Epstein Nancy E, Baisden Jamie
Clinical Professor of Neurological Surgery, The Albert Einstein College of Medicine, Bronx, NY, 10461, and Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, NY 11501.
Surg Neurol Int. 2012;3(Suppl 3):S157-66. doi: 10.4103/2152-7806.98576. Epub 2012 Jul 17.
The surgical management of lumbar synovial cysts that have extruded into the spinal canal remains controversial (e.g. decompression with/without fusion).
The neurological presentation, anatomy, pathophysiology, and surgical challenges posed by synovial cysts in the lumbar spine are well known. Neurological complaints typically include unilateral or, more rarely, bilateral radicular complaints, and/or cauda equina syndromes. Anatomically, synovial cysts constitute cystic dilatations of synovial sheaths that directly extrude from facet joints into the spinal canal. Pathophysiologically, these cysts reflect disruption of the facet joints often with accompanying instability, and potentially compromise both the cephalad and caudad nerve roots.
Aspiration of lumbar synovial cysts, which are typically gelatinous and non-aspirable, and typically performed by "pain specialists" (e.g. pain management, rehabilitation, radiologists, others) utilizing fluoroscopy or CT-guided aspiration, is associated with 50-100% failure rates. Surgical decompression with/without fusion (as the issue regarding fusion remains unsettled) results in the resolution of back and radicular pain in 91.6-92.5% and 91.1-91.9% of cases, respectively.
After a thorough review of the literature, it appears that the treatment with the best outcome for patients with synovial cysts is cyst removal utilizing surgical decompression; the need for attendant fusion remains unsettled. The use of an alternative treatment, percutaneous aspiration of cysts, appears to have a much higher recurrence and failure rate, but may be followed by surgery if warranted.
已突出至椎管内的腰椎滑膜囊肿的手术治疗仍存在争议（例如减压并/不融合）。
腰椎滑膜囊肿引起的神经表现、解剖结构、病理生理及手术挑战已为人熟知。神经症状通常包括单侧，或更少见的双侧神经根症状，和/或马尾综合征。从解剖学上看，滑膜囊肿是滑膜鞘的囊性扩张，直接从关节突关节突出至椎管内。从病理生理学角度，这些囊肿反映了关节突关节的破坏，常伴有不稳定，并且可能压迫上下行神经根。
腰椎滑膜囊肿通常为胶冻状，无法抽吸，“疼痛专科医生”（如疼痛管理、康复、放射科医生等）通常在透视或CT引导下进行抽吸，其失败率为50%-100%。减压并/不融合的手术（由于融合问题仍未解决）分别使91.6%-92.5%和91.1%-91.9%的病例的背痛和神经根性疼痛得到缓解。
在对文献进行全面回顾后，对于滑膜囊肿患者，似乎手术减压切除囊肿的治疗效果最佳；是否需要同时进行融合仍未确定。采用经皮囊肿抽吸的替代治疗方法似乎复发率和失败率更高，但如有必要可随后进行手术。
