Department of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
Spine (Phila Pa 1976). 2010 May 1;35(10):1044-53. doi: 10.1097/BRS.0b013e3181bdafed.
Retrospective study.
Compare outcomes of different treatment methods for intraspinal synovial cysts.
Intraspinal synovial cysts are cited as an increasing cause of back pain and radiculopathy. To date, few studies have compared outcomes of differing treatment methods in patients with synovial cysts.
We retrospectively reviewed 167 consecutive patients undergoing surgical management of 195 symptomatic synovial cysts at a single institution over 19 years. The incidence of postoperative mechanical back pain, radiculopathy, and cyst recurrence was compared between patients undergoing unilateral hemilaminectomy (n = 51), bilateral laminectomy (n = 39), facetectomy with in situ fusion (n = 18), and facetectomy with instrumented fusion (n = 56).
A total of 155 (97.5%) patients presented with radiculopathy, 132(82.5%) with mechanical back pain, 31 (20%) with neurogenic claudication, and 5 (3.2%) with bladder dysfunction. Most cysts occurred in the lumbar spine. After surgery, back and radicular pain improved in 91.6% and 91.9% patients, respectively. By a mean follow-up of 16 +/- 9 months, 36 (21.6%) patients developed recurrent back pain, 20 (11.8%) recurrent leg pain, and 5 (3%) recurrent synovial cysts. Patients undergoing laminectomy had a significantly increased cyst recurrence incidence compared to fusion groups via log-rank test (P = 0.042), and this risk was decreased to baseline with instrumented fusion on reoperation. Laminectomy was also associated with the highest increased risk of recurrent back pain in both log-rank test (P = 0.018) and proportional hazards regression (HR): 1.64 (1.00-3.45), P = 0.05. Instrumented fusion had the lowest risk for back pain recurrence.
Hemilaminectomy or laminectomy remains one of the mainstay surgical treatments for symptomatic intraspinal synovial cysts. Our experience shows that the majority of patients undergoing decompression/excision of synovial cysts will have immediate improvement in back and leg pain. However, within 2 years, patients receiving hemilaminectomy or laminectomy alone have an increased incidence of back pain and cyst recurrence. Decompression with instrumented fusion appears to be associated with the lowest incidences of cyst recurrence or back pain.
回顾性研究。
比较不同治疗方法治疗椎管内滑膜囊肿的效果。
椎管内滑膜囊肿被认为是导致背痛和根性痛的一个日益常见的原因。迄今为止，很少有研究比较不同治疗方法在滑膜囊肿患者中的效果。
我们回顾性分析了 19 年来在一家机构接受手术治疗的 167 例 195 例症状性滑膜囊肿患者。比较了单侧半椎板切除术（n=51）、双侧椎板切除术（n=39）、关节突切除术伴原位融合（n=18）和关节突切除术伴器械融合（n=56）患者的术后机械性背痛、根性痛和囊肿复发率。
共有 155 例（97.5%）患者出现根性痛，132 例（82.5%）出现机械性背痛，31 例（20%）出现神经性跛行，5 例（3.2%）出现膀胱功能障碍。大多数囊肿发生在腰椎。术后，91.6%的患者背痛和根性痛均有改善。平均随访 16+/-9 个月后，36 例（21.6%）患者出现复发性背痛，20 例（11.8%）患者出现复发性腿痛，5 例（3%）患者出现复发性滑膜囊肿。Log-rank 检验显示，行椎板切除术的患者囊肿复发发生率明显高于融合组（P=0.042），再次手术行器械融合可将这种风险降低至基线水平。Log-rank 检验（P=0.018）和比例风险回归（HR）也显示，椎板切除术与复发性背痛的风险增加最高相关：1.64（1.00-3.45），P=0.05。器械融合的背痛复发风险最低。
半椎板切除术或椎板切除术仍然是治疗症状性椎管内滑膜囊肿的主要手术治疗方法之一。我们的经验表明，大多数接受滑膜囊肿减压/切除的患者的背痛和腿痛将立即得到改善。然而，在 2 年内，单独接受半椎板切除术或椎板切除术的患者背痛和囊肿复发的发生率增加。器械融合减压似乎与囊肿复发或背痛的发生率最低相关。
