Wun Kelly, Hashmi Sohaib Z, Maslak Joseph, Schneider Andrew D, Katchko Karina M, Singh Gurmit, Patel Alpesh A, Hsu Wellington K
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Clin Spine Surg. 2019 Dec;32(10):E457-E461. doi: 10.1097/BSD.0000000000000870.
This is a retrospective study.
The objective of this study was to evaluate lumbar spine synovial cyst recurrence rates of decompression-alone versus decompression/fusion procedures.
Improvements in imaging modalities allow for increased diagnosis and surgical treatment of symptomatic spinal juxtafacet synovial cysts. Conservative management may be used as a first-line management strategy, however rarely provides durable, effective relief of symptoms. Surgical treatment of spinal synovial cysts ranges from decompression and cyst excision to decompression with fusion procedures. Decompression procedures alone have a higher risk of recurrence of spinal synovial cysts.
We retrospectively reviewed 87 patients undergoing surgical treatment of lumbar spinal juxtafacet synovial cysts as a single institution over 20 years. Surgical treatment consisted of either decompression versus decompression/fusion procedures. Preoperative symptoms included back pain, radiculopathy, motor deficits, or sensory deficits. The incidence of recurrence of spinal synovial cysts at the same-site or differing sites was compared between 2 categories of surgical treatment. Revision surgical procedure rates were also evaluated.
A total of 55 (63%) patients were treated with an index decompression-only procedure for the lumbar spinal synovial cyst compared with 32 (37%) patients treated with an index decompression and fusion procedure. Fifty-eight (68%) of the lumbar spinal cysts occurred at the L4-L5 level. There were 10 (11.5%) spinal synovial cyst recurrences in the decompression-only group, and 0 recurrences in the decompression/fusion group. Revision decompression procedures were performed in 4 of the 10 (4.6%) recurrences, and 6 of 10 (6.9%) recurrences had subsequent decompression and fusion surgery. The mean time to recurrence was 23.9±17.3 months. The mean length of follow-up was 65.1±48.6 months. Both recurrence and nonrecurrence cohorts had significant symptomatic improvement using Odom criteria.
Decompression and cyst excision was the more common surgical treatment of lumbar spinal synovial cysts compared with decompression/fusion procedure in our study. The rate of synovial cyst recurrence and revision surgery in patients undergoing index decompression was relatively low and comparable to current literature. Symptomatic improvement of patients undergoing decompression versus decompression/fusion was similar in our study. Although the fusion may be required for the extent of pathology or coexisting instability, decompression and excision of spinal synovial cysts provide durable, effective treatment with a known, appropriate risk of recurrence and subsequent revision surgery.
这是一项回顾性研究。
本研究的目的是评估单纯减压手术与减压/融合手术治疗腰椎滑膜囊肿的复发率。
成像方式的改进使得对有症状的脊柱关节突滑膜囊肿的诊断和手术治疗有所增加。保守治疗可作为一线治疗策略，但很少能持久、有效地缓解症状。脊柱滑膜囊肿的手术治疗范围从减压和囊肿切除到减压联合融合手术。单纯减压手术治疗脊柱滑膜囊肿的复发风险较高。
我们回顾性分析了20年间在单一机构接受腰椎关节突滑膜囊肿手术治疗的87例患者。手术治疗包括单纯减压手术与减压/融合手术。术前症状包括背痛、神经根病、运动功能障碍或感觉功能障碍。比较了两类手术治疗中脊柱滑膜囊肿在同一部位或不同部位的复发率。还评估了翻修手术率。
共有55例（63%）患者接受了单纯减压手术治疗腰椎滑膜囊肿，32例（37%）患者接受了减压联合融合手术。58例（68%）腰椎囊肿发生在L4-L5节段。单纯减压组有10例（11.5%）脊柱滑膜囊肿复发，减压/融合组无复发。10例复发患者中有4例（4.6%）接受了翻修减压手术，10例复发患者中有6例（6.9%）随后接受了减压联合融合手术。复发的平均时间为23.9±17.3个月。平均随访时间为65.1±48.6个月。根据奥多姆标准，复发组和未复发组的症状均有显著改善。
在我们的研究中，与减压/融合手术相比，减压和囊肿切除是更常见的腰椎滑膜囊肿手术治疗方法。接受初次减压手术的患者滑膜囊肿复发率和翻修手术率相对较低，与当前文献相当。在我们的研究中，接受减压手术与减压/融合手术的患者症状改善情况相似。虽然可能因病变范围或并存的不稳定情况而需要融合手术，但脊柱滑膜囊肿的减压和切除可提供持久、有效的治疗，且复发和随后翻修手术的风险已知且适当。
