Filali Zayed, Briki Amine, Ferjani Souad, Aloui Yassine, Moulahi Oubaidallah, Haddad Naoufel
Department of Orthopedic Surgery and Traumatology, Hospital Habib Bourguiba, BP 4100 Medenine, Tunisia; University of Sfax Medical School, Tunisia.
Department of Orthopedic Surgery and Traumatology, Hospital Habib Bourguiba, BP 4100 Medenine, Tunisia; University of Sfax Medical School, Tunisia.
Int J Surg Case Rep. 2024 Oct;123:110150. doi: 10.1016/j.ijscr.2024.110150. Epub 2024 Aug 10.
Synovial cysts occur more frequently in the lumbar spine, especially at L4-5 level. Traditional open surgical management with posterolateral arthrodesis is the currently recommended treatment.
This is a 64-year-old woman with no prior pathological history. Initial clinical and radiological assessment concluded that there was advanced right coxarthrosis with a degenerative lumbar spine. The patient therefore had a total hip arthroplasty secondarily presented an intermittent neurogenic claudication without sphincter disorders. The MRI concluded at a compressive synovial facet cyst at the L4-L5 level. The patient underwent surgical treatment. At two years postoperatively, the walking distance was significantly improved while maintaining moderate lower back pain.
The diagnosis of synovial facet cysts of spine is a challenge that depends heavily on history, physical examination, and MRI. MRI will demonstrate not only the nature of the cystic lesion, but also its relationship to the root, the cord or the thecal sac. The L4-L5 level of the lumbar spine is the most common location of the synovial cyst of the facet joints. As in our case, surgical treatment combining posterolateral arthrodesis is currently recommended for these types of lesions. Surgical treatment, as in our case, is sometimes delayed when this pathology is associated with advanced osteoarthritis of the hips.
Improved imaging capabilities such as magnetic resonance imaging (MRI) have resulted in increased reporting, diagnostic yield and treatment of spinal synovial cysts. Surgical treatment combining posterolateral arthrodesis is the treatment for this lesion.
滑膜囊肿在腰椎更常见，尤其是在L4 - 5节段。目前推荐采用后外侧关节融合术的传统开放手术治疗方法。
这是一位64岁无既往病史的女性。初始临床和影像学评估显示存在晚期右髋关节骨关节炎伴腰椎退变。患者因此接受了全髋关节置换术，继发出现间歇性神经源性跛行且无括约肌功能障碍。MRI检查发现L4 - L5节段有一个压迫性滑膜小关节囊肿。患者接受了手术治疗。术后两年，行走距离显著改善，同时仍伴有中度下背痛。
脊柱滑膜小关节囊肿的诊断是一项挑战，很大程度上依赖于病史、体格检查和MRI。MRI不仅能显示囊性病变的性质，还能显示其与神经根、脊髓或硬膜囊的关系。腰椎的L4 - L5节段是小关节滑膜囊肿最常见的部位。如我们的病例所示，目前对于这类病变推荐采用后外侧关节融合术的手术治疗方法。当这种病变与髋关节晚期骨关节炎相关时，手术治疗有时会延迟，就像我们的病例一样。
诸如磁共振成像（MRI）等成像能力的提高，导致脊柱滑膜囊肿的报告、诊断率和治疗增加。结合后外侧关节融合术的手术治疗是针对该病变的治疗方法。
