Hsu K Y, Zucherman J F, Shea W J, Jeffrey R A
St. Mary's Spine Center, San Francisco, California.
Spine (Phila Pa 1976). 1995 Jan 1;20(1):80-9. doi: 10.1097/00007632-199501000-00015.
This study analyzed the clinical history, physical examination, diagnostic studies, and operative and histologic findings in 19 patients with lumbar intraspinal synovial and ganglion facet cysts evaluated and treated over a 10-year period.
The results were correlated to provide a greater understanding of lumbar facet cysts and rationale for conservative or surgical treatments.
The 19 patients included 13 women and 6 men ranging in age from 38 to 79 years. 84.4% of the patients presented with radicular pain. 26.3% had significant motor deficit. 68.4% of the facet cysts were found at L4-L5, 21.1% at L5-S1, 5.2% at L1-L2, and 5.2% at L2-L3.
The clinical history and findings on physical examination, standard radiography, myelography, computed tomography-myelography, facet arthrography, post-facet arthrograph computed tomography, magnetic resonance imaging with and without contrast, and computed tomography scans were reviewed.
Bilobed cysts were found on both dorsal and ventral aspects of the involved facet joints within and outside of the spinal canal on facet arthrography, computed tomography, magnetic resonance imaging, and at the time of surgery in more than 60% of the patients. Significant facet degeneration was found in 75% of standard radiographs, and on all of the magnetic resonance imaging and computed tomography scans. In six patients, symptoms improved with rest, medication, and bracing. Epidural corticosteroid injections provided short-term relief in three out of four patients. Facet corticosteroid injections provided good relief in one, partial relief in one, and no relief in one patient. Surgical decompression in eight patients resulted in three excellent, four good, and one fair outcome.
Most of the lumbar intraspinal facet cysts were associated with significantly degenerated facet joints. Patients with intraspinal facet cysts may respond to conservative treatments if there is no significant neurologic deficit. Surgical decompression and removal of large facet cysts usually are successful in relieving symptoms.
本研究分析了19例腰椎椎管内滑膜囊肿和关节突神经节囊肿患者的临床病史、体格检查、诊断性检查以及手术和组织学检查结果，这些患者在10年期间接受了评估和治疗。
将结果进行关联分析，以更深入地了解腰椎关节突囊肿以及保守或手术治疗的理论依据。
19例患者中，女性13例，男性6例，年龄在38岁至79岁之间。84.4%的患者表现为神经根性疼痛。26.3%的患者有明显的运动功能障碍。68.4%的关节突囊肿位于L4 - L5，21.1%位于L5 - S1，5.2%位于L1 - L2，5.2%位于L2 - L3。
回顾了临床病史以及体格检查、标准X线摄影、脊髓造影、计算机断层扫描脊髓造影、关节突关节造影、关节突关节造影后计算机断层扫描、有无造影剂增强的磁共振成像以及计算机断层扫描的检查结果。
在超过60%的患者中，通过关节突关节造影、计算机断层扫描、磁共振成像以及手术时发现，受累关节突关节的椎管内外背侧和腹侧均存在双叶囊肿。75%的标准X线片以及所有磁共振成像和计算机断层扫描均发现明显的关节突退变。6例患者通过休息、药物治疗和支具固定症状得到改善。4例患者中有3例经硬膜外皮质类固醇注射获得短期缓解。关节突皮质类固醇注射1例效果良好，1例部分缓解，1例无效。8例患者接受手术减压，结果为3例优，4例良，1例一般。
大多数腰椎椎管内关节突囊肿与明显退变的关节突关节相关。如果没有明显的神经功能缺损，椎管内关节突囊肿患者可能对保守治疗有反应。手术减压并切除大的关节突囊肿通常能成功缓解症状。
