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Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome.
Acta Neurochir (Wien). 2006 Jan; 148(1):47-54; discussion 54.AN

Abstract

BACKGROUND

Synovial cysts represent an uncommon and probably underestimated pathological entity of the degenerative lumbar spine. The authors report a retrospective analysis of the clinical presentation, radiological studies and operative findings in 77 patients surgically treated for symptomatic lumbar synovial cysts at their institution.

MATERIALS AND METHOD

Between January 1992 and June 1998, a total of 77 patients presenting with symptomatic lumbar synovial cysts were operated on in the author's department. Operative procedure, complications, results and pathological findings were correlated with preoperative assessment. There were 41 men and 36 women with an average age of 63 years (range 44-90 years).

RESULTS

On the basis of their symptom complex on presentation, two populations were identified: patients who presented with a single radicular pain (group I = 51 patients), and patients who presented with bilateral neurogenic claudication (group II = 26 patients). Neurological examination on presentation demonstrated motor deficit (12%), sensory loss (26%) and reflex changes (35%). Degenerative disc disease and facet joint osteoarthritis was a frequent finding in patients with pre-operative MRI. Facet joint orientation was >45 degrees in 76.6% of patients. Preoperative spondylolisthesis was found in 48% on radiological studies. All the patients were treated surgically with resection of the cyst. No fusion was performed as a first line procedure. However subsequent fusion was necessary in one patient who developed symptomatic spondylolisthesis. Mean follow-up period was of 45 months ranging from 18 to 105 months. Only one recurrence occurred during the follow-up period. An excellent or good functional outcome was seen in 97.4% of cases, and 89% of the patients with motor deficit recovered.

CONCLUSIONS

Surgical resection of lumbar synovial cysts is an effective treatment associated with very low morbidity. Synovial cysts are associated with increased grade and frequency of facet joint asteoarthritis but not with increased grade or frequency of degenerative disc disease compared with patients without cysts. In the author's opinion, at the present time, there is no reliable criterion which allows the development of a symptomatic spinal instability to be predicted in patients with a preoperative spondylolisthesis and therefore fusion as a first line procedure is still debatable.

Authors+Show Affiliations

Neurosurgery Department, Timone Hospital, Marseille, France. philippe.metellus@mail.ap-hm.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16258839

Citation

Métellus, P, et al. "Retrospective Study of 77 Patients Harbouring Lumbar Synovial Cysts: Functional and Neurological Outcome." Acta Neurochirurgica, vol. 148, no. 1, 2006, pp. 47-54; discussion 54.
Métellus P, Fuentes S, Adetchessi T, et al. Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome. Acta Neurochir (Wien). 2006;148(1):47-54; discussion 54.
Métellus, P., Fuentes, S., Adetchessi, T., Levrier, O., Flores-Parra, I., Talianu, D., Dufour, H., Bouvier, C., Manera, L., & Grisoli, F. (2006). Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome. Acta Neurochirurgica, 148(1), 47-54; discussion 54.
Métellus P, et al. Retrospective Study of 77 Patients Harbouring Lumbar Synovial Cysts: Functional and Neurological Outcome. Acta Neurochir (Wien). 2006;148(1):47-54; discussion 54. PubMed PMID: 16258839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome. AU - Métellus,P, AU - Fuentes,S, AU - Adetchessi,T, AU - Levrier,O, AU - Flores-Parra,I, AU - Talianu,D, AU - Dufour,H, AU - Bouvier,C, AU - Manera,L, AU - Grisoli,F, Y1 - 2005/10/31/ PY - 2004/10/26/received PY - 2005/09/05/accepted PY - 2005/11/1/pubmed PY - 2006/8/2/medline PY - 2005/11/1/entrez SP - 47-54; discussion 54 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 148 IS - 1 N2 - BACKGROUND: Synovial cysts represent an uncommon and probably underestimated pathological entity of the degenerative lumbar spine. The authors report a retrospective analysis of the clinical presentation, radiological studies and operative findings in 77 patients surgically treated for symptomatic lumbar synovial cysts at their institution. MATERIALS AND METHOD: Between January 1992 and June 1998, a total of 77 patients presenting with symptomatic lumbar synovial cysts were operated on in the author's department. Operative procedure, complications, results and pathological findings were correlated with preoperative assessment. There were 41 men and 36 women with an average age of 63 years (range 44-90 years). RESULTS: On the basis of their symptom complex on presentation, two populations were identified: patients who presented with a single radicular pain (group I = 51 patients), and patients who presented with bilateral neurogenic claudication (group II = 26 patients). Neurological examination on presentation demonstrated motor deficit (12%), sensory loss (26%) and reflex changes (35%). Degenerative disc disease and facet joint osteoarthritis was a frequent finding in patients with pre-operative MRI. Facet joint orientation was >45 degrees in 76.6% of patients. Preoperative spondylolisthesis was found in 48% on radiological studies. All the patients were treated surgically with resection of the cyst. No fusion was performed as a first line procedure. However subsequent fusion was necessary in one patient who developed symptomatic spondylolisthesis. Mean follow-up period was of 45 months ranging from 18 to 105 months. Only one recurrence occurred during the follow-up period. An excellent or good functional outcome was seen in 97.4% of cases, and 89% of the patients with motor deficit recovered. CONCLUSIONS: Surgical resection of lumbar synovial cysts is an effective treatment associated with very low morbidity. Synovial cysts are associated with increased grade and frequency of facet joint asteoarthritis but not with increased grade or frequency of degenerative disc disease compared with patients without cysts. In the author's opinion, at the present time, there is no reliable criterion which allows the development of a symptomatic spinal instability to be predicted in patients with a preoperative spondylolisthesis and therefore fusion as a first line procedure is still debatable. SN - 0001-6268 UR - https://www.unboundmedicine.com/medline/citation/16258839/Retrospective_study_of_77_patients_harbouring_lumbar_synovial_cysts:_functional_and_neurological_outcome_ L2 - https://dx.doi.org/10.1007/s00701-005-0650-z DB - PRIME DP - Unbound Medicine ER -