Ramhmdani Seba, Ishida Wataru, Perdomo-Pantoja Alexander, Witham Timothy F, Lo Sheng-Fu L, Bydon Ali
Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2019 Feb;122:e1059-e1068. doi: 10.1016/j.wneu.2018.10.228. Epub 2018 Nov 9.
The pathogenesis of synovial cysts is largely unknown; however, they have been increasingly thought of as markers of spinal facet instability and typically associated with degenerative spondylosis. We specifically investigated the incidence of concomitant synovial cysts with underlying degenerative spondylolisthesis.
A literature search was performed using 4 online databases to assess the association between lumbar synovial cysts and degenerative spinal pathological features. Meta-analyses were performed on the prevalence rates of coexisting degenerative spinal pathological entities and treatment modalities. A random effects model was used to calculate the mean and 95% confidence intervals.
A total of 17 studies encompassing 824 cases met the inclusion criteria. The pooled prevalence rates of concurrent spondylolisthesis, facet arthropathy, and degenerative disc disease at the same level of the synovial cysts were 42.5% (range, 39.0%-46.1%), 89.3% (range, 79.0%-94.8%), and 48.8% (range, 43.8%-53.9%), respectively. Among these, patients with coexisting spondylolisthesis were more likely to undergo spinal fusion surgery (vs. laminectomy alone) and reoperation than were patients without spondylolisthesis with a pooled odds ratio of 11.5 (95% confidence interval, 4.5-29.1; P < 0.0001) and 2.0 (95% confidence interval, 0.9-4.2; P = 0.088), respectively.
Patients with a combination of synovial cysts and degenerative spondylolisthesis are more likely to undergo spinal fusion surgery than laminectomy alone compared with patients with synovial cysts and no preoperative spondylolisthesis. Furthermore, patients with synovial cysts and spondylolisthesis are more likely to require additional fusion surgery. The results from the present review lend credence to the argument that synovial cyst herniation might be a manifestation of an unstable spinal level.
滑膜囊肿的发病机制在很大程度上尚不清楚；然而，它们越来越被认为是脊柱小关节不稳的标志，通常与退行性脊柱病相关。我们专门研究了伴有潜在退行性腰椎滑脱的滑膜囊肿的发生率。
使用4个在线数据库进行文献检索，以评估腰椎滑膜囊肿与退行性脊柱病理特征之间的关联。对共存的退行性脊柱病理实体的患病率和治疗方式进行荟萃分析。采用随机效应模型计算均值和95%置信区间。
共有17项研究（涵盖824例病例）符合纳入标准。滑膜囊肿同一水平并发腰椎滑脱、小关节病和椎间盘退变的合并患病率分别为42.5%（范围39.0%-46.1%）、89.3%（范围79.0%-94.8%）和48.8%（范围43.8%-53.9%）。其中，与无腰椎滑脱的患者相比，共存腰椎滑脱的患者更有可能接受脊柱融合手术（与单纯椎板切除术相比）和再次手术，合并比值比分别为11.5（95%置信区间4.5-29.1；P<0.0001）和2.0（95%置信区间0.9-4.2；P=0.088）。
与术前无腰椎滑脱的滑膜囊肿患者相比，合并滑膜囊肿和退行性腰椎滑脱的患者更有可能接受脊柱融合手术而非单纯椎板切除术。此外，合并滑膜囊肿和腰椎滑脱的患者更有可能需要额外的融合手术。本综述的结果支持滑膜囊肿疝可能是脊柱不稳定节段表现的观点。
