Sarac Mustafa Emre, Boga Zeki
Department of Neurosurgery, Adana City Training and Research Hospital, 01370 Adana, Turkey.
Diagnostics (Basel). 2025 Jul 13;15(14):1767. doi: 10.3390/diagnostics15141767.
The aim of this study was to compare the clinical outcomes of cyst excision alone and the combination of excision and unilateral dynamic instrumentation in the surgical treatment of lumbar synovial cysts at the L4-L5 level and to determine which surgical approach is more effective. Thirty-three patients who underwent operations on the L4-L5-level synovial cyst in a single center between January 2015 and January 2021 were included in this retrospective study. Patients were divided into two groups: cyst excision only ( = 18) and excision with unilateral dynamic instrumentation ( = 15). The pain levels of the patients were assessed by VAS score, and their functional status was assessed by the Oswestry Disability Index. The mean follow-up period was 28.2 ± 4.0 months in the excision group and 27.6 ± 4.4 months in the instrumentation group. VAS and ODI scores improved significantly in both groups ( < 0.001). The improvement in low back pain VAS scores was more significant in the instrumentation group (delta VAS: -5.8 ± 1.3 vs. -5.0 ± 1.2, = 0.042). The complication rate was 27.8% in the excision group and 13.3% in the instrumentation group. The development of listhesis was significantly more frequent in the excision group (16.7% vs. 0%, = 0.028). Reoperation rates were 16.7% in the excision group and 6.7% in the instrumentation group. Although both surgical approaches are effective in the treatment of synovial cysts at the L4-L5 level, the addition of dynamic instrumentation unilaterally seems to be more advantageous, especially in the control of low back pain and prevention of listhesis risk. The choice of surgical technique should be individualized by considering patient-specific factors.
本研究的目的是比较单纯囊肿切除术与切除联合单侧动态内固定术在L4-L5节段腰椎滑膜囊肿手术治疗中的临床疗效，并确定哪种手术方法更有效。本回顾性研究纳入了2015年1月至2021年1月在单一中心接受L4-L5节段滑膜囊肿手术的33例患者。患者分为两组：单纯囊肿切除术（n = 18）和切除联合单侧动态内固定术（n = 15）。通过视觉模拟评分（VAS）评估患者的疼痛程度，通过Oswestry功能障碍指数评估其功能状态。切除组的平均随访时间为28.2±4.0个月，内固定组为27.6±4.4个月。两组的VAS和ODI评分均显著改善（P < 0.001）。内固定组下腰痛VAS评分的改善更显著（VAS差值：-5.8±1.3 vs. -5.0±1.2，P = 0.042）。切除组的并发症发生率为27.8%，内固定组为13.3%。切除组椎体滑脱的发生率显著更高（16.7% vs. 0%，P = 0.028）。切除组的再次手术率为16.7%，内固定组为6.7%。尽管两种手术方法在治疗L4-L5节段滑膜囊肿方面均有效，但单侧增加动态内固定似乎更具优势，尤其是在控制下腰痛和预防椎体滑脱风险方面。手术技术的选择应根据患者的具体因素进行个体化考虑。
