Epstein Nancy E
Professor of Clinical Neurosurgery, School of Medicine, State University of New York at Stony Brook, New York, United States.
Surg Neurol Int. 2020 Feb 28;11:33. doi: 10.25259/SNI_54_2020. eCollection 2020.
Lumbar synovial cysts are often not sufficiently diagnosed prior to spine surgery. Utilizing both MR and CT studies is critical for recognizing the full extent/severity of these lesions.
In patients with chronic, acute, or subacute lumbar disease, obtaining both MR and CT studies is critical to correctly diagnose; disc disease, hypertrophy/ossification of the yellow ligament (OYL), stenosis, with/without degenerative spondylolisthesis, and/or synovial cysts (SC).
MR T2 weighted images directly demonstrate hyperintensity within a SC. They initially cause lateral recess/caudad nerve root and/foraminal compromise, with larger extrusions causing significant lateral thecal sac, and far lateral/superior cephalad root compromise. CT 2 mm cuts often better demonstrate mid-vertebral level compression of cephalad nerve roots with/without SC calcification, along with the extent of mid-vertebral stenosis, hypertrophy/OYL, and DS. When CT studies directly document SC calcification, it alerts the surgeon to the increased potential risk of creating a cerebrospinal fluid fistula with full SC excision, and should prompt the adoption of alternative measures such as decompression/partial removal. Most critically, surgery for synovial cysts often warrants a 2-level laminectomy for fuller visualization of the cephalad and caudad nerve roots, and clearer differentiation of neural tissues from the large fibrotic SC capsule, to effect safer removal.
Preoperatively, establishing the full cephalad and cauda extent of lumbar synovial cysts with both MR and CT studies is critical. Anticipation and better visualization of the foraminal/far lateral and superior extent of these lesions often warrants more extensive multilevel laminectomies for thecal sac and both cephalad and caudad root decompression.
腰椎滑膜囊肿在脊柱手术前常未得到充分诊断。同时利用磁共振成像（MR）和计算机断层扫描（CT）检查对于识别这些病变的全部范围/严重程度至关重要。
对于患有慢性、急性或亚急性腰椎疾病的患者，同时进行MR和CT检查对于正确诊断椎间盘疾病、黄韧带肥厚/骨化（OYL）、狭窄、伴或不伴退行性椎体滑脱以及滑膜囊肿（SC）至关重要。
MR T2加权图像直接显示滑膜囊肿内的高信号。它们最初导致侧隐窝/尾侧神经根和/或椎间孔受压，较大的囊肿突出会导致显著的外侧硬脊膜囊受压，以及远外侧/头侧上神经根受压。CT 2毫米层厚扫描通常能更好地显示有无滑膜囊肿钙化情况下头侧神经根的椎间隙水平受压情况，以及椎间隙狭窄、肥厚/OYL和退行性椎体滑脱的程度。当CT检查直接显示滑膜囊肿钙化时，这会提醒外科医生在完全切除滑膜囊肿时发生脑脊液漏的潜在风险增加，应促使采取替代措施，如减压/部分切除。最关键的是，滑膜囊肿手术通常需要进行两级椎板切除术，以便更全面地观察头侧和尾侧神经根，更清晰地将神经组织与大的纤维化滑膜囊肿包膜区分开来，从而实现更安全的切除。
术前通过MR和CT检查确定腰椎滑膜囊肿的完整头侧和尾侧范围至关重要。对这些病变的椎间孔/远外侧和头侧范围进行预期和更好的观察，通常需要进行更广泛的多级椎板切除术以实现硬脊膜囊以及头侧和尾侧神经根减压。
