Ji Lai-Zhou, Guo Ming-Zuo, Li Si-Peng, Zhang Hao-Xuan
Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University, NO16766 Jingshi Road, Jinan, Shandong Province 250014, China; Department of Orthopedic Surgery, Shangdong Provincial Qianfoshan Hospital, Shandong University, NO16766 Jingshi Road, Jinan, Shandong Province 250014, China.
Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University, NO16766 Jingshi Road, Jinan, Shandong Province 250014, China; Department of Orthopedic Surgery, Shangdong Provincial Qianfoshan Hospital, Shandong University, NO16766 Jingshi Road, Jinan, Shandong Province 250014, China.
Int J Surg Case Rep. 2025 Sep;134:111690. doi: 10.1016/j.ijscr.2025.111690. Epub 2025 Jul 18.
This paper presents a case of lumbar intraspinal synovial cysts (LISCs) associated with secondary osteoporosis, contributing to current understanding of LISC pathogenesis and offering a safe, effective surgical strategy tailored to complex clinical conditions.
A 61-year-old woman with a history of rheumatoid arthritis and osteoporosis (lumbar spine T-score: -2.6) underwent posterior lumbar interbody fusion (PLIF) at the L4/5 segment for lumbar disc herniation and spondylolisthesis, as confirmed by MRI. Ten months postoperatively, she developed a synovial cyst at the L3/4 segment, accompanied by a fracture of the L5 pedicle screw. Therefore, she underwent a revision surgery involving cyst excision, bone cement-reinforced screw fixation, and Waveflex semi-rigid rod implantation. The postoperative recovery was smooth, and no neurological abnormalities were found during the 9-month follow-up.
The surgical strategy effectively addressed three major challenges: excision of the cyst in the context of compromised spinal stability, revision fixation in osteoporotic bone using cement augmentation, and mitigation of adjacent segment degeneration (ASD) through motion-preserving Waveflex semi-rigid stabilization.
The combination of cyst resection, Waveflex semi-rigid fixation, and cement-reinforced screw placement demonstrated favorable safety and efficacy in revision lumbar fusion for patients with secondary osteoporosis.
本文介绍了一例与继发性骨质疏松相关的腰椎椎管内滑膜囊肿（LISCs）病例，有助于增进对LISC发病机制的当前认识，并提供一种针对复杂临床情况的安全、有效的手术策略。
一名61岁女性，有类风湿性关节炎和骨质疏松病史（腰椎T值：-2.6），因腰椎间盘突出症和椎体滑脱在L4/5节段接受了后路腰椎椎间融合术（PLIF），MRI证实了这一情况。术后十个月，她在L3/4节段出现了一个滑膜囊肿，并伴有L5椎弓根螺钉骨折。因此，她接受了一次翻修手术，包括囊肿切除、骨水泥强化螺钉固定和Waveflex半刚性棒植入。术后恢复顺利，在9个月的随访期间未发现神经功能异常。
该手术策略有效应对了三大挑战：在脊柱稳定性受损的情况下切除囊肿、使用骨水泥增强在骨质疏松骨中进行翻修固定以及通过保留运动的Waveflex半刚性稳定来减轻相邻节段退变（ASD）。
对于继发性骨质疏松患者，囊肿切除、Waveflex半刚性固定和骨水泥强化螺钉置入相结合在翻修腰椎融合术中显示出良好的安全性和有效性。
