学检查结果进行了评估。对所有患者均实施了手术干预,全部囊肿均被完整切除。手术过程中,对囊肿的起源进行了仔细观察。随访数据为6至46个月。根据优良差的标准对患者的预后进行分级。对组织学检查结果进行了评估。在53例患者中发现了58个囊肿。其中4例患者有多个囊肿。所有囊肿均与活动脊柱相关。55个囊肿位于腰骶部,2个囊肿位于颈胸部,1个囊肿位于胸部。42例患者有背痛,52例患者有神经根性疼痛。4例患者出现马尾综合征。24例患者有感觉障碍,21例患者有运动无力。19例患者有间歇性跛行。所有颈胸段或胸段囊肿的患者均出现脊髓病。这些临床症状的持续时间为10天至10年。术后随访期间无囊肿复发病例。34例患者预后优良,18例患者预后良好,1例患者预后差。在58个囊肿中,32个为关节囊肿(11个滑膜囊肿,21个腱鞘囊肿)。另外19个为黄韧带囊肿,1个为后纵韧带(PLL)囊肿,其余6个为不明假性囊肿。在34个囊肿中发现了含铁血黄素沉积,8个囊肿中发现了淀粉样沉积。目前的研究及文献中的发现对这些囊性病变与脊柱活动部分进行了清晰的比较。仅在部分病例(58例中的32例)中发现与椎间关节(“关节突”)存在解剖关系。此外,“囊肿”这个名称也不正确,因为大多数囊性病变的内壁没有细胞内衬,因此它们是假性囊肿。我们认为这些囊性病变应称为“活动脊柱囊性病变”(CYFMOS),而不是“关节突旁囊肿”。如果这些囊肿导致神经根或/和脊髓受压,手术干预是最佳治疗方法。