Weiner Bradley K, Torretti Joel, Stauff Michael
Division of Spinal Surgery The Methodist Hospital 6550 Fannin, Suite 2500 Houston, Texas 77030, USA.
J Orthop Surg Res. 2007 Apr 3;2:5. doi: 10.1186/1749-799X-2-5.
Outcomes of surgical intervention for lumbar synovial cysts have been evaluated in the short and intermediate term. Concerns regarding cyst recurrence, the development of late instability at the involved level, and instability/stenosis at adjacent levels (when concomitant) fusion is performed suggest that long term follow-up is needed. This study aims to fill that void.
Forty-six patients operated by a single surgeon not involved in the study were followed up long term at an average of 9.7 years (range 5 to 22 years) post-operatively. All patients underwent decompression (+/- concomitant arthrodesis in the presence of associated degenerative spondylolisthesis) using the operative microscope for magnification/illumination. Outcomes were assessed using a customized questionnaire evaluating: relief of pain/claudicant symptoms, numbness/parasthesias, and weakness; as well as late onset low back pain, new radicular symptoms, need for additional surgery, and patient satisfaction. Outcomes in patients with or without fusion were compared as well.
87% of patients noted resolution of their pre-operative pain, numbness, and weakness. 28% of patients developed late onset low back pain. 17% developed late onset radicular symptoms in a new nerve root distribution. 15% required subsequent additional surgery. 89% of patients were satisfied with the surgical outcome. No differences were found for any outcome measure between patients undergoing concomitant fusion and those undergoing decompression alone using the two-sample t-test.
This study provides outcome data at an average of nearly ten years post-operative. This information should allow surgeons to provide realistic expectations for their patients regarding outcomes and should enhance the informed consent and surgical decision-making process.
腰椎滑膜囊肿手术干预的短期和中期结果已得到评估。由于担心囊肿复发、受累节段出现晚期不稳定以及相邻节段（如有伴随情况）出现不稳定/狭窄（当进行融合时），提示需要进行长期随访。本研究旨在填补这一空白。
对46例由未参与本研究的单一外科医生进行手术的患者进行长期随访，术后平均随访9.7年（范围为5至22年）。所有患者均使用手术显微镜进行放大/照明，接受减压手术（在伴有退行性椎体滑脱时可进行融合）。使用定制问卷评估结果，问卷内容包括：疼痛/间歇性跛行症状缓解情况、麻木/感觉异常、无力；以及迟发性下腰痛、新的神经根症状、是否需要再次手术和患者满意度。还比较了进行融合和未进行融合患者的结果。
87%的患者术前疼痛、麻木和无力症状得到缓解。28%的患者出现迟发性下腰痛。17%的患者在新的神经根分布区域出现迟发性神经根症状。15%的患者需要后续再次手术。89%的患者对手术结果满意。使用双样本t检验，在进行融合的患者和仅接受减压的患者之间，任何结果指标均未发现差异。
本研究提供了平均术后近十年的结果数据。这些信息应使外科医生能够就手术结果向患者提供现实的预期，并应加强知情同意和手术决策过程。
