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Scrofani R, De Simone M, Migliorini F, Amoroso E, Maffulli N, Narciso N, Iaconetta G. Spontaneous Resolution of Symptomatic Synovial Cysts of the Lumbar Spine: A Comprehensive Review with Two Illustrative Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1115. [PMID: 39064544 PMCID: PMC11278635 DOI: 10.3390/medicina60071115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
Although lumbar synovial cysts (LSCs) are frequently described in the literature, they are a relatively uncommon cause of low back and radicular leg pain. Furthermore, their spontaneous resolution is an even rarer event. The standard treatment of the lumbar synovial cyst is surgical excision. Spontaneous resolution in the literature is a sporadic event. In our experience, we have had two cases where the lumbar synovial cyst disappeared spontaneously. To date, only nine cases of spontaneous resolution of synovial cysts have been documented in the literature. In this discussion, we highlight a pathology that typically suggests surgical intervention, yet conservative treatment can be a viable alternative. We present two cases of large synovial cysts that were initially scheduled for surgery but ultimately resolved spontaneously without any treatment. While the spontaneous resolution of lumbar synovial cysts is extremely rare, conservative strategies are an option that should not be overlooked. Our cases contribute to the growing body of evidence on the spontaneous regression of symptomatic LSC, potentially enhancing the understanding of the disease's natural progression in the future.
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Affiliation(s)
- Raffaele Scrofani
- Department of Clinical Neurosurgery, AOU San Giovanni di Dio e Ruggi D′Aragona, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy; (R.S.); (E.A.); (N.N.)
| | - Matteo De Simone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
- BrainLab s.r.l., Mercato San Severino, 84085 Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany;
| | - Ettore Amoroso
- Department of Clinical Neurosurgery, AOU San Giovanni di Dio e Ruggi D′Aragona, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy; (R.S.); (E.A.); (N.N.)
| | - Nicola Maffulli
- Department of Orthopaedics, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, 00185 Rome, Italy;
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST5 5BG, UK
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
| | - Nicola Narciso
- Department of Clinical Neurosurgery, AOU San Giovanni di Dio e Ruggi D′Aragona, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy; (R.S.); (E.A.); (N.N.)
| | - Giorgio Iaconetta
- Department of Clinical Neurosurgery, AOU San Giovanni di Dio e Ruggi D′Aragona, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy; (R.S.); (E.A.); (N.N.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
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Badra M, Najjar E, Wardani H, Jamaleddine Y, Daccache E, Ezzeddine H, Moucharafieh R. Evaluation and Treatment of Lumbar Spine Extradural Cysts: A Narrative Review. Cureus 2024; 16:e60604. [PMID: 38894794 PMCID: PMC11185196 DOI: 10.7759/cureus.60604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
The main objective was to describe the different types and characteristics of lumbar spine extradural cysts and their optimal treatment options with a focus on endoscopic technique. We searched Pubmed, EMBASE, Medline, and Google Scholar for articles published between 1967 and 2020 using the keywords "Spinal Cyst," "Extradural Cyst," and "Lumbar Cyst." The various anatomical and histological types of the extradural cysts with their presentations, etiologies, imaging, and optimal treatment with a focus on endoscopic techniques were reviewed from the articles. Lumbar spinal cysts are relatively rare pathologies that might cause radicular symptoms similar to lumbar disc herniation. Spinal extradural cysts are classified either histologically based on the cyst lining tissues (synovial cysts or non-synovial, ganglion cysts) or anatomically based on the structure of origin (epidural cysts, ligamentum flavum cysts, discal cysts, post-discectomy pseudocysts, posterior longitudinal ligament cysts, facet cysts). Surgical excision is the recommended treatment of symptomatic cysts with endoscopic techniques being a viable option. Extradural lumbar cysts can be identified based on their histological structure or depending on their structure of origin. Regardless of their classification, they could all give similar clinical findings, and the optimal treatment would be surgical excision with endoscopic technique being a viable option with a satisfactory outcome.
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Affiliation(s)
- Mohammad Badra
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center, Johns Hopkins International, Beirut, LBN
| | - Elie Najjar
- Department of Orthopedics, Center for Spinal Studies and Surgery (CSSS) Queen's Medical Centee, Nottingham University Hospitals, Nottingham, GBR
| | - Hassan Wardani
- Department of Orthopedic Surgery, Faculty of Medicine, Lebanese University, Beirut, LBN
| | - Youssef Jamaleddine
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, LBN
| | - Elio Daccache
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, LBN
| | - Hady Ezzeddine
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
| | - Ramzi Moucharafieh
- Department of Orthopedic Surgery, Faculty of Medicine, Balamand University, Beirut, LBN
- Department of Orthopedics and Traumatology, Clemenceau Medical Center, Johns Hopkins International, Beirut, LBN
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Romano A, Butera G, Moltoni G, Acqui M, Miscusi M, Rossi-Espagnet MC, Trasimeni G, Raco A, Bozzao A. Epidural bleeding secondary to a synovial cyst rupture: a case report and review of literature. Br J Neurosurg 2023; 37:1263-1265. [PMID: 33241949 DOI: 10.1080/02688697.2020.1849547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
Hemorrhage into a juxtafacet cyst is rare and cyst rupture with hemorrhagic extension into the epidural space is even less commonly seen. We describe the case of a patient with a hemorrhagic synovial cyst with rupture associated to abundant bleeding in the epidural space. A 61-year-old man had a 5-month history of worsening low back pain radiating into the right leg with associated weakness and numbness. A magnetic resonance imaging scan showed the presence of a mild anterior spondylolisthesis of L5 on S1 with increased synovial fluid into both facet joints. A suspected synovial cyst of the right facet joint at level L5-S1, with signal characteristics consistent with hemorrhage was seen. Caudally, epidural blood was evident from S1 to S2 that involved spinal canal and right S1 and S2 foramens. These findings were confirmed at surgery.
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Affiliation(s)
- Andrea Romano
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulia Butera
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulia Moltoni
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Michele Acqui
- NESMOS, Department of Neurosurgery, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Massimo Miscusi
- NESMOS, Department of Neurosurgery, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Maria Camilla Rossi-Espagnet
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Guido Trasimeni
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Antonino Raco
- NESMOS, Department of Neurosurgery, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessandro Bozzao
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
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Benato A, Menna G, Rapisarda A, Polli FM, D’Ercole M, Izzo A, D’Alessandris QG, Montano N. Decompression with or without Fusion for Lumbar Synovial Cysts—A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072664. [PMID: 37048747 PMCID: PMC10095101 DOI: 10.3390/jcm12072664] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
The management of symptomatic lumbar synovial cysts (LSC) is still a matter of debate. Previous systematic reviews did not stratify data according to different treatment techniques or incompletely reported comparative data on patients treated with lumbar posterior decompression (LPD) and lumbar decompression and fusion (LDF). The aim of our study was to compare LPD and LDF via a systematic review and meta-analysis of the existing literature. The design of this study was in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review questions were as follows: among patients suffering from symptomatic lumbar synovial cysts (population) and treated with either posterior lumbar decompression or posterior decompression with fusion (intervention), who gets the best results (outcome), in terms of cyst recurrence, reoperation rates, and improvement of postoperative symptoms (comparison)? The search of the literature yielded a total of 1218 results. Duplicate records were then removed (n = 589). A total of 598 articles were screened, and 587 records were excluded via title and abstract screening; 11 studies were found to be relevant to our research question and were assessed for eligibility. Upon full-text review, 5 were excluded because they failed to report any parameter separately for both LPD and LDF. Finally, 6 studies for a total of 657 patients meeting the criteria stated above were included in the present investigation. Our analysis showed that LDF is associated with better results in terms of lower postoperative back pain and cyst recurrence compared with LPD. No differences were found in reoperation rates and complication rates between the two techniques. The impact of minimally invasive decompression techniques on the different outcomes in LSC should be assessed in the future and compared with instrumentation techniques.
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Affiliation(s)
- Alberto Benato
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Grazia Menna
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Rapisarda
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Maria Polli
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Manuela D’Ercole
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Izzo
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Quintino Giorgio D’Alessandris
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola Montano
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Hawa A, Denasty A, Elmobdy K, Mesfin A. The Most Impactful Articles on Cauda Equina Syndrome. Cureus 2023; 15:e38069. [PMID: 37228568 PMCID: PMC10208163 DOI: 10.7759/cureus.38069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Cauda equina syndrome (CES) is an uncommon condition that can lead to permanent neurological deficits if not diagnosed and addressed promptly. Varying prognoses, including retropulsed fracture fragments, disc herniations, and epidural abscesses, can result in CES. Our objective was to identify the top 50 most impactful articles on CES and analyze the characteristics of these publications. In August of 2021, we used the Web of Science Core Collection bibliographic database to query the phrase "cauda equina syndrome." Articles between 1900 and 2021 were included in the search, and these articles were ranked based on the number of citations. The following variables were recorded: title, first author, journal, year of publication, number of citations, country of origin, the institution of publication, and topic of the paper. A total of 2096 articles matched the search criteria. The top 50 most impactful articles ranged from 43 to 439 in their number of citations. All articles on the list were published in English, with the year of publication ranging from 1938 to 2014. The United States accounted for the greatest number of articles published at 27. The medical journal Spine accounted for the greatest number of publications at nine. And the 2000s was the decade with the most cited articles. It is generally acknowledged that the clinical signals for CES are diverse with no predictive value on patient outcomes. Similar uncertainty exists in the etiology of the condition, though CES induced by spinal anesthesia is a factor of particular interest. Additionally, it is generally recognized that delayed diagnosis of the condition often results in permanent neurological deficits. Identification of the most impactful articles on CES is critical in drawing attention to this significant condition.
