Abstract:BackgroundIntraspinal synovial cysts of vertebral facet joints are uncommon cause of radicular pain as well as neurological deficits. They can be managed both conservatively and surgically.Case reportA 77-year old polymorbid patient presented with bilateral low back pain which worsened during the course of time and did not respond to the conservative treatment. A diagnosis of intraspinal synovial cyst was made using the magnetic resonance imaging (MRI). Percutaneous computed tomography (CT) guided injection wi… Show more
“…20,75 Nevertheless, noninvasive treatment is an option in cases of severe illness or other contraindications for surgery. 45,97 As shown in the present series, excision of the cyst and decompression of neural structures is effective; can be performed with low risk; and leads to immediate, dramatic pain relief and improvement of the symptoms in the majority of cases. 12,24,28,34,53,75,81,87,101 Various techniques for cyst resection have been described.…”
Section: Treatment Optionsmentioning
confidence: 55%
“…If rupture of the cyst via fluoroscopic percutaneous corticosteroid injection is targeted and accomplished, success rates can be increased. 2,4,15,45,60,72 Amoretti et al 4 recorded durable results in 75% of 120 patients after 1 year. Martha et al 60 reported a cyst rupture rate of 81% in 101 patients, but 54% required surgical intervention within 1 year.…”
OBJECTIVESynovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery.METHODSA total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors’ department were analyzed. 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, or poor based on the Macnab classification.RESULTSThe approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation.CONCLUSIONSSurgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion.
“…20,75 Nevertheless, noninvasive treatment is an option in cases of severe illness or other contraindications for surgery. 45,97 As shown in the present series, excision of the cyst and decompression of neural structures is effective; can be performed with low risk; and leads to immediate, dramatic pain relief and improvement of the symptoms in the majority of cases. 12,24,28,34,53,75,81,87,101 Various techniques for cyst resection have been described.…”
Section: Treatment Optionsmentioning
confidence: 55%
“…If rupture of the cyst via fluoroscopic percutaneous corticosteroid injection is targeted and accomplished, success rates can be increased. 2,4,15,45,60,72 Amoretti et al 4 recorded durable results in 75% of 120 patients after 1 year. Martha et al 60 reported a cyst rupture rate of 81% in 101 patients, but 54% required surgical intervention within 1 year.…”
OBJECTIVESynovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery.METHODSA total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors’ department were analyzed. 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, or poor based on the Macnab classification.RESULTSThe approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation.CONCLUSIONSSurgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion.
“…The potential indications for using the DSS under sonography guidance are vast, ranging from joint injections, 5 , 6 conservative treatment of ganglion cysts ( Figure 3 ) 19 and Baker cyst in particular, 10 bursitis, 20 to rare pathology like intra-neural ganglion cyst 21 or intra-spinal synovial cyst 22 , 23 and many other clinical situations that require an aspiration/injection procedure. Figure 3 Technique presentation for aspiration/injection procedure of a wrist synovial cyst; ( A ) approach and needle placement was done after understanding local anatomy with sonography, with wide skin preparation and sterile technique under local anesthesia; ( B ) aspiration of cyst content; ( C ) injection of corticosteroid after aspiration is completed; ( D ) 6 week follow-up visit with clinical assessment (patient used compressive bandage during activities after the procedure).…”
Section: Discussionmentioning
confidence: 99%
“…The potential indications for using the DSS under sonography guidance are vast, ranging from joint injections, 5,6 conservative treatment of ganglion cysts (Figure 3) 19 and Baker cyst in particular, 10 bursitis, 20 to rare pathology like intra-neural ganglion cyst 21 or intra-spinal synovial cyst 22,23 and many other clinical situations that require an aspiration/ injection procedure. The technique described brings many advantages and benefits to the field of MSK injections.…”
Introduction
Diverse musculo-skeletal pathology can be treated conservatively by different types of injections and in most cases, results are significantly better if the existing inflammatory fluid is aspirated prior to injection of medication solutions. The present study analyses an original technique which uses infusion therapy accessories to create two types of closed sterile double syringe systems, and compares the benefits of using such a system in aspiration/injection procedures to classic aspiration injection technique that implies changing and connecting multiple syringes to the same needle, thus increasing the risk for septic complications. The aim of the present study is to minimize therapeutic risk of iatrogenic septic complications during aspiration/injection procedures.
Methods
1024 patients underwent aspiration/injection procedures in our clinic using the double syringe system between 2015 and 2020. During the early stages of the study, the second type of assembly was rendered impractical so the study continued with analyzing a single type of double syringe system using a three way infusion therapy device which is readily available, and allows the assembly of a closed sterile system with a single, two-step procedure technique. Iatrogenic local septic complications were followed by means of a six week clinical follow-up evaluation with additional investigations only if necessary.
Results
In 1024 procedures we report 0% incidence of iatrogenic septic complications, or other types of complications and recommend this technique in a vast array of rheumatic, orthopedic or traumatic conditions that require aspiration/injection procedures.
Discussion
The double syringe system is practical, easy to use, it completely eliminates the risk of iatrogenic infection due to manipulation errors, and significantly simplifies the technique for sonography guided aspiration/injection procedures for musculo-skeletal pathology.
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