Garg Kanwaljeet, Kasliwal Manish K
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
University Hospitals Cleveland Medical Centre, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Clin Neurol Neurosurg. 2021 Jul;206:106667. doi: 10.1016/j.clineuro.2021.106667. Epub 2021 May 4.
Lumbar synovial cysts (LSC) are one of the manifestations of spinal degenerative cascade. Spinal stenosis or presence of instability in these patients can lead to various symptoms and surgery is indicated following failure of non-operative management for symptomatic synovial cysts. Surgery when performed consists of either decompression with resection of cyst with our without fusion. The efficacy and complications of minimally invasive techniques using tubular retractors (microscopic or endoscopic) in comparison to traditional open techniques remain to be studied.
A comprehensive search of different databases was performed to retrieve studies describing the use of minimal invasive techniques using tubular retractors (both microscopic and endoscopic) in patients with LSC. Meta-analysis with subgroup analysis and metaregression was done.
Twenty articles were selected for the systematic review and meta-analysis with total of 388 patients. Eighty-six percent of patients (95% Confidence Interval (CI): 80-90%) had favorable outcome as per Macnab's criteria (excellent and good outcome) with the pooled standard mean difference between preoperative and postoperative Oswestry Disability Index (ODI) being -4.44 (95% CI -8.78 to -0.10, p-value=0.0474, I 82%). The pooled percentage change in visual analogue scale (VAS) after surgery was 76.5% (95% CI 66.9-84%, I 82%). The pooled proportion of incidental durotomies, cyst recurrence and patients requiring operation being 8% (95% CI 5-11%, I 0%), 4% (95% CI 2-7%, I 0%,) and 5% (95% CI 3-9%) respectively. Studies were homogeneous with an I value of 0%. Subgroup analysis revealed no significant difference in the outcome rates or complication rates between the microscopic and endoscopic subgroups.
Minimally invasive techniques for the resection of LSC is a safe and effective alternative to traditional surgical approaches with no difference between the microscopic and endoscopic approaches.
腰椎滑膜囊肿（LSC）是脊柱退变级联反应的表现之一。这些患者的椎管狭窄或存在不稳定可导致多种症状，对于有症状的滑膜囊肿，非手术治疗失败后需行手术治疗。手术方式包括单纯减压、囊肿切除或联合融合术。与传统开放手术相比，使用管状牵开器（显微镜或内镜）的微创技术的疗效和并发症仍有待研究。
全面检索不同数据库，以获取描述在LSC患者中使用管状牵开器（显微镜和内镜）的微创技术的研究。进行亚组分析和元回归的荟萃分析。
20篇文章被选入系统评价和荟萃分析，共388例患者。根据Macnab标准（优和良的结果），86%的患者（95%置信区间（CI）：80 - 90%）预后良好，术前和术后Oswestry功能障碍指数（ODI）的合并标准平均差为 -4.44（95% CI -8.78至 -0.10，p值 = 0.0474，I² = 82%）。术后视觉模拟量表（VAS）的合并百分比变化为76.5%（95% CI 66.9 - 84%，I² = 82%）。意外硬脊膜切开、囊肿复发和需要再次手术的患者的合并比例分别为8%（95% CI 5 - 11%，I² = 0%）、4%（95% CI 2 - 7%，I² = 0%）和5%（95% CI 3 - 9%）。研究具有同质性，I²值为0%。亚组分析显示，显微镜组和内镜组的预后率或并发症率无显著差异。
LSC切除的微创技术是传统手术方法的一种安全有效的替代方法，显微镜和内镜方法之间无差异。