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Affiliation(s)
- Aasim Hawa
- Orthopedics, University of Rochester Medical Center, Rochester, USA
| | - Adwin Denasty
- Orthopedics, University of Rochester Medical Center, Rochester, USA
| | - Karim Elmobdy
- Orthopedics, University of Rochester Medical Center, Rochester, USA
| | - Addisu Mesfin
- Orthopedics, University of Rochester Medical Center, Rochester, USA
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Kumaria A, Wood A, Gakhar HPS, Howarth SPS, Bateman AH. Facet joint cyst haematoma: a rare cause of cauda equina syndrome. Br J Neurosurg 2019:1-2. [PMID: 31507217 DOI: 10.1080/02688697.2019.1662370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Facet joint cysts are a feature of lumbar spondylosis and are an uncommon cause of radiculopathy. Facet joint cyst haematoma is a very rare entity and has previously been reported as a subacute cause of leg pain, back pain, sensory deficit and lower limb weakness. We present the unique case of facet joint cyst haematoma presenting as cauda equina syndrome. An 81 year old lady presented with a 7 day history of back pain and left foot drop, a 1 day history of perineal numbness and urinary retention with absent rectal tone, perianal anaesthesia and left leg hypoaesthesia. Emergency MRI scan demonstrated spinal canal stenosis as the aetiology of her cauda equina syndrome. She was taken to theatre for emergency lumbar decompression. At operation a facet joint haematoma compressing the cauda equina was found and extirpated with complete resolution of symptoms. In this case, the aetiology of cauda equina compression was not demonstrated effectively on pre-operative MRI scanning.
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Affiliation(s)
- Ashwin Kumaria
- Royal Derby Spinal Centre , Derby , UK.,Department of Neurosurgery, Queen's Medical Centre , Nottingham , UK
| | - Alexandra Wood
- Department of Trauma and Orthopaedics, Lincoln County Hospital , Lincoln , UK
| | | | | | - Antony H Bateman
- Royal Derby Spinal Centre , Derby , UK.,Department of Neurosurgery, Queen's Medical Centre , Nottingham , UK
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Kim HS, Kim SW. Hemorrhagic Lumbar Synovial Cyst after Microscopic Discectomy. KOREAN JOURNAL OF SPINE 2017; 14:93-95. [PMID: 29017304 PMCID: PMC5642099 DOI: 10.14245/kjs.2017.14.3.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/21/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Abstract
Intraspinal synovial cysts are rare but they are being documented with increasing frequency due to improvements in radiological imaging. However, hemorrhage into synovial cysts is uncommon, and affected patients may present with acute onset radiculopathy. This type of hemorrhage is known to result from rupture of fragile neoangiogenic vessels in the cyst wall, due to a traumatic event or anticoagulant therapy. Here, the authors present a rare case of hemorrhagic lumbar synovial cyst caused by spinal instability after microscopic discectomy. To the best of the authors’ knowledge, this is the first report of hemorrhagic lumbar synovial cyst caused by spinal instability following microscopic discectomy in the absence of a traumatic event or anticoagulant therapy. We discuss the pathophysiological mechanism of this uncommon entity and provide a review of the literature.
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Affiliation(s)
- Hak Sung Kim
- Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea
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Domenicucci M, Ramieri A, Marruzzo D, Missori P, Miscusi M, Tarantino R, Delfini R. Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review. World J Orthop 2017; 8:697-704. [PMID: 28979853 PMCID: PMC5605355 DOI: 10.5312/wjo.v8.i9.697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze different terms used in literature to identify lumbar extradural cysts and propose a common scientific terminology; to elaborate a new morphological classification of this pathology, useful for clinical and surgical purposes; and to describe the best surgical approach to remove these cysts, in order to avoid iatrogenic instability or treat the pre-existing one. METHODS We retrospectively reviewed 34 patients with symptomatic lumbar ganglion cysts treated with spinal canal decompression with or without spinal fixation. Microsurgical approach was the main procedure and spinal instrumentation was required only in case of evident pre-operative segmental instability. RESULTS The complete cystectomy with histological examination was performed in all cases. All patients presented an improvement of clinical conditions, evaluated by Visual Analogic Scale and Japanese Orthopaedic Association scoring. CONCLUSION Spinal ganglion cysts are generally found in the lumbar spine. The treatment of choice is the microsurgical cystectomy, which generally does not require stabilization. The need for fusion must be carefully evaluated: Pre-operative spondylolisthesis or a wide joint resection, during the operation, are the main indications for spinal instrumentation. We propose the terms "ganglion cyst" to finally identify this spinal pathology and for the first time its morphological classification, clinically useful for all specialists.
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Affiliation(s)
- Maurizio Domenicucci
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Daniele Marruzzo
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Paolo Missori
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Massimo Miscusi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
| | - Roberto Tarantino
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberto Delfini
- Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
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Shtaya A, Sadek AR, Walker M, Nader-Sepahi A. Ventral Lumbar Synovial Cyst Causing Cauda Equina Compression: Case Report and Literature Review. World Neurosurg 2017; 106:1055.e1-1055.e3. [PMID: 28735122 DOI: 10.1016/j.wneu.2017.07.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Juxtafacet spinal cysts are cystic synovial lesions that often are indistinguishable clinically or radiologically and require histopathology analysis to confirm the diagnosis. Lumbar synovial cysts usually arising from the synovium of the facet joints. They have been described posterolaterally or rarely in the posterior midline. However, we describe the first synovial cyst ventral to the dural sac. CASE DESCRIPTION We report a lumbar 3-4 lesion causing cauda equina compression in a 57-year-old man who presented with a 3-month history of low back pain and bilateral sciatica, intermittent urinary incontinence, and erectile dysfunction. Preoperative magnetic resonance imaging suggested prolapsed disc, after decompression, histological analysis of the fragment confirmed a synovial cyst. CONCLUSIONS Hitherto synovial cysts have not been reported anterior to the dural sac. We describe a lumbar ventral cystic mass with cauda equina compression that mimicked a disc prolapse due to synovial metaplasia. The patient had urgent decompression with subsequent resolution of the symptoms.
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Affiliation(s)
- Anan Shtaya
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom.
| | - Ahmed-Ramadan Sadek
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
| | - Mark Walker
- Neuropathology Department, University Hospital Southampton, Southampton, United Kingdom
| | - Ali Nader-Sepahi
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
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Bruder M, Cattani A, Gessler F, Droste C, Setzer M, Seifert V, Marquardt G. 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; 27:256-267. [PMID: 28686146 DOI: 10.3171/2016.12.spine16756] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- Markus Bruder
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Christian Droste
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
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11
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Ozdemir B, Kanat A, Batcik OE, Gucer H, Yolas C. Ligamentum flavum hematomas: Why does it mostly occur in old Asian males? Interesting point of reported cases: Review and case report. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:7-12. [PMID: 27041879 PMCID: PMC4790154 DOI: 10.4103/0974-8237.176605] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hematoma of the ligamentum flavum (LF) is a rare cause of neural compression and sciatica. Currently, the etiology and epidemiological characteristics of ligamentum flavum hematoma (LFH) are unknown and epidemiological investigations using rewieving of reported cases have not been performed. We report the case of a 63-year-old man with a LFH compressing the spinal canal at the left L2-L3 level, rewieved relevant literature. In Medline research, wefound a total of 50 reported cases with LFHs, and the interesting point of these cases were analyzed. Many of cases were old males. Interestingly, 39 of the 50 cases were reported from Asian countries. The ages of 42 patients could be verified. The youngest age was 45 years, oldest age was 81 years, and mean age was 66.07 years. Thirty-three out of these 42 patients (78.53%) were older than 60 years. An important aspect of the present review is to bring attention for occurrence in older Asian males. With an increasing number of elderly people in the general population, there is a need to investigate risk factors such as sexual gender, age, and geographic location for LFH.
