Terao Tohru, Takahashi Hiroshi, Taniguchi Makoto, Ide Katsuhisa, Shinozaki Munehisa, Nakauchi Jyun, Kubota Mayumi
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2007 Jun;47(6):250-7; discussion 257. doi: 10.2176/nmc.47.250.
Retrospective analysis of 10 cases of resection of symptomatic lumbar juxtafacet cysts in nine patients (mean age 65.4 years) investigated the relationship between surgical method and progression of spinal spondylolisthesis or cyst recurrence. Patient characteristics, surgical methods, and postoperative course were reviewed. The most common preoperative symptom, painful radiculopathy, occurred in all cases, followed by motor weakness in five, sensory loss in four, and intermittent claudication in four. All patients underwent bilateral total (n = 6) or partial laminectomy (n = 4), with minimal (n = 3) or no (n = 7) facetectomy. Cysts were gross totally resected in eight cases and partially resected in two. Concomitant fixation was not performed. Painful radiculopathy, motor weakness, and sensory disturbance all resolved, resulting in good or excellent outcome in all patients. Postoperative symptomatic spondylolisthesis had not been noted at mean 52.1 months postoperatively. However, new juxtafacet cysts were later detected on the contralateral side to the initial lesion in two patients. Surgical removal of juxtafacet cysts is recommended for immediate symptomatic relief. Concomitant spinal fixation to prevent progression of spinal spondylolisthesis or cyst recurrence depends on cyst size, involvement of surrounding structures, degree of preoperative spondylolisthesis, and facet joint destruction.
对9例（平均年龄65.4岁）有症状的腰椎关节突囊肿切除的10例病例进行回顾性分析，以研究手术方法与脊柱滑脱进展或囊肿复发之间的关系。回顾了患者特征、手术方法和术后病程。最常见的术前症状是神经根性疼痛，所有病例均有，其次是5例运动无力、4例感觉丧失和4例间歇性跛行。所有患者均接受了双侧全椎板切除术（n = 6）或部分椎板切除术（n = 4），小关节切除术最少（n = 3）或未进行（n = 7）。8例囊肿被大体完全切除，2例部分切除。未进行同期固定。神经根性疼痛、运动无力和感觉障碍均得到缓解，所有患者均获得良好或优秀的结果。术后平均52.1个月未发现有症状的脊柱滑脱。然而，后来在两名患者的初始病变对侧发现了新的关节突囊肿。建议手术切除关节突囊肿以立即缓解症状。是否进行同期脊柱固定以防止脊柱滑脱进展或囊肿复发取决于囊肿大小、周围结构受累情况、术前脊柱滑脱程度和小关节破坏程度。
