Chugh Arunit J S, Alonso Fernando, Moore Ryan, Cox Efrem, Eubanks Jason
Department of Neurosurgery, University Hospitals of Cleveland.
Case Western Reserve University School of Medicine.
Clin Spine Surg. 2019 May;32(4):170-174. doi: 10.1097/BSD.0000000000000803.
This is a retrospective cohort review.
To determine whether a correlation exists between facet cysts and lumbar instability.
Lumbar facet cysts are common degenerative entities observed in patients with low-grade spondylolisthesis at a rate of 10%-50%. Surgical management with partial facetectomy with or without fusion remains controversial.
Review of 86 patients with lumbar degenerative spondylolisthesis is performed. Preoperative magnetic resonance imagings were reviewed for the presence of lumbar facet cysts and Facet Fluid Indices (FFI)-calculated as the ratio of facet fluid width to facet width. Instability was defined as a difference of >3 mm in vertebral displacement between flexion and extension radiographs. T tests and the Pearson correlation analyses were used to determine statistical significance.
In total, 26 patients had unstable and 60 had stable spondylolisthesis. Facet cysts were present at an overall prevalence of 30.1%-in 10/26 patients in the unstable group and in 18/60 patients in the stable group (P>0.05). The average FFIs for the unstable and stable groups were 0.13 and 0.09, respectively (P>0.05). FFI in patients with facet cysts was significantly higher than those without (P<0.05). In addition, the group with facet cysts had a significantly higher proportion of patients with FF effusions >3 mm.
Lack of correlation with instability hints that the presence of facet cysts may not indicate instability in lumbar degenerative spondylolisthesis. Therefore, presence of facet cysts in static magnetic resonance imaging revealing spondylolisthesis should not preclude the physician from performing dynamic films to evaluate for instability. Significantly higher FFI in patients with facet cysts reaffirms the degenerative pathophysiology involved in their formation. Although this is not an outcomes study, it does spark interest into whether patients with stable spondylolisthesis and concurrent facet cysts are suitable for partial facetectomy alone with fusion.
这是一项回顾性队列研究。
确定小关节囊肿与腰椎不稳之间是否存在相关性。
腰椎小关节囊肿是在低度腰椎滑脱患者中常见的退变病变，发生率为10% - 50%。采用部分小关节切除术并辅以或不辅以融合术的手术治疗仍存在争议。
对86例腰椎退变性腰椎滑脱患者进行回顾性研究。术前对磁共振成像进行评估，以确定是否存在腰椎小关节囊肿以及小关节液指数（FFI）——通过小关节液宽度与小关节宽度之比计算得出。不稳的定义为屈伸位X线片上椎体位移差异>3毫米。采用t检验和Pearson相关分析来确定统计学意义。
总共26例患者存在腰椎不稳，60例患者腰椎稳定。小关节囊肿的总体患病率为30.1%——不稳组26例中有10例，稳定组60例中有18例（P>0.05）。不稳组和稳定组的平均FFI分别为0.13和0.09（P>0.05）。有小关节囊肿的患者的FFI显著高于无小关节囊肿的患者（P<0.05）。此外，有小关节囊肿的组中FFI积液>3毫米的患者比例显著更高。
与不稳缺乏相关性提示小关节囊肿的存在可能并不表明腰椎退变性腰椎滑脱存在不稳。因此，在显示腰椎滑脱的静态磁共振成像中存在小关节囊肿不应妨碍医生进行动态影像学检查以评估不稳情况。有小关节囊肿的患者中显著更高的FFI再次证实了其形成过程中涉及的退变病理生理机制。虽然这不是一项疗效研究，但它确实引发了对于稳定型腰椎滑脱并发小关节囊肿的患者是否适合单纯行部分小关节切除术并辅以融合术的思考。