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Affiliation(s)
- Bulent Ozdemir
- Department of Neurosurgery, Recep Tayyip Erdogan University, Medical Faculty, Rize, Turkey
| | - Ayhan Kanat
- Department of Neurosurgery, Recep Tayyip Erdogan University, Medical Faculty, Rize, Turkey
| | - Osman Ersegun Batcik
- Department of Neurosurgery, Recep Tayyip Erdogan University, Medical Faculty, Rize, Turkey
| | - Hasan Gucer
- Department of Pathology, Recep Tayyip Erdogan University, Medical Faculty, Rize, Turkey
| | - Coskun Yolas
- Neurosurgery Clinic, Erzurum Training and Research Hospital, Erzurum, Turkey
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Li K, Li Z, Geng W, Wang C, Ma J. Postdural disc herniation at L5/S1 level mimicking an extradural spinal tumor. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25 Suppl 1:80-3. [PMID: 26573459 DOI: 10.1007/s00586-015-4125-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 07/10/2015] [Accepted: 07/11/2015] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Postdural disc herniation has been documented rarely and the pathogenesis is still unknown. The average age of postdural disc herniations is between 50 and 60 years, and the sites most frequently affected by postdural lumbar disc herniations are L3-L4 and L4-L5, only less than 10 % in L5-S1. Although magnetic resonance imaging (MRI) is a useful tool in the diagnosis of this disease, the postdural disc herniation is usually misdiagnosed as extradural spine tumor preoperatively. The definitive diagnosis is made during operation or according to the postoperative pathology. METHODS In this article, we described here a 48-year-old male patient who presented with intermittent pain in the low back and frequent urination for 4 years as well as hypesthesia and pain of the left lower extremity for 1 month. RESULTS A standard total laminectomy was performed and the histopathological diagnosis was consistent with a degenerated intervertebral disc. The patient presented significant relief of the pain and of the neurological symptoms, but no improvement of frequent urination, in the postoperative period. CONCLUSIONS The diagnosis of postdural disc herniations is very difficult and mainly based on intraoperative and histopathological results. Early surgical intervention is important to relieve symptoms and prevent severe neurological deficits.
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Affiliation(s)
- Kunpeng Li
- People's hospital of Liaocheng, 67 Dongchang West Road, Liaocheng, 252000, Shandong, China
| | - Zhong Li
- People's hospital of Liaocheng, 67 Dongchang West Road, Liaocheng, 252000, Shandong, China
| | - Wei Geng
- People's hospital of Liaocheng, 67 Dongchang West Road, Liaocheng, 252000, Shandong, China
| | - Chenghu Wang
- People's hospital of Liaocheng, 67 Dongchang West Road, Liaocheng, 252000, Shandong, China
| | - Jinzhu Ma
- People's hospital of Liaocheng, 67 Dongchang West Road, Liaocheng, 252000, Shandong, China.
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13
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Sukkarieh HG, Hitchon PW, Awe O, Noeller J. Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases. J Neurosurg Spine 2015; 23:444-50. [DOI: 10.3171/2015.1.spine14996] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach.
METHODS
All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times.
RESULTS
There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m2. Sixty-nine percent (9 of 13) of the cysts were at L4–5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series.
CONCLUSIONS
The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.
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Ikeda O, Minami N, Yamazaki M, Koda M, Morinaga T. Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level. J Spinal Cord Med 2015; 38:239-44. [PMID: 24976137 PMCID: PMC4397208 DOI: 10.1179/2045772314y.0000000216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. FINDINGS A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5-S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. CONCLUSION We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions.
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Affiliation(s)
- Osamu Ikeda
- Department of Orthopedic Surgery, Kashiwa City Kashiwa Hospital, Kashiwa, Chiba, Japan,Correspondence to: Osamu Ikeda, Department of Orthopedic Surgery, Kashiwa City Kashiwa Hospital, 1-3 Fuse, Kashiwa, Chiba 277-0825, Japan.
| | - Norihiko Minami
- Department of Orthopedic Surgery, Kashiwa City Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Tsukuba University, Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Tatsuo Morinaga
- Department of Orthopedic Surgery, Kashiwa City Kashiwa Hospital, Kashiwa, Chiba, Japan
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15
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Park JH, Im SB, Kim HK, Hwang SC, Shin DS, Shin WH, Kim BT. Histopathological findings of hemorrhagic ganglion cyst causing acute radicular pain: a case report. KOREAN JOURNAL OF SPINE 2014; 10:242-5. [PMID: 24891856 PMCID: PMC4040643 DOI: 10.14245/kjs.2013.10.4.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 11/19/2022]
Abstract
Although juxtafacet cysts of the lumbar spine are being reported with increasing frequency, hemorrhage from a ganglion cyst is rare, and the pathophysiologic mechanism of the hemorrhage from the cyst is still unclear. A 75-year-old male presented with sudden radicular leg pain caused by hemorrhage from the ganglion cyst. Computed tomography revealed bony erosion of vertebral body and multiple punched-out lesions on facets. Magnetic resonance imaging showed the neural structure was compressed by a sharply delineating mass. Capsule and old hematoma with elastic consistency that extended to the epidural space were removed through a paramedian transforaminal approach, which led to the resolution of the patient's symptoms. Histopathologically, chronic inflammation with neovascularization and myxoid degeneration were present in the capsule. Alcian blue staining demonstrated the mixture of mucin and hematoma. The probable pathogenesis of hemorrhage from the cyst was discussed from the unique histopathological findings of surgical specimen.
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Affiliation(s)
- Jong-Hyun Park
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Soo Bin Im
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Hee Kyung Kim
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Sun Chul Hwang
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Dong-Seung Shin
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Won Han Shin
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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Oliveira J, Silva PS, Pereira P, Vaz R. Paraparesis as the Presenting Form of a Lumbar Hemorrhagic Synovial Cyst: A Case Report and Review of the Literature. JBJS Case Connect 2013; 3:e136. [PMID: 29252292 DOI: 10.2106/jbjs.cc.m.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Joana Oliveira
- Neurosurgery Department, Hospital São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
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17
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Pindrik J, Macki M, Bydon M, Maleki Z, Bydon A. Midline synovial and ganglion cysts causing neurogenic claudication. World J Clin Cases 2013; 1:285-289. [PMID: 24364023 PMCID: PMC3868712 DOI: 10.12998/wjcc.v1.i9.285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/05/2013] [Accepted: 11/19/2013] [Indexed: 02/05/2023] Open
Abstract
Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. This article summarizes the clinical presentation, radiographic appearance, and management of three intraspinal, midline facet cysts. Three patients with symptomatic midline intraspinal facet cysts were retrospectively reviewed. Documented clinical visits, operative notes, histopathology reports, and imaging findings were investigated for each patient. One patient presented with neurogenic claudication while two patients developed partial, subacute cauda equina syndrome. All 3 patients initially responded favorably to lumbar decompression and midline cyst resection; however, one patient required surgical stabilization 8 mo later. Following the three case presentations, we performed a thorough literature search in order to identify articles describing intraspinal cystic lesions in lateral or midline locations. Midline intraspinal facet cysts represent an uncommon cause of lumbar stenosis and thecal sac compression. Such entities should enter the differential diagnosis of midline posterior cystic lesions. Midline cysts causing thecal sac compression respond favorably to lumbar surgical decompression and cyst resection. Though laminectomy is a commonly performed operation, stabilization may be required in cases of spondylolisthesis or instability.
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18
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GANAU M, ENNAS F, BELLISANO G, GANAU L, AMBU R, FAA G, MALECI A. Synovial Cysts of the Lumbar Spine. Neurol Med Chir (Tokyo) 2013; 53:95-102. [DOI: 10.2176/nmc.53.95] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mario GANAU
- Chair of Neurosurgery, University of Cagliari
| | | | | | - Laura GANAU
- Chair of Neurosurgery, University of Cagliari
| | - Rossano AMBU
- Institute of Anatomic Pathology, University of Cagliari
| | - Gavino FAA
- Institute of Anatomic Pathology, University of Cagliari
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19
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True synovial cysts of the lumbar spine: an epiphenomenon of instability of the functional spine unit? Neurosurg Rev 2012. [DOI: 10.1007/s10143-012-0443-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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20
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El Shazly AA, Khattab MF. Surgical excision of a Juxtafacet cyst in the lumbar spine: A report of thirteen cases with long-term follow up. Asian J Neurosurg 2012; 6:78-82. [PMID: 22347328 PMCID: PMC3277074 DOI: 10.4103/1793-5482.92162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
CONTEXT Juxtafacet cysts of the lumbar spine are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. Surgical treatment is indicated when there is failure of conservative measures. Primary spinal fusion at the time of surgical excision of the cyst is a matter of controversy. Few reports have described long-term follow-up for surgical treatment of spinal cysts. AIM The purpose of this study is to assess the long-term outcome of the surgical excision of a Juxtafacet cyst without spinal fusion. STUDY DESIGN This is a retrospective case series study, level IV evidence. MATERIALS AND METHODS This is a retrospective case series study on 13 patients with Juxtafacet cysts, who were treated with surgical excision of the cysts without spinal fusion. A questionnaire scoring system was used for evaluation of the surgical outcome. RESULTS The study was conducted on 13 patients, seven females (54%) and six males (46%), their age ranging from 38 to 69 years, with a mean age of 52 (±9.93 STD) years. The mean duration of the symptoms was 10.5 (±6.22 STD) months. All patients got benefit from surgery, with six excellent (46%), six good (46%), and one fair outcome (8%), with no surgery-related complications. The mean follow-up period of the patients at the time of this study was 4.2 years (±1.43 STD). CONCLUSION Long-term follow-up for surgical excision of symptomatic Juxtafacet cysts without spinal fusion revealed excellent to good results in 92% of the patients, with a satisfaction rate of 80% (±8.41 STD).
