Epstein Nancy E, Agulnick Marc A
Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook and Editor-in-Chief Surgical Neurology International NY, USA, and c/o Dr. Marc Agulnick, 1122 Franklin Avenue Suite 106, Garden City, NY, USA.
Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA, 1122 Frankling Avenue Suite 106, Garden City, NY, USA.
Surg Neurol Int. 2024 Mar 1;15:65. doi: 10.25259/SNI_95_2024. eCollection 2024.
Lumbar synovial cysts (LSC), best diagnosed on MR studies, may cause symptoms/signs ranging from unilateral radiculopathy to cauda equina compressive syndromes. Attempts at percutaneous treatment of LSC typically fail. Rather, greater safety/efficacy is associated with direct surgical resection with/without fusion.
Treatment of LSC with percutaneous techniques, including cyst aspiration/perforation, injection (i.e., with/without steroids, saline/other), dilatation, and/or disruption/bursting, classically fail. This is because LSCs' tough, thickened, and adherent fibrous capsules cause extensive thecal sac/nerve root compression, and contain minimal central "fluid" (i.e., "crank-case" and non-aspirable). Multiple percutaneous attempts at decompression, therefore, typically cause several needle puncture sites risking dural tears (DT)/cerebrospinal fluid (CSF) leaks, direct root injuries, failure to decompress the thecal sac/nerve roots, infections, hematomas, and over the longer-term, adhesive arachnoiditis.
Alternatively, many studies document the success of direct or even partial resection of LSC (i.e., partial removal with marked cyst/dural adhesions with shrinking down the remnant of capsular tissue). Surgical decompressions of LSC, ranging from focal laminotomies to laminectomies, may or may not warrant additional fusions.
Symptomatic LSC are best managed with direct or even partial operative resection/decompression with/without fusion. The use of varying percutaneous techniques classically fails, and increases multiple perioperative risks.
腰椎滑膜囊肿（LSC）在磁共振成像（MR）检查中最易确诊，其可引发从单侧神经根病到马尾神经压迫综合征等一系列症状和体征。经皮治疗LSC的尝试通常会失败。相比之下，直接手术切除（无论是否融合）具有更高的安全性和有效性。
采用经皮技术治疗LSC，包括囊肿抽吸/穿刺、注射（即使用/不使用类固醇、盐水/其他药物）、扩张和/或破坏/破裂，传统上都会失败。这是因为LSC坚韧、增厚且粘连的纤维囊会导致广泛的硬膜囊/神经根受压，且囊内中央“液体”极少（即“曲轴箱积液”且无法抽吸）。因此，多次经皮减压尝试通常会造成多个穿刺部位，有导致硬脑膜撕裂（DT）/脑脊液（CSF）漏、直接神经根损伤、硬膜囊/神经根减压失败、感染、血肿的风险，从长期来看，还会引发粘连性蛛网膜炎。
另外，许多研究记录了直接或甚至部分切除LSC（即部分切除伴有明显囊肿/硬膜粘连并使囊膜组织残余缩小）的成功案例。LSC的手术减压，从局部椎板切开术到椎板切除术，可能需要也可能不需要额外融合。
有症状的LSC最好通过直接或甚至部分手术切除/减压（无论是否融合）来处理。使用各种经皮技术传统上会失败，并增加多种围手术期风险。
