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Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases
Journal article   Open access   Peer reviewed

Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases

Hamdi G Sukkarieh, Patrick W Hitchon, Olatilewa Awe and Jennifer Noeller
Journal of neurosurgery. Spine, Vol.23(4), pp.444-450
10/2015
DOI: 10.3171/2015.1.SPINE14996
PMID: 26115025
url
https://doi.org/10.3171/2015.1.SPINE14996View
Published (Version of record) Open Access

Abstract

The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach. All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times. There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m(2). Sixty-nine percent (9 of 13) of the cysts were at L4-5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series. The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.
 Minimally Invasive Surgical Procedures - methods Blood Loss, Surgical - statistics & numerical data Humans Male Treatment Outcome Low Back Pain - surgery Synovial Cyst - diagnosis Low Back Pain - diagnosis Spondylolisthesis - surgery Operative Time Magnetic Resonance Imaging Spondylolisthesis - diagnosis Female Lumbosacral Region - surgery Aged Synovial Cyst - surgery Pain Measurement Length of Stay - statistics & numerical data

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