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Affiliation(s)
- Ayman A El Shazly
- Departments of Neurosurgery and Orthopedics, Ain Shams University, Ramses Extension Road, Abbasia Square, Cairo, Egypt
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21
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Mattei TA, Goulart CR, McCall TD. Pathophysiology of regression of synovial cysts of the lumbar spine: the 'anti-inflammatory hypothesis'. Med Hypotheses 2012; 79:813-8. [PMID: 23021571 DOI: 10.1016/j.mehy.2012.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/25/2012] [Accepted: 08/30/2012] [Indexed: 12/12/2022]
Abstract
The term 'synovial cysts' of the lumbar spine refers to cysts that arise from the zygapophyseal joint capsule of the lumbar spine. Although several cases of regression of lumbar spine synovial cysts after oral anti-inflammatory therapy as well as local steroid injection have already been reported in the literature, no study up to now has addressed the role of 'inflammation suppression' in the regression of such lesions. In fact most of the previous studies have regarded 'spontaneous rupture' as well as 'instability resolution' as the most probable explanations for such phenomenon. In this article the authors review the current experimental data about the role of cytokines and inflammation in the development of synovial cysts of the lumbar spine. Additionally with basis on both our clinical experience of regression of a synovial cyst after conservative treatment with a non-steroidal anti-inflammatory drug (Cox-2 inhibitor) as well as on the experimental data supporting the multi-factorial effects of such drugs on the lumbar facet joints, the authors hypothesize that inhibition of inflammation might play a significant role in the pathophysiology of lumbar spine synovial cysts' regression.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, University of Illinois, Peoria, IL, USA.
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22
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Abstract
An 89 year old gentleman awaiting surgery for carcinoma of caecum presented with sudden back pain and developed foot drop two weeks later. MRI revealed multiple spinal metastases with a cyst in the canal at L4/5 causing spinal canal stenosis. Surgery revealed a juxta articular synovial cyst with haemorrhage in it. We discuss the presentation and management of juxtarticular cysts with a review of the literature.
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Affiliation(s)
- Kj George
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - D Roy
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - A Shad
- University Hospitals Coventry and Warwickshire, Coventry, UK
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23
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Machino M, Yukawa Y, Ito K, Kanbara S, Kato F. Spontaneous hemorrhage in an upper lumbar synovial cyst causing subacute cauda equina syndrome. Orthopedics 2012; 35:e1457-60. [PMID: 22955421 DOI: 10.3928/01477447-20120822-41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lumbar spine synovial cysts are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. They are common in lower lumbar lesions but rare in upper lumbar lesions. Several cases of hemorrhage into lower lumbar juxtafacet cysts after trauma or anticoagulation therapy have been reported in the literature. This article describes a case of subacute cauda equina syndrome resulting from spontaneous hemorrhage into an upper lumbar synovial cyst. A 65-year-old man presented with a 3-month history of intermittent bilateral lumbar pain. One week before, he experienced a sudden exacerbation of lumbar pain and began falling frequently; he also reported weakness and tingling in his lower limbs. A hematic collection associated with a large juxtafacet cyst at L2-L3 was suspected on magnetic resonance imaging. He underwent surgical decompression, and the cyst was resected. Microscopic examination was consistent with the diagnosis of a synovial cyst. Two days postoperatively, he was walking independently. Although several descriptions exist of hemorrhagic lumbar juxtafacet cysts after trauma or anticoagulant therapy, to the authors' knowledge, this is the first documented case of hemorrhage in an upper lumbar synovial cyst with no previous traumatic event or medication use. Magnetic resonance imaging was essential in making the preoperative diagnosis. Surgical removal of the cyst was an effective treatment.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan.
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24
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Bashir EF, Ajani O. Management of lumbar spine juxtafacet cysts. World Neurosurg 2012; 77:141-6. [PMID: 22405394 DOI: 10.1016/j.wneu.2011.06.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 05/14/2011] [Accepted: 06/23/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We review a series of 21 patients with lumbar juxtafacet cysts (LJFCs) treated in two institutions. METHODS The charts of 21 patients with a diagnosis of LJFCs during a 6- year period, January 2001 to December 2006, treated at Hamad Hospital, Doha, Qatar, and El Ribat University Hospital, Khartoum, Sudan, were reviewed. Demographic data, clinical and imaging findings, management, and outcome were reviewed. RESULTS Twenty-one patients with 23 LJFCs were identified (14 men, 7 women) with a mean age of 54 years. All presented with back pain and radicular symptoms. Ten patients presented with neurogenic claudication due to spinal canal stenosis. All had magnetic resonance imaging and dynamic spine radiographs. Fourteen LJFCs were found at L4-5 level, 8 at L5-S1 level, and 1 at L3-4 level. Three patients had sustained improvement with conservative treatment and 17 patients underwent surgical management, mainly through a microsurgical approach. Nine of 10 patients with lumbar canal stenosis underwent decompressive laminectomy; one patient refused treatment. One patient with bilateral LJFCs and mobile spondylolisthesis underwent spinal fusion. All patients, except one, were followed up for a period of 12-72 months. CONCLUSIONS LJFCs may lead to symptoms similar to degenerative disc disease. Surgery is reserved for symptomatic patients who do not improve satisfactorily with conservative treatment. The microsurgical approach is our preferred surgical method and spinal fusion should be reserved for patients with spinal instability. Long-term outcome with surgical treatment appears satisfactory.
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Affiliation(s)
- El Fatih Bashir
- Neuro Spine Center, El Ribat University Hospital, Khartoum, Sudan.
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25
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Using precisely controlled bidirectional orthopedic forces to assess flexibility in adolescent idiopathic scoliosis: comparisons between push-traction film, supine side bending, suspension, and fulcrum bending film. Spine (Phila Pa 1976) 2011; 36:1679-84. [PMID: 21221052 DOI: 10.1097/brs.0b013e31820e6265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE To validate the effectiveness of push-traction film (PTF) in assessment of curve flexibility in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA There is no agreement among surgeons about the most advantageous method in flexibility evaluation of scoliosis. As all methods available provide the orthopedic force from one direction and use a single torque, it is difficult for them to achieve the postoperative correction; also they could not meet the needs for different types of curves. METHODS Precisely controlled bidirectional (push and traction) orthopedic forces were applied for curve flexibility evaluation in 31 consecutive adolescent idiopathic scoliosis patients. The correction rate (CR) of postoperation, supine side-bending, suspension, and fulcrum bending radiographs were compared with PTF in instrumented main thoracic (MT) and thoracolumbar/lumbar curves. Correlation and linear regression analyses were also been done to find the best predictor among the four methods. RESULTS In MT group, CR of PTF was significantly higher than that of side bending (P = 0.010) and suspension (P = 0.000) but not significantly different from that of fulcrum bending (P = 0.335). In TL/L group, CR of PTF was significantly higher than that of suspension (P = 0.000), but not significantly different from that of side bending (P = 0.681) and fulcrum bending (P = 0.382). There was no significant difference between CR of PTF and postoperation in both MT (P = 0.122) and TL/L (P = 0.068) groups. Correlation and linear regression analyses showed that PTF provided the highest correlation of the four methods, with the postoperative angle in both MT (r = 0.957) and MT/L group (r = 0.779). CONCLUSION To our knowledge, this was the first report about using precisely controlled bidirectional correction forces for curve flexibility evaluation. Although it did not achieve the best CR among the four methods studied, correlation and regression analyses confirmed that PTF was a more stable and accurate method to predict flexibility. We believe that further exploration of a more rational push-traction force ratio would help to obtain a better flexibility.
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26
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Subaxial cervical synovial cysts: report of 35 histologically confirmed surgically treated cases and review of the literature. Spine (Phila Pa 1976) 2011; 36:E1285-9. [PMID: 21358479 DOI: 10.1097/brs.0b013e31820709a8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study OBJECTIVE The authors' aim of the present study is to report their experience with subaxial cervical synovial cysts hoping to provide further insight into these lesions including the presenting symptoms, possible mechanisms of cyst development associated with cervical level, surgical treatments and clinical outcomes. SUMMARY OF BACKGROUND DATA Synovial cysts are relatively common in the lumbar spine and very uncommonly identified in the subaxial cervical spine. Several case reports and a few small series have been reported in the literature over the past four decades. METHODS The authors retrospectively reviewed the cases of 35 patients who underwent surgical treatment for histologically confirmed symptomatic subaxial cervical synovial cysts between 1993 and 2009. The presenting symptoms, age, sex, cervical level, operation, complications and outcomes were analyzed in this cohort. Preoperative and postoperative neurologic assessments were done by staff neurologists independent of the operating surgeon. This study was approved by the Mayo Clinic institutional review board. RESULTS Thirty-five patients underwent surgical treatment for their synovial cysts and follow-up for at least 12 months postoperatively. The mean follow-up time was 49 months (range, 12-134). There were no deaths associated with the surgery. There was one postoperative infection in a patient undergoing a decompressive laminectomy and posterior instrumented fusion. Patient outcomes were assessed using the Modified Rankin Score for 12 patients was 0, 17 patients was 1, 4 patients was 2, and 2 patients was 3. CONCLUSION This series of 35 patients with subaxial cervical synovial cysts surgically treated over a period of 17 years illustrates the relative rarity of these lesions. Magnetic resonance imaging is currently the optimal radiographic study to identify these lesions. Surgical resection can be an effective treatment.
