Elsevier

World Neurosurgery

Volume 108, December 2017, Pages 555-559
World Neurosurgery

Original Article
Minimally Invasive Versus Open Surgery for Lumbar Synovial Cysts

https://doi.org/10.1016/j.wneu.2017.09.039Get rights and content

Objective

Lumbar synovial cysts are relatively infrequent. Historically, these benign lesions have been treated with open excision, sometimes associated with fusion. The aim of this study is to compare minimally invasive surgery (MIS) with open surgery (OS) for the treatment of lumbar synovial cysts.

Methods

This was a retrospective review of patients who underwent minimally invasive or open excision of lumbar synovial cysts. Clinical outcomes, recurrence rate, and surgical complications were compared in the 2 groups.

Results

A total of 37 cases were identified, of which 24 were MIS and 13 were OS. MIS was significantly more effective in improving leg pain and radicular symptoms. There was no statistical difference between the 2 groups with regard to improvements of back pain and neurogenic claudication. Postoperative length of hospital stay and postoperative pain were significantly reduced in the MIS group (15 hours vs. 24 hours and 0.9/10 vs. 4.7/10 respectively, P < 0.5). There were no statistical differences in duration of surgery, intra- or postoperative complications, no recurrence of cyst in either of the 2 groups, and no patients required fusion at a later stage.

Conclusions

In this study, MIS for the treatment of lumbar synovial cysts appears to be more effective than OS in relieving radicular symptoms. Furthermore, MIS is better tolerated by patients and is potentially cost saving for the Health Service, due to the reduction in hospital stay and the reduced requirement for painkillers.

Introduction

Synovial cysts in the spine arise from the synovia as a result of degenerative changes of the facet joints. The most common area of presentation is the lumbar spine (91.7%), whereas they are located rarely in the cervical (6.6%) and thoracic (1.7%) spine.1 As a result of nerve root compression or lumbar canal stenosis, they can cause back pain, neurogenic claudication, and radiculopathy.2, 3, 4, 5, 6 Although nonsurgical treatments, such as aspiration and corticosteroid injection, have been described as effective options,7, 8, 9 surgical resection generally is considered a more definitive treatment.3 Surgery classically has been performed via open laminectomy. More recently, due to the increasing popularity of minimally invasive surgery (MIS), a few reports of lumbar synovial cysts removed via such an approach have been published.3, 5, 10, 11, 12, 13, 14 However, no studies have compared MIS and open surgery (OS) for the treatment of lumbar synovial cysts so far, which is the objective of this study.

Section snippets

Materials and Methods

A retrospective review of clinical notes and radiologic scans was performed. Thirty-seven patients who underwent excision of lumbar synovial cysts were identified between 2011 and 2016. Revision or reoperation cases were excluded from the study. The patients were divided into 2 groups: MIS (24 cases) and OS (13 cases). Clinical notes were reviewed to record hospital stay, postoperative pain, and perioperative complications. Outpatient clinic letters were reviewed to assess follow-up and

Results

Of the 37 patients included in the study, 1 was lost to follow-up. The mean follow-up was 9.4 months in the MIS group (range 3–48 months) and 14.9 months in the OS group (range 3–48 months). The main presenting symptoms were leg pain, back pain, neurogenic claudication, buttock pain, and sensory disturbance. The demographics showed an even sex spread, with 19 men and 17 women. The average age was 68 years (range 47–84 years). Most of the synovial cysts were found at the L4–L5 level (64.8%;

Discussion

Because of the increasing numbers of patients with back symptoms having magnetic resonance imaging scans, synovial cysts are an increasingly detected cause of radicular pain, back pain, and neurogenic claudication, with a prevalence of 2.3% in a series of 303 symptomatic patients.16 Synovial cysts are more common at L4–L5 level, which is the area of maximum movement in the lumbar spine.5, 17 There are well-documented cases of synovial cysts resolving spontaneously. Management options for

Conclusions

This is the first comparative series between MIS and OS for the treatment of lumbar synovial cysts. Although both techniques have shown similar outcomes and complication rates, MIS seems to be more effective in improving leg symptoms and better tolerated by the patients.

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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