Juxtafacettenzysten als raumfordernde intraspinale Prozesse

Abstract

Ganglionic and synovial cysts (juxta-facet cysts) causing nerve root compression are very rare. Magnetic resonance imaging is the best means of diagnosis. The treatment of choice is surgical removal of the cysts, though spontaneous remissions do occur. CT-guided aspiration of the cysts and corticosteroid injection can lead the symptoms to disappear, but only for a short time. In a retrospective study covering a period of 16.5 years, we discovered 24 juxta-facet cysts (10 ganglionic and 14 synovial cysts) with clinical symptoms in a total of 19,107 lumbar and thoracic operations performed to relieve nerve root compression: 16 cysts were located at the level L4-5,3 at the level L5-S1,2 at L3-4, and 1 each at the levels L2-3, L1-2, and T10-1. Seven patients complained of radicular pain, and the other 17 patients also had neurological deficits. Fourteen cysts were resected, and in 10 cases the lumbar disc was removed simultaneously. The average follow-up in 23 of the 24 patients was 26.6 months. Most (74%) of the patients became free of pain. Pareses disappeared in 89% and sensory deficits in 73% of cases.

Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience

“…Many authors have described these lesions and recognized their propensity to cause nerve root and cauda equina compression. 1,3,4,7,10,11,13,19,25,28,30,32,33,[37][38][39][40][41][42][43]46 Initially thought to be uncommon, 3,4,9,11,19,32,37,38,43,46 synovial cysts have been more recently reported as increasingly recognized causative agents of lumbosacral radicular and/or claudicatory pain. 37,39,41 Refinements in neurodiagnostic imaging and the advent of MR imaging have markedly enhanced the preoperative identification of these lesions.…”

“…The advent of MR imaging has markedly improved diagnostic capability and is currently the imaging modality of choice. 3,15,38 Much debate remains regarding the cause of synovial cysts. Traumatic injury 17,19,25,27,29,40,44,45 and segmental instability 5,12,37,41,43,46,47 are the most often cited potential causative factors for the development of synovial cysts.…”

“…19,29,32,42,35 The most common level for synovial cysts of the lumbar spine in this study was L4-5, and this is consistent with other reports. 3,37,41 Onofrio and Mih 37 have reported their series of 12 patients with lumbar synovial cysts, of whom eight had preoperative spondylolisthesis at the site of the cyst and two developed increased spondylolisthesis. They did not perform fusion procedures in any of those patients and the patients remained asymptomatic.…”

MR imaging of lumbar facet joint synovial cysts

“…The literature indicates a minor female preponderance of 53 % with an age range of 16±81 years (mean age 57 years) [1,2,5,6,7,8,9,10,11,12,13,14,15,16,17]. A review of 26 published cases showed a female predominance of 66 % [17].…”

“…In the third case the bilaterally located cyst was identified 1 year later at the same level. In a total of 137 cases culled from the literature, 68 % arose at L4/5, 15 % at L5/S1, 12 % at L3/4 and 5 % at more proximal levels [2,5,6,8,10,11,12,14,15,22,25]. Few reports specifically mention the side of the cyst.…”