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27
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Hemorrhagic facet cyst in the lumbar spine causing contralateral leg symptoms: a case report. Asian Spine J 2011; 5:196-200. [PMID: 21892394 PMCID: PMC3159070 DOI: 10.4184/asj.2011.5.3.196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 06/13/2010] [Accepted: 06/22/2010] [Indexed: 11/08/2022] Open
Abstract
Here we present a case of hemorrhagic lumbar facet cyst presenting with progressive radiculopathy only on the contralateral side. If a patient has previous back pain or neuropathy for several months and then suddenly deteriorates, hemorrhagic facet cyst of the lumbar spine should be part of the differential diagnosis. However, as in the present case, we should be aware that there is a possibility of a contralateral lesion.
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28
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Xu R, Solakoglu C, Maleki Z, McGirt MJ, Gokaslan ZL, Bydon A. Hemorrhagic synovial cyst: the possible role of initial trauma and subsequent microtrauma in its pathogenesis: case report. Neurosurgery 2011; 68:E858-65; discussion E865. [PMID: 21311282 DOI: 10.1227/neu.0b013e3182080127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Intraspinal synovial cysts are uncommon causes of back and radicular leg pain. Usually associated with degenerative spinal disease, these juxtafacet cysts are usually located in the lumbar spine and may rarely undergo intracystic hemorrhage. The pathogenesis of these cysts are unclear, and risk factors that may contribute to hemorrhagic complications are largely unknown. CLINICAL PRESENTATION A 68-year-old man presented to the clinic 4 months after a fall on ice with persistent back pain and lumbar radiculopathy. A week after the initial clinic consultation, the patient presented to the emergency room with increased pain and worsening weakness in the left foot. An emergent magnetic resonance image showed thecal sac compression secondary to a large, juxtafacet cyst that was hyperintense on T1-weighted and hypointense on T2-weighted images. Lumbar decompressive laminectomies were performed at L3 and L4 with cyst removal and stabilization. CONCLUSION We present the eighth reported case of a hemorrhagic juxtafacet cyst secondary to physical trauma, the second in which the patient's symptoms acutely worsened several months after the initial insult without new trauma. We also present summary statistics of the 31 cases of hemorrhagic juxtafacet cysts reported in the literature and propose a putative mechanism that may account for the development and progression of symptoms in some patients.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Bydon A, Xu R, Parker SL, McGirt MJ, Bydon M, Gokaslan ZL, Witham TF. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. Spine J 2010; 10:820-6. [PMID: 20488765 DOI: 10.1016/j.spinee.2010.04.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 03/14/2010] [Accepted: 04/08/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear. PURPOSE To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence. STUDY DESIGN Systematic review of the literature. PATIENT SAMPLE All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion. OUTCOME MEASURES Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales. METHODS We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts. RESULTS Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4-L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion. CONCLUSIONS Surgical decompression results in symptomatic resolution in the vast majority of patients; however, recurrent back pain occurs in a significant number of patients. Cyst recurrence occurs in less than 2% of patients but has never been reported after cyst excision with concomitant fusion. The lack of cyst recurrence after concomitant fusion supports the need to investigate the value of fusion of the involved motion segment in the treatment of symptomatic synovial cysts of the spine.
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Affiliation(s)
- Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Cicuendez M, Alen JF, Ramos A, Lobato RD, Lagares A. Spontaneous hemorrhage into a lumbar synovial cyst. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19 Suppl 2:S190-2. [PMID: 20174835 DOI: 10.1007/s00586-010-1332-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 01/17/2010] [Accepted: 01/24/2010] [Indexed: 11/24/2022]
Abstract
Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and/or progressive symptoms of spinal canal compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage into synovial cysts have been reported in the literature.
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Affiliation(s)
- Marta Cicuendez
- Departamento de Neurocirugia, Hospital 12 de Octubre, Av Andalucia km 5.4, 28041 Madrid, Spain.
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Ikuta K, Tono O, Oga M. Prevalence and clinical features of intraspinal facet cysts after decompression surgery for lumbar spinal stenosis. J Neurosurg Spine 2009; 10:617-22. [DOI: 10.3171/2009.2.spine08769] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Object
Although many cases of primary intraspinal facet cysts in the lumbar spine have been reported, there have only been a few reports of postoperative intraspinal facet cysts in the lumbar spine. The purpose of this study was to investigate the prevalence and clinical features of postoperative intraspinal facet cysts in the lumbar spine.
Methods
Data from 81 patients undergoing microendoscopic posterior decompression to treat lumbar spinal stenosis were reviewed. The development of a postoperative intraspinal facet cyst was observed using MR imaging during 1 year after surgery. If the patient demonstrated a postoperative intraspinal facet cyst, additional MR imaging was performed to evaluate the natural course of the cyst. Furthermore, the authors conducted a comparative evaluation to identify the factors associated with the causes of cyst development.
Results
A postoperative intraspinal facet cyst developed in 7 patients (8.6%) during 1 year after surgery. Spondylotic spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis were revealed before surgery in 2, 4, and 1 patient, respectively. In 5 patients, the cysts developed within 3 months after surgery. Although 3 patients exhibited symptoms caused by cyst development, all symptoms were relieved by conservative treatment. On radiographic evaluations, postoperative segmental spinal instability, including a progression of spondylolisthesis and disc degeneration, was revealed in 6 (86%) of the 7 patients. Spontaneous regression of the cysts was observed in 5 (71%) of these 7 patients. On comparative evaluation of patients with and without postoperative intraspinal facet cysts, the presence of segmental spinal instability before surgery (including degenerative spondylolisthesis) and the appearance of postoperative segmental spinal instability were related to the development of the cysts.
Conclusions
The prevalence of postoperative intraspinal facet cysts, including asymptomatic cysts, was 8.6% during 1 year after decompression surgery for lumbar spinal stenosis. The development of postoperative intraspinal facet cysts was related to the presence of segmental spinal instability before surgery (including degenerative spondylolisthesis) and postoperative segmental spinal instability, including a progression of spondylolisthesis and disc degeneration after surgery. A postoperative intraspinal facet cyst, which can be expected to regress spontaneously with a probability > 50%, should be recognized as one of the postoperative complications of decompression surgery for lumbar spinal stenosis.
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Affiliation(s)
- Ko Ikuta
- 1Department of Orthopedic Surgery, Karatsu Red Cross Hospital, Karatsu City; and
| | - Osamu Tono
- 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Masayoshi Oga
- 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
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Miyatake N, Aizawa T, Hyodo H, Sasaki H, Kusakabe T, Sato T. Facet cyst haematoma in the lumbar spine: a report of four cases. J Orthop Surg (Hong Kong) 2009; 17:80-4. [PMID: 19398800 DOI: 10.1177/230949900901700118] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present 4 cases of facet cyst haematoma in the ligamentum flavum of the lumbar spine. All patients presented with a one-to-3-month history of back pain or numbness in the legs, and sudden neurological deterioration. One also developed cauda equina syndrome and another developed radiculopathy. In all cases, magnetic resonance imaging showed a mass with high signal intensity on both T1- and T2-weighted images. Facet arthrography and computed tomography revealed communication between the mass and the neighbouring facet joint. The haematomas were removed en bloc with the ligamentum flavum. They were surrounded by the ligament and contained degenerated and lacerated elastic fibres but no synovial lining cells. Facet cyst haematoma is so-named because of bleeding from tissue adjacent to the facet joint into a pre-existing facet cyst.
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Affiliation(s)
- N Miyatake
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a case of a subacute radiculopathy resulting from a spontaneous hemorrhage into a lumbar ganglion cyst. SUMMARY OF BACKGROUND DATA Ganglion and synovial cysts of the lumbar spine are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. Few cases of hemorrhage into lumbar juxtafacet cysts after trauma or anticoagulation therapy have been described in the literature. METHODS A case of a spontaneous hemorrhage in a lumbar ganglion cyst is presented. RESULTS A 61-year-old man presented with a 2-month history of intermittent bilateral lumbar ache. Eight days before admission he had a sudden exacerbation of the lumbar pain and began to fall frequently and noticed weakness and tingling in his lower members, mainly in the right leg. Magnetic resonance imaging scan revealed a hematic collection associated with a large juxtafacet cyst at the L4-L5 level. He was submitted to surgery and the cyst was totally removed. Microscopic examination was consistent with the diagnosis of a ganglion cyst. Two days after surgery he had already an independent gait. CONCLUSION Although, there are a few descriptions of hemorrhagic lumbar justafacet cysts after trauma or anticoagulant therapy, this is the first case of a hemorrhagic ganglion cyst with no previous traumatic event or use of medication. Magnetic resonance imaging was essential for making the preoperative diagnosis. Neurosurgical cyst removal proved to be an effective treatment.
