Ishihara Yohei, Morishita Masutaro, Kanzaki Koji
Asao General Hospital Spine Center, 6-25-1, Kamiasao, Asao-ku, Kawasaki, Kanagawa 215-0021, Japan.
Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-8501, Japan.
Adv Orthop. 2023 Mar 13;2023:5591496. doi: 10.1155/2023/5591496. eCollection 2023.
Percutaneous rupture of lumbar facet cysts (LFC) is the only nonsurgical treatment which is effective in directly reducing cysts. However, this is not yet a common procedure, and its effectiveness, including the associated complications, remains unclear. Therefore, this study aimed to evaluate the clinical outcomes of percutaneous rupture for LFC and elucidate whether this minimally invasive procedure could become an alternative to surgeries for cases resistant to conservative treatments.
This study investigated 57 symptomatic patients with LFC for whom conservative treatments were ineffective and underwent percutaneous rupture of the LFC. All patients were followed up for >2 years posttreatment. Clinical evaluations (visual analogue scale (VAS) and recovery rate calculated using the Japanese Orthopedic Association (JOA) scores) and radiographic evaluations (size of LFC based on magnetic resonance imaging (MRI)) were performed from pretreatment to the final follow-up examination.
Successful LFC rupture, without hospitalization and general anesthesia, was achieved in 48 patients. No severe complications occurred during treatment through the last observation. Satisfactory clinical results with significant improvements in the VAS and JOA scores were obtained (VAS: pre/posttreatment: 80.7 mm/11.2 mm, JOA: pre/posttreatment: 15.6 points/26.7 points, and recovery rate: 82.3%). A significant reduction in the LFC was also observed in all cases based on the posttreatment MRI findings. No successful rupture cases required subsequent surgical treatments, although four cases of LFC recurrence required additional percutaneous rupture treatment.
Percutaneous rupture for LFC is not only a safe and minimally invasive procedure without any severe complications or requirements for hospitalization and general anesthesia but also a beneficial procedure that can eliminate the need for surgery in cases resistant to conservative treatments.
经皮腰椎小关节囊肿破裂术是唯一能直接有效减小囊肿的非手术治疗方法。然而，这一手术并不常见，其有效性，包括相关并发症，仍不明确。因此，本研究旨在评估经皮腰椎小关节囊肿破裂术的临床疗效，并阐明这种微创手术是否可成为保守治疗无效病例的手术替代方案。
本研究纳入57例有症状的腰椎小关节囊肿患者，这些患者保守治疗无效，接受了经皮腰椎小关节囊肿破裂术。所有患者在治疗后随访超过2年。从治疗前到最终随访检查，进行了临床评估（视觉模拟评分（VAS）和使用日本骨科协会（JOA）评分计算的恢复率）和影像学评估（基于磁共振成像（MRI）的腰椎小关节囊肿大小）。
48例患者成功实现了腰椎小关节囊肿破裂，无需住院和全身麻醉。在最后一次观察前的治疗过程中未发生严重并发症。获得了满意的临床结果，VAS和JOA评分有显著改善（VAS：治疗前/后：80.7mm/11.2mm，JOA：治疗前/后：15.6分/26.7分，恢复率：82.3%）。根据治疗后的MRI结果，所有病例的腰椎小关节囊肿也有显著缩小。虽然有4例腰椎小关节囊肿复发需要额外的经皮破裂治疗，但没有成功破裂的病例需要后续手术治疗。
经皮腰椎小关节囊肿破裂术不仅是一种安全、微创的手术，无任何严重并发症，无需住院和全身麻醉，而且是一种有益的手术，可避免保守治疗无效病例的手术需求。
