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Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts.
Clin Spine Surg. 2017 Dec; 30(10):E1399-E1404.CS

Abstract

STUDY DESIGN

This is a retrospective study.

OBJECTIVE

To compare (1) recurrence of radiculopathy and (2) back pain after decompression with and without fusion for patients with a symptomatic synovial cyst.

BACKGROUND

Previous work described favorable outcomes following cyst excision with and without fusion. Because of the association of facet cysts with spinal instability it is hypothesized that a decompression with fusion will lead to better outcomes. However, previous studies present contradicting results.

METHODS

We included 314 consecutive patients that underwent operative treatment for a facet cyst between 2003 and 2013 at 2 tertiary spine referral centers: 224 (71%) underwent decompression without fusion (35% spondylolisthesis), 90 (29%) underwent decompression with fusion (63% spondylolisthesis). Baseline data were compared between the groups. Bivariate log-rank analysis was used to compare outcomes between groups, followed by multivariable Cox regression analysis accounting for differences in baseline characteristics.

RESULTS

Patients undergoing decompression with fusion presented with a higher incidence of back pain (P=0.004) and spondylolisthesis (P<0.001), had more often bilateral decompressions (P<0.001), more facetectomies (P<0.001), and more levels of decompression (P=0.004) than those who underwent decompression alone. We found a difference in recurrence of radiculopathy (no fusion: 25% vs. fusion: 9.4%, P=0.029) in bivariate analysis. However, this difference did not hold when accounting for confounders (hazard ratio, 0.50, 95% confidence interval, 0.19-1.31, P=0.16). There was no difference in recurrence of back pain in bivariate (no fusion: 29% vs. fusion: 22%, P=0.51) and multivariable analysis (hazard ratio 0.51, 95% confidence interval, 0.23-1.14, P=0.10).

CONCLUSIONS

We found, with the numbers evaluated, no difference in recurrence of radiculopathy or back pain between patients undergoing decompression with or without fusion after accounting for confounders. The decision for fusion should be considered in light of the extent of decompression and the existence of other pathology.

LEVEL OF EVIDENCE

Level III-therapeutic study.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.Department of Orthopaedic Surgery, Orthopaedic Spine Service, Stanford University Medical Center, Stanford, CA.Department of Neurosurgery, Massachusetts General Hospital-Harvard Medical School.Department of Orthopaedic Surgery, Orthopaedic Spine Service, Brigham and Women's Hospital-Harvard Medical School, Boston, MA.Department of Orthopaedic Surgery, Orthopaedic Spine Service, Brigham and Women's Hospital-Harvard Medical School, Boston, MA.Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27753698

Citation

van Dijke, Maarten, et al. "Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts." Clinical Spine Surgery, vol. 30, no. 10, 2017, pp. E1399-E1404.
van Dijke M, Janssen SJ, Cha TD, et al. Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts. Clin Spine Surg. 2017;30(10):E1399-E1404.
van Dijke, M., Janssen, S. J., Cha, T. D., Wood, K. B., Borges, L. F., Harris, M. B., Bono, C. M., & Schwab, J. H. (2017). Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts. Clinical Spine Surgery, 30(10), E1399-E1404. https://doi.org/10.1097/BSD.0000000000000449
van Dijke M, et al. Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts. Clin Spine Surg. 2017;30(10):E1399-E1404. PubMed PMID: 27753698.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts. AU - van Dijke,Maarten, AU - Janssen,Stein J, AU - Cha,Thomas D, AU - Wood,Kirkham B, AU - Borges,Lawrence F, AU - Harris,Mitchel B, AU - Bono,Christopher M, AU - Schwab,Joseph H, PY - 2016/10/19/pubmed PY - 2018/7/7/medline PY - 2016/10/19/entrez SP - E1399 EP - E1404 JF - Clinical spine surgery JO - Clin Spine Surg VL - 30 IS - 10 N2 - STUDY DESIGN: This is a retrospective study. OBJECTIVE: To compare (1) recurrence of radiculopathy and (2) back pain after decompression with and without fusion for patients with a symptomatic synovial cyst. BACKGROUND: Previous work described favorable outcomes following cyst excision with and without fusion. Because of the association of facet cysts with spinal instability it is hypothesized that a decompression with fusion will lead to better outcomes. However, previous studies present contradicting results. METHODS: We included 314 consecutive patients that underwent operative treatment for a facet cyst between 2003 and 2013 at 2 tertiary spine referral centers: 224 (71%) underwent decompression without fusion (35% spondylolisthesis), 90 (29%) underwent decompression with fusion (63% spondylolisthesis). Baseline data were compared between the groups. Bivariate log-rank analysis was used to compare outcomes between groups, followed by multivariable Cox regression analysis accounting for differences in baseline characteristics. RESULTS: Patients undergoing decompression with fusion presented with a higher incidence of back pain (P=0.004) and spondylolisthesis (P<0.001), had more often bilateral decompressions (P<0.001), more facetectomies (P<0.001), and more levels of decompression (P=0.004) than those who underwent decompression alone. We found a difference in recurrence of radiculopathy (no fusion: 25% vs. fusion: 9.4%, P=0.029) in bivariate analysis. However, this difference did not hold when accounting for confounders (hazard ratio, 0.50, 95% confidence interval, 0.19-1.31, P=0.16). There was no difference in recurrence of back pain in bivariate (no fusion: 29% vs. fusion: 22%, P=0.51) and multivariable analysis (hazard ratio 0.51, 95% confidence interval, 0.23-1.14, P=0.10). CONCLUSIONS: We found, with the numbers evaluated, no difference in recurrence of radiculopathy or back pain between patients undergoing decompression with or without fusion after accounting for confounders. The decision for fusion should be considered in light of the extent of decompression and the existence of other pathology. LEVEL OF EVIDENCE: Level III-therapeutic study. SN - 2380-0194 UR - https://www.unboundmedicine.com/medline/citation/27753698/Comparison_of_Decompression_With_and_Without_Fusion_for_Patients_With_Synovial_Facet_Cysts_ L2 - https://doi.org/10.1097/BSD.0000000000000449 DB - PRIME DP - Unbound Medicine ER -