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KIM JU, LEE SH, LEE DY. Extraforaminal Lumbar Synovial Cyst Causing Sudden Foot Drop -Case Report-. Neurol Med Chir (Tokyo) 2008; 48:578-81. [DOI: 10.2176/nmc.48.578] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jin Uk KIM
- Department of Orthopaedic Surgery, Wooridul Spine Hospital
| | - Sang-Ho LEE
- Department of Neurosurgery, Wooridul Spine Hospital
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Affiliation(s)
- Chisako Fukuda
- Department of Orthopaedic Surgery, Tenri Hospital, 200 Mishima-cho Tenri, Nara, 632-8552, Japan
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a case of spinal epidural hematoma arising from the synovial joint due to anticoagulation therapy. SUMMARY OF BACKGROUND DATA Spontaneous spinal epidural hematoma is a rarity in the literature with a variety of etiologies. In 1 study, it was reported to originate from a synovial joint due to osteoarthritis of the joint. METHODS A case of hematoma of the lumber synovial joint is presented. RESULTS A 67-year-old man who was on anticoagulation therapy presented with progressive neurologic symptoms in the right lower limb. Magnetic resonance imaging scan revealed what was thought to be a L4-L5 synovial joint cyst. During surgery, it was proven to be an epidural hematoma originating from the synovial joint. Microscopic examination confirmed the diagnosis and excluded the possibility of spinal synovial cyst. After spinal decompression, neurologic symptoms improved completely in 2 weeks. CONCLUSIONS This is the first report of a synovial cyst hematoma due to anticoagulation therapy. Its magnetic resonance imaging features can be similar to synovial cyst, especially when it is hemorrhagic. Spinal decompression was the definitive treatment.
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Affiliation(s)
- Ali Nourbakhsh
- Division of Spine Surgery, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX 77555-0165, USA
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Christophis P, Asamoto S, Kuchelmeister K, Schachenmayr W. "Juxtafacet cysts", a misleading name for cystic formations of mobile spine (CYFMOS). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:1499-505. [PMID: 17203271 PMCID: PMC2200759 DOI: 10.1007/s00586-006-0287-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 04/18/2006] [Accepted: 12/03/2006] [Indexed: 12/15/2022]
Abstract
To present 58 cystic space-occupying formations of the spinal canal in 53 cases; these formations are called "juxtafacet cysts". Fifty-Three patients (33 women and 20 men, with an average age of 60.8 years) were evaluated retrospectively by neurosurgery. All of the patients had received simple X-P, computed tomography (CT) and magnetic resonance imaging (MRI) before surgery. The neurological findings were evaluated on admission and in a follow-up review. Surgical intervention was performed on all patients and they underwent gross-total cyst removal. During surgery, the origin of a cyst was well observed. Follow-up data ranged from 6 to 46 months. Patient outcome was graded on a scale of excellent, good, or poor. Histological findings were evaluated. In 53 patients 58 cysts were identified. Four of the patients had multiple cysts. All cysts were associated with mobile spine. Fifty-five cysts were found in the lumbo-sacral region, two cysts were found in the cervico-thoracic region and one cyst in the thoracic region. Forty-two patients presented back pain and 52 patients presented radicular pain. Four patients had a cauda equina syndrome. Sensory disturbance was observed in 24 cases and motor weakness was observed in 21 cases. Claudication was observed in 19 cases. All cases with cervico-thoracic or thoracic cysts presented myelopathy. The duration of these clinical symptoms ranged from 10 days to 10 years. After surgery there was no case of a recurrent cyst during the follow-up period. Thirty-four cases had an excellent outcome, 18 a good outcome, and one a poor outcome. Out of 58 cysts 32 were joint cysts (11 synovial cysts, 21 ganglion cysts). A further 19 were flavum cysts, one was a posterior longitudinal ligament (PLL) cyst and six others were unknown pseudo cysts. In 34 of the cysts we found hemosiderin deposits and in eight amyloid deposits. Present investigation and findings in literature show a clear comparison of these cystic formations and the mobile part of the spine. An anatomical relation to a vertebral joint ("facet") is only found in some of the cases (32 of 58). Further to that, the name "cyst" is not correct either, because most of the cystic formations are presented without a cell lining on their internal wall and therefore they are pseudo-cystic. We think that these cystic formations should be called "cystic formations of mobile spine" (CYFMOS) rather than "juxtafacet cysts". A surgical intervention is the best treatment for these cysts if they cause a compression of nerve roots or/and of the spinal cord.
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Affiliation(s)
- Petros Christophis
- Department of Neurosurgery, University Hospital of Giessen, Klinikstrasse 29, 35385 Giessen, Hessen, Germany.
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Vasani SS, Demetriades AK, Joshi SM, Yeh J, Ellamushi H. Traumatic intraspinal extradural ganglion cyst in a teenager: Case report and review of the literature. Clin Neurol Neurosurg 2007; 109:88-91. [PMID: 16647199 DOI: 10.1016/j.clineuro.2006.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 03/10/2006] [Accepted: 03/15/2006] [Indexed: 11/19/2022]
Abstract
Spinal extradural cyst is a rare cause of spinal cord or nerve root compression. We present a case which is unique due to both the young age of the patient and its distinctly acute haemorrhagic presentation. In what is normally considered a degenerative disease in older patients this has implications for the possibility of a traumatic aetiology in children. The literature on the classification of extradural cysts is reviewed.
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Affiliation(s)
- Sarju S Vasani
- Department of Neurosurgery, Royal London Hospital, Whitechapel, London, UK
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Deinsberger R, Kinn E, Ungersböck K. Microsurgical treatment of juxta facet cysts of the lumbar spine. ACTA ACUST UNITED AC 2006; 19:155-60. [PMID: 16770210 DOI: 10.1097/01.bsd.0000188660.31212.83] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Juxta facet cysts are a common cause of low back and radicular pain. They are mostly associated with degenerative facet joints and spondylolisthesis. The study focuses on long-term outcomes after microsurgical treatment without fusion. METHOD From April 2002 to April 2004, 31 patients (23 female and 8 male) underwent microsurgical resection of lumbar juxta facet cysts. The patient age ranged from 31 to 83 years (mean 67.2 years). The most affected level was L4-L5 (19 patients), followed by L3-L4 (9 patients). Fourteen patients additionally had spondylolisthesis of the involved segment. All patients had signs of nerve root compression and had received conservative treatment preoperatively. We performed limited bone removal (sparing the facet joints) and cyst resection in 27 patients. In four patients, cyst resection and standard laminectomy were performed owing to spinal stenosis. RESULTS Conservative treatment was without any effect in all patients. At follow-up, 12-30 months after surgery, excellent to good outcome was achieved in 25 of 31 patients (80.7%), and 6 patients (19.3%) showed fair results. Persistent low back pain was more common in patients with spondylolisthesis than in the other group (6/14 vs 3/17); this may be due to instability. Spondylolisthesis did not progress or become mobile after surgery radiographically in any of our patients. CONCLUSIONS Conservative therapy does not adequately improve symptoms in patients with intraspinal juxta facet cysts and radicular signs. Juxta facet cysts can be treated effectively with a minimally invasive microsurgical approach. This may be of particular significance when the cysts are associated with spondylolisthesis, minimizing the risk of instability and the need for fusion. In a selected group of patients with persistent low back pain, fusion may become necessary to improve symptoms.
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Affiliation(s)
- Robert Deinsberger
- Department of Neurosurgery, Landesklinikum St. Pölten, Propst Führerstrasse 4, A-3100 St. Pölten, Austria.
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Ghannane H, Lemaire JJ, Kemeny JL, Mendes-Martins V, Chazal J. Kyste lombaire hémorragique juxta-articulaire. Neurochirurgie 2006; 52:138-41. [PMID: 16840975 DOI: 10.1016/s0028-3770(06)71210-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report the case of a hemorrhagic lumbar juxta facet cyst (L2-L3), revealed by a chronic right lumbocruralgia, in a 77-year-old woman treated by anticoagulants for cardiac arrhythmia. Computerized tomography and magnetic resonance imaging suggested the diagnosis of benign tumor. During surgical removal of the whole lesion, a hemorrhagic synovial cyst was evoked. The operation dramatically relieved the symptoms. The diagnosis was confirmed by the histopathological analysis confronted with the clinical and the radiological findings. This uncommon observation allows the discussion of the pathogenic mechanism and of the differential diagnosis.
