Elsevier

World Neurosurgery

Volume 110, February 2018, Pages e520-e525
World Neurosurgery

Original Article
Surgical Treatment of Spinal Synovial Cysts in Elderly Patients: Symptoms, Treatment Course, and Outcome in Patients >75 Years of Age

Parts of this article were presented as an oral presentation within a plenary session at the 68th Annual Meeting of the German Society of Neurosurgery (DGNC) on May 16, 2017, in Magdeburg, Germany.
https://doi.org/10.1016/j.wneu.2017.11.031Get rights and content

Background

With the aging of our society comes a rising number of elderly patients with progressive degeneration of the spine associated with synovial cysts. Surgical treatment may be particularly challenging in elderly patients because of comorbidities.

Methods

Patients treated in our department between 1999 and 2014 for spinal synovial cysts were screened. The 28 patients ≥75 years old were classified as elderly and were compared with 96 patients 50–74 years old. No patient underwent fusion as part of cyst resection.

Results

Despite a significantly higher frequency of muscle reflex changes in elderly patients at presentation, symptoms, cyst levels, rate of complications, and surgical method were not different between groups. Cyst adherence to the dura and subtotal resection were observed significantly more often in the elderly group (18% vs. 3%; P < 0.05). Outcome according to the Oswestry Disability Index was classified as no disability or minimal disability in 85% of the elderly group and in 82% of the control group. Recurrent cyst and delayed fusion rates were lower in the elderly group (4% and 4%) compared with the control group (7% and 8%).

Conclusions

The clinical course of elderly patients with surgical treatment of spinal synovial cysts did not differ compared with younger patients. Good or excellent results could be achieved and persisted for a long time in most cases. Fusion should be performed only in cases of severe instability. Nonaggressive cyst removal in cases of dural attachment enables low cerebrospinal fluid fistula rates without increasing cyst recurrence rates.

Introduction

With the aging of our society, degeneration of the musculoskeletal system is increasingly the focus of surgical treatment, especially in regard to spinal disorders. Cystic joint adjacent lesions are a known problem of degeneration that were first described by Baker in 1877.1 Cystic lesions adjacent to joints of the spinal column, which were first described by Vosschulte and Borger in 1950,2 usually manifest with nerve root compression or stenosis of the spinal canal. The pathogenesis of these cysts is still a matter of discussion, but degeneration and destabilization seem to be common to all explanations.3, 4, 5 As conservative treatment options, such as physiotherapy, corticosteroid injection, percutaneous cyst rupture, and aspiration, do not sustain durable effects,6, 7, 8, 9 surgical resection of the cyst and decompression of the neural structures is the treatment of choice and enables immediate and long-lasting improvement of symptoms.10 However, comorbidities, such as cardiac disorders, increase with age,11 and older patients often present with multiple degenerative changes of the spinal column. Therefore, indicating surgery in older patients can be delicate. We performed a retrospective survey to compare patients ≥75 years old with younger patients focusing on symptoms, course of treatment, and results of surgically treated patients.

Section snippets

Materials and Methods

This study was approved by the local ethics committee. We reviewed all patients who underwent surgery in our department to treat synovial cysts of the spine between January 1997 and January 2014.10 Of 141 patients, 28 patients (20%) were ≥75 years old and classified as elderly. These patients were compared with 96 patients who were 50–74 years old. Clinical data were retrospectively obtained by reviewing medical reports and outpatient charts. The medical reports and outpatient charts were

Patient Characteristics, Symptoms, and Radiologic Findings

Of all patients treated between 1997 and 2014, 20% were ≥75 years old at the time of operation of a spinal synovial cyst. Mean age of the elderly group was 78.7 ± 2.6 years, and 57.1% of patients were female. A comparison of preoperative symptoms is shown in Figure 1. Most patients in the elderly group (85.7%) had leg pain, of either femoral or sciatic type, and lumbago (82.1%). Half of the patients (53.6%) presented with motor deficits. Sensory deficits were present in 35.7% of patients. Rates

Discussion

The progressive aging of society results in a rising number of degenerative diseases of the spinal column secondary to years of physical stress. The incidence of cystic lesions of the spine based on surgical findings is 0.5%–2.2%.14, 15, 16 The mean age reported in the literature is 63 years.10 The youngest reported patient was an 8-year-old boy, and the oldest reported patient was a 92-year-old woman, both with a retrodental cyst.17, 18 The youngest patient with a juxtafacet cyst was 14 years

Conclusions

The clinical course of elderly patients with surgical treatment of spinal synovial cysts does not differ compared with younger patients, and good or excellent results can be achieved. In >80% of cases, good results persisted during long-term follow-up. Use of fusion procedures should be restricted to cases of severe instability. Nonaggressive cyst removal in cases of dural attachment enables low cerebrospinal fluid fistula rates without increasing the rate of recurrent cysts.

References (54)

  • J.U. Howington et al.

    Intraspinal synovial cysts: 10-year experience at the Ochsner Clinic

    J Neurosurg

    (1999)
  • B. Pirotte et al.

    Synovial cysts of the lumbar spine: surgery-related results and outcome

    J Neurosurg

    (2003)
  • P. Métellus et al.

    Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome

    Acta Neurochir (Wien)

    (2006)
  • R. Deinsberger et al.

    Microsurgical treatment of juxta facet cysts of the lumbar spine

    J Spinal Disord Tech

    (2006)
  • M. Bruder et al.

    Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts

    J Neurosurg Spine

    (2017)
  • D. Mozaffarian et al.

    Heart disease and stroke statistics—2015 update: a report from the American Heart Association

    Circulation

    (2015)
  • A.F. Mannion et al.

    Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity

    Eur Spine J

    (2006)
  • I. Macnab

    Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients

    J Bone Joint Surg Am

    (1971)
  • D.R. Charest et al.

    Radicular pain caused by synovial cyst: an underdiagnosed entity in the elderly?

    J Neurosurg

    (2000)
  • V.P. Sachdev et al.

    Synovial cysts of the lumbar facet joint

    Mt Sinai J Med

    (1991)
  • W.E. Krauss et al.

    Juxtafacet cysts of the cervical spine

    Neurosurgery

    (1998)
  • O. Velán et al.

    Atlantoaxial joint synovial cyst: diagnosis and percutaneous treatment

    Cardiovasc Intervent Radiol

    (2008)
  • T. Ito et al.

    Retrodental synovial cyst which disappeared after posterior C1-C2 fusion: a case report

    J Orthop Surg (Hong Kong)

    (2000)
  • M. Gelabert-González et al.

    Lumbar synovial cyst in an adolescent: case report

    Childs Nerv Syst

    (2009)
  • S. Asamoto et al.

    Cyst of the ligamentum flavum—case report

    Neurol Med Chir (Tokyo)

    (2005)
  • T. Kusakabe et al.

    Facet cyst in the lumbar spine: radiological and histopathological findings and possible pathogenesis

    J Neurosurg Spine

    (2006)
  • B.M. Onofrio et al.

    Synovial cysts of the spine

    Neurosurgery

    (1988)
  • 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.

    Matthias Setzer and Gerhard Marquardt are co–last authors.

    View full text