gms | German Medical Science

Objective: The ongoing aging of the society leads to a rising number of patients with degeneration of the spine. Synovial cysts of the spine are strongly associated with degenerative changes, and treatment decision can be challenging especially in the elderly due comorbidities.

Methods: Patients treated between 1999 and 2014 due to spinal synovial cysts in our department were screened. 28 patients were ≥75 years and classified as “the elderly”. Those were compared to 96 patients which were between 50 and 74 years of age. Medical reports regarding signs and symptoms, operative findings, complications, and postoperative status were reviewed. None patient was fused within cyst resecting procedure. Outcome was assessed according to Oswestry Disability Index (ODI) and Macnab classification. Mean follow up period in the elderly was 67 ±59 month and 79 ±54 month in the control group.

Results: Despite a significant lower frequency of muscle reflex changes in the elderly (p<0.05), lumbago, radicular pain and sensory deficits were less often - motoric deficits were more often present at initial presentation in the elderly than in the control group but not on a significant level. Cyst levels, rate of complications and surgical method did not differ between both groups. The cyst was more often adherent to the dura in the elderly and significantly more often parts of the cyst were left behind (16% vs. 2%; p<0.05). Postoperative examination revealed dramatic improvement of lumbago and radicular pain, and significant improvement of sensory and motor deficits and motor reflex changes in both groups. Outcome according to Macnab was “excellent or good” slightly less often in the elderly than in the control group (82% vs. 89%; p=0.3). Based on ODI, outcome in the elderly group (vs. control group) was classified as “no disability” in 39% (vs. 51%), “minimal disability” in 46% (vs. 31%), “moderate disability” 11% (vs. 14%) and “severe disability” in 4% (vs. 4%). None of the patients was classified as crippled or bed bound. Recurrent cyst and delayed fusion rates in the elderly were low (4% and 4%), and lower compared to the control group with a recurrence rate of 7% and delayed fusion rate of 8% respectively.

Conclusion: Clinical course of elderly patients with spinal synovial cysts does not differ compared to younger patients. Good or excellent results can be achieved and persisted for a long time in more than 80% with microsurgical resection without initial fusion. The higher rate of subtotal cyst removal due to dural adherence, enables low CSF fistula rates without increasing the rate of recurrent cysts.