Decompressive laminectomy without fusion for lumbar facet joint cysts

Siu, Kevin C.; Stoodley, Marcus A.

doi:10.1016/j.jocn.2018.09.013

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…(1) Retrospective studies of laminectomy alone have reported a generally low cyst recurrence rate and low reoperation rate that were comparable across institutions (up to 9%-13%). 1,5,7,8,28 However, a number of previous studies including randomized controlled studies, as well as this study, compared between these 2 groups and reported lower reoperation rate in the LF group, with as low as 0% cyst recurrence rate. 5,8,29,30 (2) Improvements of surgical procedures may help preserve stability after laminectomy and further reduce the needs for subsequent fusions, such as the facet-sparing techniques, 1 cyst location–dependent excision approach, 20 and minimally invasive surgery.…”

Section: Discussionmentioning

confidence: 58%

“…In the past decade, multiple case series and retrospective studies of patients with lumbar synovial cyst have reported clinical outcomes with 1 to 10 years of follow-up timeframe after different surgical treatments, namely, laminectomy or decompression alone, laminectomy with cyst excision, LF, and minimally invasive spine surgeries. 1,5,[7][8][9][18][19][20] The debate on whether fusion is needed in initial surgical management remains, and studies using larger cohorts were warranted. Therefore, to the best of our knowledge, we reported with the largest cohort of matched patients (n = 3843) using the IBM MarketScan CCAE Database.…”

Section: Discussionmentioning

confidence: 99%

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Lumbar Synovial Cysts—Should You Fuse or Not?

Gonzalez

Corso

Kothari³

et al. 2022

Neurosurgery

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BACKGROUND:Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown.OBJECTIVE:To test the hypothesis that select patients who underwent decompression with instrumented fusion for lumbar synovial cysts would be less likely to have subsequent surgery (SS) in a 2-year period than patients treated with laminectomy alone.METHODS:This retrospective cohort study was performed using IBM MarketScan Commercial Claims and Encounters Database. Patients who had a lumbar synovial cyst diagnosis and laminectomy surgery with or without fusion surgery were included in this study. Patients were tracked for SS 2 years after surgery. Laminectomy patients were propensity score–matched to laminectomy with fusion (LF) patients using a 2:1 ratio. The log-rank test and Cox regression were used to compare the cumulative incidence of SS between groups.RESULTS:There were 7664 and 1631 patients treated with laminectomy and LF before matching. After matching, there were 2212 laminectomy and 1631 LF patients and patient characteristics were balanced. The 2-year incidence of recurrent SS was 3.1% ([CI]: 2.2%, 4.0%) and 1.7% (95% CI: 0.9%, 2.5%) laminectomy and LF, respectively. Compared with laminectomy, LF had a statistically significant lower risk of recurrent SS (hazard ratio: 0.56 [95% CI: 0.32-0.97]; P-value: .04).CONCLUSION:All patients who had concomitant lumbar fusion showed decreased chance of having a cyst- or noncyst-related recurrence SS when compared with all patients undergoing laminectomy alone, regardless of diagnosis at the time of SS.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Lumbar Synovial Cysts—Should You Fuse or Not?

Gonzalez

Corso

Kothari³

et al. 2022

Neurosurgery

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“…Neural elements' decompression by performing an instrumented fusion must be taken into account in patients suffering from spondylolisthesis and/or facet arthrosis [ 9 ], since it decreases the risk of recurrence, even though it increases perioperative morbidity and procedure-related complications (dural tear, pseudarthrosis, infections) [ 21 ]. Fixation is recommended depending on whether there is instability and the outcomes of cyst recurrence, to decrease pain and to improve the patient's functionality [ 4 – 6 , 9 – 12 , 14 , 16 , 17 , 19 , 22 ]. Campbell et al [ 23 ] proposed a different classification based on the percentage of canal compression and the grade of spondylolisthesis, by studying standing lateral radiographs and MR scans.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

