Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Spine J. 2010 Sep;10(9):820-6. doi: 10.1016/j.spinee.2010.04.010. Epub 2010 May 20.
With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear.
To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence.
Systematic review of the literature.
All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion.
Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales.
We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts.
Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4-L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion.
Surgical decompression results in symptomatic resolution in the vast majority of patients; however, recurrent back pain occurs in a significant number of patients. Cyst recurrence occurs in less than 2% of patients but has never been reported after cyst excision with concomitant fusion. The lack of cyst recurrence after concomitant fusion supports the need to investigate the value of fusion of the involved motion segment in the treatment of symptomatic synovial cysts of the spine.
随着神经影像学的进步，越来越多的报告显示出症状性脊柱滑膜囊肿。手术切除已被公认为治疗症状性关节突旁囊肿的明确方法。然而，对于同时进行融合的作用以及手术后复发背痛和复发囊肿的发生率仍然不清楚。
确定手术后症状缓解、囊肿切除和减压后复发背痛和腿痛以及滑膜囊肿复发的累积发生率。
文献系统回顾。
迄今为止，所有报告滑膜囊肿切除伴或不伴脊柱融合术结果的研究。
我们对 1970 年至 2009 年期间发表的所有报告脊柱滑膜囊肿手术后结果的文章进行了系统文献回顾。共确定并回顾了 82 篇发表的研究，共纳入 966 例患者。672 例（69.6%）患者表现为神经根痛，467 例（48.3%）患者表现为背痛。最常涉及的脊柱水平为 L4-L5（75.4%），仅分别有 25 例（2.6%）和 12 例（1.2%）报告颈椎或胸段有滑膜囊肿。801 例（84.0%）患者仅接受减压手术切除，而 155 例（16.0%）患者接受了额外的同时性脊柱融合术。654 例（92.5%）和 880 例（91.1%）患者的背痛或腿痛完全缓解。平均随访 25.4 个月后，155 例（21.9%）和 123 例（12.7%）患者出现背痛或腿痛复发。60 例（6.2%）患者需要再次手术，其中大多数（n=47）需要融合以纠正脊柱不稳和机械性背痛。单纯减压后出现同节段滑膜囊肿复发 17 例（1.8%），但未见减压和融合后复发。
手术减压可使绝大多数患者的症状得到缓解；然而，仍有大量患者出现背痛复发。囊肿复发发生率低于 2%，但在伴融合的患者中从未报告过。伴融合后无囊肿复发支持需要研究融合受累运动节段在治疗脊柱症状性滑膜囊肿中的价值。
