Dagain A, Dulou R, Dutertre G, Delmas J-M, Pouit B, de Soultrait F, Pernot P
Service de neurochirurgie, HIA Val-de-Grâce, 74, boulevard Port-Royal, 75005 Paris, France.
Rev Chir Orthop Reparatrice Appar Mot. 2008 May;94(3):289-96. doi: 10.1016/j.rco.2007.11.003. Epub 2008 Mar 4.
Lumbar synovial cysts are an uncommon cause of radiculopathy, low back pain and neurogenic claudication. We report a retrospective analysis of the clinical presentation, radiological studies, operative findings and outcome in 52 patients surgically treated for symptomatic lumbar synovial cysts.
Retrospective data from 52 consecutive patients treated from January 1996 to February 2006 were analyzed. We studied the clinical symptoms, diagnostic methods and radiological findings in all patients, reviewed the types of conservative therapy applied, the surgical findings and techniques, as well as the immediate and long-term results. Surgical outcomes were evaluated according to the Friedberg scale.
There were 35 women and 17 men with an average age of 63.2 years (range 36-84 years). The most common symptoms were radiculopathy (65,4%) and neurogenic multiroot claudication (34,6%). Forty-seven patients had back pain and 22 paresthesia. Preoperative neurological examination demonstrated motor weakness (5.7%), sensory loss (7.6%). The radiological work-up consisted in CT-scan and/or MRI for all patients. The correct preoperative diagnosis was established in 44 patients. A total of 56 cysts were found. Five patients had bilateral cysts. The L4-L5 level was affected in 66%. Total resection of the synovial cyst was possible for 46 patients. No fusion was performed as a first line procedure. However, subsequent fusion was necessary in one patient who developed delayed symptomatic spondylolisthesis. Mean follow up period was 14 months ranging from six to 24 months. Three recurrences occurred during the follow-up period. Functional outcome was excellent in 61.6%, good in 34.6% and poor in 3.8%.
Surgery should be proposed when synovial cysts fail to respond to conservative therapy. Recurrence and surgical complication rates are low. The usefulness of systematic fusion procedure is questionable.
腰椎滑膜囊肿是神经根病、腰痛和神经源性间歇性跛行的罕见病因。我们报告了对52例因有症状的腰椎滑膜囊肿接受手术治疗的患者的临床表现、影像学检查、手术发现及结果的回顾性分析。
分析了1996年1月至2006年2月连续治疗的52例患者的回顾性数据。我们研究了所有患者的临床症状、诊断方法和影像学表现，回顾了应用的保守治疗类型、手术发现和技术，以及近期和长期结果。根据弗里德伯格量表评估手术结果。
52例患者中，女性35例，男性17例，平均年龄63.2岁（范围36 - 84岁）。最常见的症状是神经根病（65.4%）和神经源性多根间歇性跛行（34.6%）。47例患者有背痛，22例有感觉异常。术前神经学检查显示运动无力（5.7%）、感觉丧失（7.6%）。所有患者均进行了CT扫描和/或MRI影像学检查。44例患者术前得到正确诊断。共发现56个囊肿。5例患者为双侧囊肿。66% 的患者L4 - L5节段受累。46例患者可行滑膜囊肿全切术。一线手术未行融合术。然而，1例出现延迟性症状性椎体滑脱的患者随后需要进行融合术。平均随访期为14个月，范围为6至24个月。随访期间发生3例复发。功能结果优良率为61.6%，良好率为34.6%，差为3.8%。
当滑膜囊肿对保守治疗无效时应考虑手术治疗。复发率和手术并发症率较低。系统性融合手术的实用性值得怀疑。