Ruiz-Picazo

Ramírez-Villaescusa

Verdejo-González

2020

Case Reports in Orthopedics

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Introduction. Spinal synovial cysts (SSCs) constitute an uncommon degenerative lesion of the spine. They are usually asymptomatic but they may also cause symptoms of variable severity. SSCs are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy, and neurological deficit. There are different treatment options that range from conservative management to interventions like image-guided epidural steroid injection or direct cyst puncture and finally to open or endoscopic spinal canal decompression and spinal bone fusion with/without instrumentation. A discussion of current management options for this unusual disease is presented. Material and Methods. A 52-year-old female patient presented with low back pain and left leg pain. Plain radiography demonstrated instability at the L4-L5 level. Magnetic resonance images (MRIs) revealed a bilateral cystic lesion at the L4-L5 level with associated instability and degenerative disc disease at the level L5-S1. Initially, conservative treatment was performed by aspiration of the left cyst and infiltration with corticosteroids with improvement of the pain for 1 year. After this period, the radicular and the low back pain reoccurred. Results. Following leg pain recurrence, a hybrid L4-S1 fusion was performed. After surgery, there was clinical improvement and six months later, the patient returned to daily activities. The radiological study after five-year follow-up shows adequate implant position, without signs of loosening, compatible with solid fusion. Conclusion. After reviewing the literature, the optimal management for patients with symptomatic lumbar synovial cyst must be very individualized, which is essential to achieve a favorable outcome.

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“…(1 month-13 years); only 2 (4.3%) later required fusions. [6] In 2018, Epstein successfully treated an elderly male with large bilateral L3-L4 synovial cysts filling the canal, along with grade I L3-L4 spondylolisthesis (static on dynamic X-rays), and L2-L4 stenosis; this was successfully treated with L2-L4 laminectomy for decompression of stenosis and bilateral L3-L4 synovial cyst excision without fusion. [4] When Hohenberger et al .…”

Section: Discussionmentioning

confidence: 99%

Case of the Week: Preoperative MR/CT Diagnosis of Left L2-L3 Disc Surgically Documented As Massive Synovial Cyst

Epstein¹

2019

Surgical Neurology International

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Background: The diagnosis of a lumbar herniated disc, stenosis, and other degenerative findings are typically established preoperatively with MR scans, supplemented with non-contrast CT studies. Here, a 77-year-old female, diagnosed as having L2-S1 stenosis and a large left-sided L2-L3 herniated disc was found at surgery to have a massive left-sided L2-L3 synovial cyst. Case Description: A 77-year-old female was followed by pain management for 6-months with proximal left lower extremity weakness. The lumbar MR at that time was read as demonstrating a large left L2-L3 disc herniation with inferior migration to the L3 mid pedicle level, accompanied by L2-S1 lumbar stenosis. When she finally consulted neurosurgery, she exhibited severe left iliopsoas and quadriceps weakness (2/5), absent lower extremity reflexes, and profound decreased pin appreciation in the left L2-L3 distributions. The repeat MR and new CT studies confimred a large left L2-L3 disc accompanied by moderate/marked L2-S1 stenosis. However, at surgery, consisting of a laminectomy L2-S1, the supposed left L2-L3 disc proved to be a massive synovial cyst. Postoperatively, the patient regained normal function, and remained neurologically intact 6 months later. Conclusion: In this 77 year-old female, the preoperative MR and CT scans were interpreted as showing a “typical” large left L2-L3 herniated disc. This proved at surgery to be a massive left L2-L3 synovial cyst. As demonstrated in this case, older patients with degenerative lumbar disease/stenosis, may have synovial cysts that mimic disc herniations both clinically and on preoperative diagnostic studies.

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Decompressive laminectomy without fusion for lumbar facet joint cysts

Cited by 8 publications

References 14 publications

Lumbar Synovial Cysts—Should You Fuse or Not?

Lumbar Synovial Cysts—Should You Fuse or Not?

An Unusual Case of Radicular Pain Caused by Bilateral Lumbar Synovial Cyst: A Case Report and Review of the Literature

Case of the Week: Preoperative MR/CT Diagnosis of Left L2-L3 Disc Surgically Documented As Massive Synovial Cyst

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