Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
Real World Data Sciences, Medical Device Epidemiology, Johnson & Johnson, New Brunswick, New Jersey, USA.
Neurosurgery. 2023 May 1;92(5):1013-1020. doi: 10.1227/neu.0000000000002314. Epub 2022 Dec 30.
Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown.
To test the hypothesis that select patients who underwent decompression with instrumented fusion for lumbar synovial cysts would be less likely to have subsequent surgery (SS) in a 2-year period than patients treated with laminectomy alone.
This retrospective cohort study was performed using IBM MarketScan Commercial Claims and Encounters Database. Patients who had a lumbar synovial cyst diagnosis and laminectomy surgery with or without fusion surgery were included in this study. Patients were tracked for SS 2 years after surgery. Laminectomy patients were propensity score-matched to laminectomy with fusion (LF) patients using a 2:1 ratio. The log-rank test and Cox regression were used to compare the cumulative incidence of SS between groups.
There were 7664 and 1631 patients treated with laminectomy and LF before matching. After matching, there were 2212 laminectomy and 1631 LF patients and patient characteristics were balanced. The 2-year incidence of recurrent SS was 3.1% ([CI]: 2.2%, 4.0%) and 1.7% (95% CI: 0.9%, 2.5%) laminectomy and LF, respectively. Compared with laminectomy, LF had a statistically significant lower risk of recurrent SS (hazard ratio: 0.56 [95% CI: 0.32-0.97]; P -value: .04).
All patients who had concomitant lumbar fusion showed decreased chance of having a cyst- or noncyst-related recurrence SS when compared with all patients undergoing laminectomy alone, regardless of diagnosis at the time of SS.
脊柱滑膜囊肿是最常见于腰椎区域的病变。除了切除滑膜囊肿的腰椎减压外，是否需要进行器械性脊柱融合术尚不清楚。
检验下述假说，即与单独接受椎板切除术治疗的患者相比，接受减压联合器械性融合术治疗的腰椎滑膜囊肿患者在 2 年内进行后续手术（SS）的可能性更小。
本回顾性队列研究使用 IBM MarketScan 商业索赔和就诊数据库进行。本研究纳入了诊断为腰椎滑膜囊肿且接受椎板切除术联合或不联合融合术治疗的患者。术后 2 年内对患者进行 SS 随访。采用 2:1 的比例对行椎板切除术的患者进行倾向评分匹配，以匹配行椎板切除术联合融合术（LF）的患者。采用对数秩检验和 Cox 回归比较组间 SS 的累积发生率。
匹配前，分别有 7664 例和 1631 例患者接受了椎板切除术和 LF 治疗。匹配后，分别有 2212 例椎板切除术和 1631 例 LF 患者，且患者特征均衡。2 年时的 SS 再发率分别为 3.1%（[CI]：2.2%，4.0%）和 1.7%（95% CI：0.9%，2.5%），椎板切除术和 LF 组之间的差异具有统计学意义（危险比：0.56[95% CI：0.32-0.97]；P 值：<.05）。与椎板切除术相比，LF 降低了 SS 再发的风险（危险比：0.56[95% CI：0.32-0.97]；P 值：<.05）。
与所有单独接受椎板切除术的患者相比，所有接受腰椎融合术的患者在 SS 时发生与囊肿或非囊肿相关的复发性 SS 的几率降低，无论 SS 时的诊断如何。
