Article
Synovial cysts of the lumbar spine – long-term results of minimal invasive surgery in a series of 141 patients
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Authors
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Markus Bruder
- Neurochirurgische Klinik, Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany
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Adriano Cattani
- Neurochirurgische Klinik, Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany
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Christian Droste
- Neurochirurgische Klinik, Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany
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Volker Seifert
- Neurochirurgische Klinik, Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany
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Gerhard Marquardt
- Neurochirurgische Klinik, Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Synovial cysts of the spine are a relatively rare lesion predominantly arising in the lumbar region. Despite their generally benign behaviour, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. We performed a single center survey focusing on long-term results after minimal invasive surgery.
Method: 141 consecutive patients treated surgically due to synovial cyst of the lumbar spine between 1999 and 2014 in our department were analysed. 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, and poor based on the Mac Nab classification.
Results: The most often used approach for synovial cyst treatment was extended interlaminar fenestration in 72.6%, hemilaminectomy was necessary in the remaining 27.4%. At short-term follow-up, presence of severe and moderate leg pain has decreased from 97.8% to 5%. Presence of low back pain decreased from 90.7% to 5.7%. Rates of motor and sensory deficits were reduced from 40.4% to 14.9% and 45.4% to 12.7%, respectively. Follow-up rate was 70.9% and mean follow-up period was 90 months. Each, leg pain and lower back pain was still absent in 76.5%. Outcome was excellent in 77.5%, good in 15%, fair in 2.5% and poor in 5.1%. According to ODI, 87.2% of patients had no or only minimal disability, 16.7% moderate and 5.1% severe disability at the time of follow-up. 4.8% necessitated operation due to recurrent cyst and 6% required stabilization procedure after initial operation.
Conclusions: Symptomatic synovial cysts of the lumbar spine can be sufficiently treated with minimal invasive surgery. Even though some patients need further surgical treatment, the number of patients necessitating stabilization procedures is low and the profit from surgery is maintained beyond the usual postoperative observation period. Thus, ultimate outcome at long-term follow-up is very gratifying in the vast majority of patients.