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Affiliation(s)
- H Ghannane
- Service de Neurochirurgie A, Hôpital Gabriel Montpied, Centre Hospitalier et Universitaire de Clermont-Ferrand
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Ramieri A, Domenicucci M, Seferi A, Paolini S, Petrozza V, Delfini R. Lumbar hemorrhagic synovial cysts: diagnosis, pathogenesis, and treatment. Report of 3 cases. SURGICAL NEUROLOGY 2006; 65:385-390. [PMID: 16531204 DOI: 10.1016/j.surneu.2005.07.073] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 07/08/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND To define the etiologic, clinical, histological, and surgical features of lumbar hemorrhagic synovial cysts (LHSCs). Three personal cases are reported together with a review of the pertinent literature. METHODS We identified 3 cases of LHSC treated in our departments and 20 cases culled from the literature. RESULTS A total of 23 cases of LHSC were selected. All the patients underwent surgical treatment because of untreatable radicular pain and/or neurological deficits. The amount of bleeding, either massive or minor but repeated, influenced the timing of surgery. In our cases, the histological examinations showed an inflammatory reaction within the cyst and the consequent formation of neoangiogenic vessels. CONCLUSIONS Hemorrhagic synovial cyst of the spine is rare and its most common localization is lumbar. Bleeding within the cyst leads to an increase of its volume, accompanied by neurological deficits and/or painful symptoms that are violent and generally intractable. In this event, surgical excision is the treatment of choice and, in some cases, emergency surgery is necessary. Hemorrhages are probably caused by the rupture of fragile neoangiogenic vessels.
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MESH Headings
- Adult
- Aged
- Back Pain/etiology
- Back Pain/physiopathology
- Back Pain/surgery
- Blood Vessels/pathology
- Blood Vessels/physiopathology
- Decompression, Surgical
- Female
- Hematoma, Epidural, Spinal/diagnosis
- Hematoma, Epidural, Spinal/etiology
- Hematoma, Epidural, Spinal/physiopathology
- Humans
- Laminectomy
- Leg/physiopathology
- Lumbar Vertebrae/pathology
- Lumbar Vertebrae/physiopathology
- Lumbar Vertebrae/surgery
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Muscle Weakness/etiology
- Muscle Weakness/physiopathology
- Neovascularization, Pathologic/etiology
- Neovascularization, Pathologic/physiopathology
- Radiculopathy/diagnosis
- Radiculopathy/etiology
- Radiculopathy/physiopathology
- Sciatica/etiology
- Sciatica/physiopathology
- Spinal Cord Compression/etiology
- Spinal Cord Compression/physiopathology
- Spinal Cord Compression/surgery
- Spinal Nerve Roots/pathology
- Spinal Nerve Roots/physiopathology
- Synovial Cyst/diagnosis
- Synovial Cyst/physiopathology
- Tomography, X-Ray Computed
- Treatment Outcome
- Zygapophyseal Joint/pathology
- Zygapophyseal Joint/physiopathology
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Khan AM, Girardi F. Spinal lumbar synovial cysts. Diagnosis and management challenge. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:1176-82. [PMID: 16440202 PMCID: PMC3233964 DOI: 10.1007/s00586-005-0009-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 08/25/2005] [Accepted: 10/16/2005] [Indexed: 12/15/2022]
Abstract
Sophisticated and newer imaging capabilities have resulted in increased reporting and treatment options of spinal lumbar synovial cysts (LSS). Most of the patients with lumbar cysts tend to be in their sixth decade of life with a slight female predominance. The incidence of LSS is thought to be less than 0.5% of the general symptomatic population. They may be asymptomatic and found incidentally or the epidural growth of cysts into the spinal canal can cause compression of neural structures and hence associated clinical symptoms. Most of the symptomatic LSS patients present with radicular pain and neurological deficits. Spinal synovial cysts are commonly found at L4-5 level, the site of maximum mobility. They may be unilateral or bilateral and at one or multilevel. MRI is considered the tool of choice for its diagnosis. The etiology of LSS is still unclear, but underlying spinal instability, facet joint arthropathy and degenerative spondylolisthesis has a strong association for worsening symptoms and formation of spinal cysts. Synovial cysts resistant to conservative therapy should be treated surgically. Resection and decompression with or without fusion and instrumentation remains an appropriate option. Synovial cysts may recur following surgery. The optimal approach for patients with juxtafacet LSS remains unclear. The best surgical treatment option for each particular individual should be tailored depending upon the symptoms, radiological findings and other co morbidities.
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Affiliation(s)
- Amir M Khan
- Orthopaedics, VA Medical Center, Bronx, NY 10468, USA.
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Khan AM, Synnot K, Cammisa FP, Girardi FP. Lumbar synovial cysts of the spine: an evaluation of surgical outcome. ACTA ACUST UNITED AC 2005; 18:127-31. [PMID: 15800428 DOI: 10.1097/01.bsd.0000156830.68431.70] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Our aim was to study the outcomes and results of surgically treated patients with synovial cysts of the lumbar spine in our institution. METHODS Retrospective data from 39 consecutive patients, treated during the period of December 1996 to August 2004, were analyzed. Twenty-eight men (70%) and 11 women (30%) of mean age 63.3 years were studied. All pre- and postoperative signs, symptoms, extension/flexion radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) with or without myelography were reviewed. All underwent surgery for synovial cysts with excision and decompression. Additional fusion in 26 patients was performed; 22 of them had degenerative spinal spondylolisthesis. Nine (23%) patients had prior decompression procedures, with three (8%) having had prior spinal instrumentation. Surgical outcomes were evaluated according to a questionnaire scoring system (scale of 1-4; 4 = excellent, 3 = good, 2 = fair, 1 = poor). Various preoperative attributes such as gender, age, weight, and height were analyzed to see if they had any effect on the outcome of surgery. Modified musculoskeletal outcomes data evaluation and management system (MODEM), questionnaire was provided to all; 24 (62%) responded. The following categories were determined: excellent (<20), very good (21-40), good (41-60), fair (61-80), and poor (81-100). Postoperative complications were also recorded. RESULTS All patients had pain in their lower extremities, with 62% experiencing pain bilaterally. Ninety-five percent had pain in their back and 36% in the buttocks (36%). Eighteen (46%) patients had CT myelography. A total of 42 cysts were found. Two patients had bilateral cysts at L4-L5 level. Histology revealed two hemorrhagic cysts. The average duration of surgery was 231 minutes (range 92-391 minutes), and a mean blood loss of 930 mL (range 200-2500 mL) was recorded. Two operative dural tears and one postoperative wound dehiscence were observed. One patient had a recurrent synovial cyst at the site of original surgery. Eight patients (four each in the fusion and nonfusion group) had junctional degeneration and symptoms. A regression analysis performed on age, height, weight, and gender showed that they were not determining factors of surgical outcome. Surgery of spinal cysts at L4-L5 segment produced good and those at L5-S1 and multilevel excellent results. Patients with spinal segment fusion had superior outcomes, with 80% having excellent or good outcomes versus approximately 70% without fusion. With the modified MODEM questionnaire, 22 of the 24 (92%) patients scored between excellent, very good, and good. Two patients scored in the fair range, and none of the 24 patients scored in the range of poor. CONCLUSIONS Spinal cysts are commonly found at the L4-L5 level, the site of maximum instability. MRI is the tool of choice for diagnosis. The etiology is still unclear, but underlying spinal instability has a strong association for formation of spinal cysts and worsening symptoms. Synovial cysts resistant to conservative therapy should be treated surgically. Resection and decompression with fusion remain an appropriate option. The optimal approach for patients with juxtafacet cysts remains unclear. The best surgical treatment approach for each particular individual appears to remain speculative.
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Affiliation(s)
- Amir M Khan
- Hospital for Special Surgery, New York, NY, USA.
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Brown C, Stambough JL. Epidural hematoma secondary to a rupture of a synovial cyst. Spine J 2005; 5:446-50. [PMID: 15996614 DOI: 10.1016/j.spinee.2005.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Accepted: 03/02/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTENT With modern advances in imaging studies, synovial cysts are becoming more evident as a common component of erosive lumbar degenerative disc disease causing spinal stenosis and radiculopathy. Whereas hemorrhage can occur inside the cyst and is reported, rupture causing epidural hematoma is a rare complication and finding of this disorder. PURPOSE To report a rare clinical presentation of a synovial cyst and spinal stenosis, where rupture of the cyst leads to an early cauda equina syndrome. STUDY DESIGN Case report with a review of literature. METHODS Clinical history, physical findings, and magnetic resonance imaging studies of a patient with an intraspinal synovial cyst at L4-5 1 week before a sudden worsening of symptoms are reported. RESULTS A case report is presented of a male with a known synovial cyst at L4-5, presenting initially with neurogenic claudication. This patient developed sudden worsening of symptoms with bilateral lower extremity pain, weakness, and radiculopathy with difficult voiding. The patient had developed an epidural hematoma, secondary to rupture of a synovial cyst, documented at surgical decompression. CONCLUSIONS Although synovial cyst associated with erosive facet and erosive degenerative disc disease are common, rupture of the cyst is not. A case report of a ruptured synovial cyst leading to an early cauda equina syndrome is presented. This case illustrates the spectrum of clinical features and presentations possible with spinal stenosis complicated by lumbar synovial cyst formation.
