gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Are lumbar synovial cysts a sign of segmental instability? A clinical evaluation in 40 patients

Meeting Abstract

  • Martin Merkle - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Gottlieb Maier - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Marcos S. Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Florian Roser - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1797

DOI: 10.3205/10dgnc268, URN: urn:nbn:de:0183-10dgnc2689

Published: September 16, 2010

© 2010 Merkle et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Lumbar synovial cysts are frequently associated with segmental degenerative changes. Radiculopathy is the leading clinical presentation. However signs of instability are frequently present or arise after surgical decompression. We evaluate a series of patients with lumbar synovial cysts to elucidate if all patients need spinal fusion as primary treatment or if decompression is sufficient for a subset of patients.

Methods: Retrospective data of 40 patients treated during January 2004 to August 2009 were analysed (26 males, 24 females). All patients underwent a complete microsurgical resection of the synovial cyst by an interlaminar approach and a partial facetectomy. Fourteen patients showed additional degenerative spinal spondylolistesis requiring instrumentation in eight cases. The pre- and postoperative symptoms and imaging studies were reviewed.

Results: Most of the synovial cysts were at level L4/5. We found a strong correlation between degenerative spinal spondylolistesis and occurrence of synovial cysts. All patients presented with radiculopathy and local back pain, with 25% having neurological deficits. Postoperatively in thirty-four patients radiculopathy resolved, whereas back pain persisted in over 80%. These patients required secondary spinal fusion, reporting then about a marked remission of local back pain.

Conclusions: According to the literature the aetiology of synovial cysts is still unclear. However there seems to be a strong association for the development of a synovial cyst and spinal segmental instability. We can provide evidence that primary spinal fusion after resection of synovial cysts provides a better outcome.