Bydon Mohamad, Lin Joseph A, de la Garza-Ramos Rafael, Sciubba Daniel M, Wolinsky Jean Paul, Witham Timothy F, Gokaslan Ziya L, Bydon Ali
Spinal Column Biomechanics and Surgical Outcomes Laboratory and.
J Neurosurg Spine. 2014 Dec;21(6):919-28. doi: 10.3171/2014.8.SPINE13897. Epub 2014 Sep 26.
This study was undertaken to compare surgical outcomes between patients with atlantoaxial versus subaxial cervical synovial cysts (CSCs) and to compare outcomes between patients who underwent decompression alone versus decompression and fusion for the treatment of CSCs.
The authors present a series of 17 cases involving patients treated at their institution and report the surgical outcomes. Due to the rarity of CSCs, a meta-analysis was conducted, and results of the literature search were combined with the case series to enhance the power of the study.
Seventeen patients underwent surgical treatment for CSCs at our institution: 3 patients (17.6%) had atlantoaxial cysts and 14 (82.3%) had subaxial cysts. Of the 17 patients, 16 underwent a decompression and fusion; most patients experienced symptom resolution at last follow-up, and there were no cyst recurrences. A total of 54 articles (including the current series) and 101 patients were included in the meta-analysis. The mean age at presentation was 64 ± 13.9 years, and the most common symptoms were motor and sensory deficits. Forty-one patients (40.6%) presented with atlantoaxial cysts, and 60 (59.4%) with subaxial cysts. There were no significant differences between groups in terms of presenting symptoms, Nurick scores, surgical treatment, or surgical outcomes. Fifty-two patients (51.4%) underwent surgical decompression without fusion, while 49 patients (48.6%) underwent fusion. The preoperative Nurick scores were significantly lower in the fused group (p = 0.001), with an average score of 1.32 compared with 2.75 in the nonfused group. After a mean follow-up of 16.5 months, a difference of means analysis between final and preoperative Nurick scores revealed that patients who received a decompression alone improved on average 1.66 points (95% CI 1.03-2.29) compared with 0.8 points (95% CI 0.23-1.39) in the fused group (p = 0.004). However, there was no statistically significant difference in symptom resolution between the groups, and the rate of cyst recurrence was found to be 0%.
In this study, patients with CSCs had similar outcomes regardless of cyst location and regardless of whether they underwent decompression only or fusion. In the authors' institutional experience, 16 of 17 patients underwent fusion due to underlying spinal instability. While there were no reports of cyst recurrence in their series or in the literature in patients who only received decompression, this is likely due to the limited follow-up time available for the study population. Longer follow-up and prospective and biomechanical studies are needed to corroborate these findings.
本研究旨在比较寰枢椎与下颈椎滑膜囊肿（CSCs）患者的手术效果，并比较单纯减压与减压融合治疗CSCs患者的疗效。
作者报告了在其机构治疗的一系列17例患者的手术结果。由于CSCs罕见，进行了一项荟萃分析，并将文献检索结果与病例系列相结合以增强研究的效力。
17例患者在我们机构接受了CSCs手术治疗：3例（17.6%）有寰枢椎囊肿，14例（82.3%）有下颈椎囊肿。17例患者中，16例接受了减压融合手术；大多数患者在末次随访时症状缓解，且无囊肿复发。荟萃分析共纳入54篇文章（包括本病例系列）和101例患者。就诊时的平均年龄为64±13.9岁，最常见的症状是运动和感觉障碍。41例（40.6%）患者有寰枢椎囊肿，60例（59.4%）有下颈椎囊肿。两组在症状表现、Nurick评分、手术治疗或手术结果方面无显著差异。52例（51.4%）患者接受了单纯减压手术，49例（48.6%）患者接受了融合手术。融合组术前Nurick评分显著更低（p = 0.001），平均评分为1.32，而非融合组为2.75。平均随访16.5个月后，末次与术前Nurick评分的均值差异分析显示，单纯减压组患者平均改善1.66分（95%CI 1.03 - 2.29），而融合组为0.8分（95%CI 0.23 - 1.39）（p = 0.004）。然而，两组在症状缓解方面无统计学显著差异，且囊肿复发率为0%。
在本研究中，CSCs患者无论囊肿位置如何，无论仅接受减压还是融合手术，其结果相似。根据作者的机构经验，17例患者中有16例因潜在的脊柱不稳定而接受了融合手术。虽然在他们的系列研究或文献中，仅接受减压的患者没有囊肿复发的报告，但这可能是由于研究人群的随访时间有限。需要更长时间的随访以及前瞻性和生物力学研究来证实这些发现。