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Affiliation(s)
- Christopher Brown
- University of Cincinnati, College of Medicine, 231 Albert B. Sabin Way, Cincinnati, OH 45267, USA
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Eck JC, Triantafyllou SJ. Hemorrhagic lumbar synovial facet cyst secondary to anticoagulation therapy. Spine J 2005; 5:451-3. [PMID: 15996615 DOI: 10.1016/j.spinee.2005.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2004] [Accepted: 01/04/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT Acute onset of radicular symptoms has been reported following hemorrhage into lumbar synovial cysts after trauma or in cases of spinal instability. No previous cases have been linked to anticoagulation therapy. PURPOSE To present a case of symptomatic hemorrhagic lumbar synovial cyst occurring after anticoagulation therapy. STUDY DESIGN A case report and review of the literature. METHODS A patient presented with low back and radicular pain secondary to a large synovial facet cyst. Magnetic resonance imaging revealed a large facet cyst compressing the thecal sac and L3 exiting nerve root. RESULTS The synovial cyst was excised during a lumbar decompression and fusion. Gross blood was present in the cyst. CONCLUSIONS This is the first reported case of symptomatic hemorrhagic lumbar facet cyst associated with anticoagulation therapy.
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Affiliation(s)
- Jason C Eck
- Department of Orthopaedic Surgery, Memorial Hospital, 325 S, Belmont Avenue, York, PA 17403, USA.
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Indar R, Tsiridis E, Morgan M, Aldham CH, Hussein AA. Intraspinal lumbar synovial cysts: diagnosis and surgical management. Surgeon 2005; 2:141-4. [PMID: 15570815 DOI: 10.1016/s1479-666x(04)80074-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lumbar synovial cysts are a common association of facet joint degenerative disease. However, it is relatively rare for these cysts to cause symptoms of radiculopathy and nerve root compression. PATIENTS AND METHODS We report a series of eight cases which were treated over a period of 20 months. There were five female and three male patients with a mean age of 66 years, and an average follow-up of seventeen months. All patients had pre-operative flexion/extension radiographs and MRI scans. Two patients had failed non-surgical treatment, two were associated with a Grade 1 spondylolisthesis, and all were associated with facet joint arthropathy. There were five cases occurring at L4/5 and three at L5/S1. RESULTS All patients underwent identical procedures, which involved exploration, hemi-laminotomy, flavectomy and minimal facet joint excision. No patient required posterior lumbar interbody fusion and at follow-up five patients had excellent and three had good results.
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Affiliation(s)
- R Indar
- Department of Trauma and Orthopaedics, Princess Alexandra Hospital, Harlow, Essex, UK.
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Asamoto S, Jimbo H, Fukui Y, Doi H, Sakagawa H, Ida M, Takahashi M, Shiraishi N. Cyst of the Ligamentum Flavum-Case Report-. Neurol Med Chir (Tokyo) 2005; 45:653-6. [PMID: 16377956 DOI: 10.2176/nmc.45.653] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An 86-year-old man presented with intermittent claudication caused by a cyst of the ligamentum flavum. Lumbar magnetic resonance imaging demonstrated an extradural cystic mass at the L5-S1 intervertebral space and canal stenosis at the L4-5 space. L-5 laminectomy and flavectomy at the L4-5 and L5-S1 spaces were performed, and the cystic mass was excised. The histological features were consistent with cyst of the ligamentum flavum. The histological diagnosis was ganglion cyst of the ligamentum flavum. After surgery, claudication completely disappeared and the patient made a good recovery.
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Affiliation(s)
- Shunji Asamoto
- Spine and Spinal Cord Center, Tokyo Mita Hospital, International University of Health and Welfare, Japan.
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Abstract
OBJECT Thoracic synovial cysts (TSCs) are rare and are usually the subject of case reports. The authors studied the clinical manifestations, radiological aspects, and surgical treatment in a series of patients at their institution who harbored TSCs. They also review the literature to discuss the potential factors involved in the pathogenesis of this lesion. METHODS A database search of 16,000 patients who underwent decompressive spine surgery at the Mayo Clinic (Rochester, MN) between 1976 and 2003 disclosed nine patients (0.06%) in whom a diagnosis of TSC had been made. All patients were men. The mean age at presentation was 73 +/- 5 years and mean duration of symptoms was 5 +/- 3 months. The mean duration of follow up was 4 +/- 3 years. The patients had no history of trauma or spine surgery. All patients had spastic paraparesis; two had urinary difficulties. Detailed neurological examination revealed myelopathy and radiculopathy with a sensory level of T10-L4. Magnetic resonance imaging revealed bilateral cysts in four patients and unilateral lesions in five. Three of the cysts were at the T-10 interspace, seven at the T-11 interspace, and three at the T-12 interspace. Seven cysts were on the right and six were on the left. Computerized tomography myelography performed in five patients revealed a gas bubble in the TSC in two patients. All patients underwent laminectomy/partial facetectomy, excision of the cyst, and decompression of the thecal sac and nerve root without any complications. None of these patients underwent a fusion. Eight patients (89%) experienced moderate to excellent relief of their preoperative signs and symptoms and one patient (11%) remained stable. There was no evidence of cyst recurrence at the site of surgery or other spinal segments at follow-up examination in any patient. CONCLUSIONS When compared with their lumbar and cervical spine counterparts, TSCs are exceedingly rare. Their rarity may be explained by the decreased mobility of the thoracic spinal segments. The origin of TSCs is more likely degenerative rather than traumatic. Based on their experience and the follow-up duration, surgery provided durable relief from symptoms.
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Affiliation(s)
- Aaron A Cohen-Gadol
- Departments of Neurologic Surgery and Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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Epstein NE. Lumbar laminectomy for the resection of synovial cysts and coexisting lumbar spinal stenosis or degenerative spondylolisthesis: an outcome study. Spine (Phila Pa 1976) 2004; 29:1049-55; discussion 1056. [PMID: 15105680 DOI: 10.1097/00007632-200405010-00018] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN Surgeon- and patient-based (SF-36) outcome measures were used to assess the results of decompressive laminectomies for the excision of synovial cysts with coexistent lumbar spinal stenosis (45 patients) or for synovial cysts with coexistent lumbar stenosis and degenerative spondylolisthesis (35 patients). OBJECTIVES To evaluate the results following laminectomy and the excision of synovial cysts/stenosis with or without olisthy. SUMMARY OF BACKGROUND DATA SF-36 outcome studies evaluating these surgical results deserve further investigation. METHODS Before surgery, patients with synovial cysts/ stenosis (45 patients) or cysts/stenosis/degenerative spondylolisthesis (35 patients), respectively, exhibited low back pain (40 and 33 patients), radiculopathy (43 and 33 patients), and neurogenic claudication (41 and 26 patients). Surgery required average 3.8 and 3.5 level laminectomies, respectively, for patients with cysts/stenosis and cysts/stenosis and olisthy. Outcomes were assessed 2 years after surgery. RESULTS Five of 45 patients undergoing laminectomy alone for cysts/stenosis developed postoperative olisthy. Of 35 patients with cysts/stenosis and preoperative Grade 1 degenerative spondylolisthesis, olisthy increased after surgery to Grade 2 in 11 patients. Good/excellent results (58% and 63%) and SF-36 improvement on the Physical Function Scale (+44 and +38 points) were, respectively, documented for these two groups. CONCLUSIONS Using both surgeon and SF-36 outcome measures, 2 years following laminectomy for synovial cysts/lumbar stenosis with or without olisthy, patients exhibited a moderate degree of improvement. As synovial cysts reflect disruption of the facet joint and some degree of instability, primary fusion should be considered to improve operative results for patients in both categories.
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Affiliation(s)
- Nancy E Epstein
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
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Wang YY, McKelvie P, Trost N, Murphy MA. Trauma as a precipitant of haemorrhage in synovial cysts. J Clin Neurosci 2004; 11:436-9. [PMID: 15080968 DOI: 10.1016/j.jocn.2003.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2003] [Accepted: 04/07/2003] [Indexed: 10/26/2022]
Abstract
Synovial cysts have been well reported as a cause of sciatica, with a sudden acute exacerbation being attributed to haemorrhage and subsequent enlargement of the cyst. Cyst formation is attributed to facet joint degeneration associated with a defect or rupture of the joint capsule. The mechanisms of haemorrhage have not been well described previously. Two cases of haemorrhagic synovial cysts causing acute exacerbation of sciatica are described. Both cases were directly attributable to manipulation of degenerate spines. The MRI and histopathological findings are discussed and we propose a mechanism whereby excessive stress on a degenerate revascularized synovium leads to haemorrhage within synovial cysts.
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Affiliation(s)
- Y Y Wang
- Department of Neurosurgery, Pathology and Radiology, St. Vincents Hospital, Melbourne, Vic., Australia
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