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Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts.
J Neurosurg Spine. 2017 Sep; 27(3):256-267.JN

Abstract

OBJECTIVE

Synovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery.

METHODS

A total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors' department were analyzed. Medical reports with regard to signs and symptoms, operative findings, complications, and short-term outcome were reviewed. Assessment of long-term outcome was performed with a standardized telephone questionnaire based on the Oswestry Disability Index (ODI). Furthermore, patients were questioned about persisting pain, symptoms, and further operative procedures, if any. Subjective satisfaction was classified as excellent, good, fair, or poor based on the Macnab classification.

RESULTS

The approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation.

CONCLUSIONS

Surgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion.

Authors+Show Affiliations

Department of Neurosurgery, Goethe University, Frankfurt, Germany.Department of Neurosurgery, Goethe University, Frankfurt, Germany.Department of Neurosurgery, Goethe University, Frankfurt, Germany.Department of Neurosurgery, Goethe University, Frankfurt, Germany.Department of Neurosurgery, Goethe University, Frankfurt, Germany.Department of Neurosurgery, Goethe University, Frankfurt, Germany.Department of Neurosurgery, Goethe University, Frankfurt, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28686146

Citation

Bruder, Markus, et al. "Synovial Cysts of the Spine: Long-term Follow-up After Surgical Treatment of 141 Cases in a Single-center Series and Comprehensive Literature Review of 2900 Degenerative Spinal Cysts." Journal of Neurosurgery. Spine, vol. 27, no. 3, 2017, pp. 256-267.
Bruder M, Cattani A, Gessler F, et al. Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts. J Neurosurg Spine. 2017;27(3):256-267.
Bruder, M., Cattani, A., Gessler, F., Droste, C., Setzer, M., Seifert, V., & Marquardt, G. (2017). Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts. Journal of Neurosurgery. Spine, 27(3), 256-267. https://doi.org/10.3171/2016.12.SPINE16756
Bruder M, et al. Synovial Cysts of the Spine: Long-term Follow-up After Surgical Treatment of 141 Cases in a Single-center Series and Comprehensive Literature Review of 2900 Degenerative Spinal Cysts. J Neurosurg Spine. 2017;27(3):256-267. PubMed PMID: 28686146.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts. AU - Bruder,Markus, AU - Cattani,Adriano, AU - Gessler,Florian, AU - Droste,Christian, AU - Setzer,Matthias, AU - Seifert,Volker, AU - Marquardt,Gerhard, Y1 - 2017/07/07/ PY - 2017/7/8/pubmed PY - 2017/9/14/medline PY - 2017/7/8/entrez KW - ODI = Oswestry Disability Index KW - ganglion cyst KW - juxtafacet cyst KW - lumbar KW - pseudocyst KW - radiculopathy KW - spine KW - synovial cyst SP - 256 EP - 267 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 27 IS - 3 N2 - OBJECTIVE Synovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery. METHODS A total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors' department were analyzed. Medical reports with regard to signs and symptoms, operative findings, complications, and short-term outcome were reviewed. Assessment of long-term outcome was performed with a standardized telephone questionnaire based on the Oswestry Disability Index (ODI). Furthermore, patients were questioned about persisting pain, symptoms, and further operative procedures, if any. Subjective satisfaction was classified as excellent, good, fair, or poor based on the Macnab classification. RESULTS The approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation. CONCLUSIONS Surgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/28686146/Synovial_cysts_of_the_spine:_long_term_follow_up_after_surgical_treatment_of_141_cases_in_a_single_center_series_and_comprehensive_literature_review_of_2900_degenerative_spinal_cysts_ L2 - https://thejns.org/doi/10.3171/2016.12.SPINE16756 DB - PRIME DP - Unbound Medicine ER -