Denis Daniel R, Hirt Daniel, Shah Saumya, Lu Daniel C, Holly Langston T
Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA.
Department of Neurosurgery, University of California, Los Angeles, CA, USA.
Int J Spine Surg. 2016 Oct 24;10:37. doi: 10.14444/3037. eCollection 2016.
About one third of lumbar synovial cysts are associated with degenerative spondylolisthesis. Segmental instability is thought to contribute to the pathogenesis and recurrence of synovial cysts and lumbar fusion has been advocated as a treatment of choice in the presence of spondylolisthesis. In patients with spondylolisthesis, minimally invasive resection of lumbar synovial cysts, without fusion, could minimize surgically induced segmental instability while providing good pain relief.
Clinical and radiological outcomes of lumbar synovial cyst patients with and without spondylolisthesis were retrospectively compared. Pain outcomes were assessed with modified Macnab criteria.
Fifty-three patients (18 with grade 1 spondylolisthesis) underwent minimally invasive synovial cyst resection and all had either excellent or good pain outcome at ≤ 8 post- operative weeks (P = 1.000, n = 53). At > 8 post-operative weeks (mean (SD) follow-up of 200 (175) weeks), excellent or good outcomes were noted in 89% of patients without spondylolisthesis and in 75% of patients with spondylolisthesis (P = 0.425, n = 40). Four patients developed a new grade 1 spondylolisthesis at a mean follow-up of 2.6 ± 2.1 years. Nine patients were assessed for spondylolisthesis measurements at 1.2 ± 1.3 years of follow up and no significant difference was observed (5 ± 0 vs 5 ± 1 mm; P = 0.791). Two patients without spondylolisthesis and none of the patients with spondylolisthesis had a synovial cyst recurrence.
Patients with concomitant lumbar degenerative spondylolisthesis and synovial cyst can have good short- and long-term clinical outcomes with minimally invasive surgery without fusion. Post-operative segmental instability does not appear to be significant in patients with spondylolisthesis. All patients included in this article signed an informed consent for the use of their medical information for research.
约三分之一的腰椎滑膜囊肿与退行性椎体滑脱有关。节段性不稳定被认为是滑膜囊肿发病机制和复发的原因之一，在存在椎体滑脱的情况下，腰椎融合术一直被倡导为首选治疗方法。对于椎体滑脱患者，在不进行融合的情况下微创切除腰椎滑膜囊肿，可以在缓解疼痛的同时，将手术引起的节段性不稳定降至最低。
回顾性比较有和没有椎体滑脱的腰椎滑膜囊肿患者的临床和影像学结果。采用改良Macnab标准评估疼痛结果。
53例患者（18例为1度椎体滑脱）接受了微创滑膜囊肿切除术，所有患者在术后≤8周时疼痛结果均为优或良（P = 1.000，n = 53）。在术后>8周（平均（标准差）随访200（175）周）时，无椎体滑脱患者中89%和有椎体滑脱患者中75%的结果为优或良（P = 0.425，n = 40）。4例患者在平均随访2.6±2.1年时出现新的1度椎体滑脱。9例患者在随访1.2±1.3年时接受了椎体滑脱测量评估，未观察到显著差异（5±0 vs 5±1 mm；P = 0.791）。2例无椎体滑脱的患者和所有有椎体滑脱的患者均未出现滑膜囊肿复发。
伴有腰椎退行性椎体滑脱和滑膜囊肿的患者，采用不融合的微创手术可获得良好的短期和长期临床效果。椎体滑脱患者术后节段性不稳定似乎并不明显。本文纳入的所有患者均签署了知情同意书，同意将其医疗信息用于研究。
