43 Minimally Invasive Resection of Lumbar Synovial Cysts and Foraminal Disks

Background: Lumbar intraspinal synovial cyst (LISC) refers to a cyst that arises from the zygapophyseal joint capsule of the lumbar spine and contains serous or gelatinous fluid. In cases of LISCs resistant to conservative treatments, various minimally invasive percutaneous spinal techniques (MIPSTs) may be applied prior to open surgery. Objectives: The outcomes of 3-staged MIPSTs for the treatment of symptomatic LISCs resistant to conservative treatments were evaluated. Study Design: An institutional review board approved retrospective chart review. Setting: University hospital inpatients referred to our pain clinic. Methods: Review of charts of all patients who underwent MIPSTs for symptomatic LISCs resistant to conservative treatments during a time period of 13 years at a university hospital pain clinic. Patients with symptomatic LISCs resistant to conservative treatments were treated with 3-staged MIPSTs, including image-guided intraarticular aspiration, cyst distention and rupture, and injection of corticosteroids (ARI), endoscopic cyst enucleation (ECE), and endoscopic superior facetectomy (ESF) by a single pain specialist. A symptom-free period after each intervention was evaluated. Recurrence was defined as the same recurrent symptomatic radicular pain with confirmation of the LISC on magnetic resonance imaging. All patients with a minimum follow-up time of 3 years were included. Results: Of the 40 patients who underwent ARI, 3 patients failed to complete a follow-up and 19 patients (51.4%) who had recurring symptoms received ECE. Ten patients (52.6%) who had rerecurring symptoms after ECE received ESF. There was no recurrence after ESF. Limitations: This retrospective and observational study with a limited number of patients does not represent a high level of evidence. Conclusions: This information provided the recurrence rate after each intervention. Half of the patients who went on to receive ARI experienced recurrence, whereas half of the patients with recurrence who received ECE experienced re-recurrence. ESF treatment resulted in no recurrence within the 3-year study period. Key words: Conservative treatment, endoscopic surgical procedures, facet joint, intraarticular injection, minimally invasive surgical procedures, needle biopsy, nerve root compression, radiculopathy, synovial cysts

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Minimally Invasive Surgical Treatment of Lumbar Synovial Cysts

Neurosurgery ◽

10.1227/01.neu.0000097269.79994.2f ◽

2004 ◽

Vol 54 (1) ◽

pp. 107-112 ◽

Cited By ~ 70

Author(s):

Faheem A. Sandhu ◽

Paul Santiago ◽

Richard G. Fessler ◽

Sylvain Palmer

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Minimally Invasive ◽

Surgical Techniques ◽

Synovial Cyst ◽

Complete Excision ◽

Tubular Retractor ◽

Minimally Invasive Surgical ◽

Average Patient ◽

Synovial Cysts

Abstract OBJECTIVE Synovial cysts are a rare cause of lumbar radiculopathy and back pain. Surgical treatment is directed at complete excision of the cyst. We used minimally invasive surgical techniques for a series of patients, to assess the effectiveness of this approach for resection of synovial cysts. METHODS Seventeen patients (10 female and 7 male patients) with presumed synovial cysts, as indicated on magnetic resonance imaging scans, underwent surgical resection with the 18-mm METRx tubular retractor system (Medtronic Sofamor Danek, Memphis, TN). A unilateral approach was used, with either an operating microscope (13 cases) or a magnifying endoscope (4 cases), depending on the preference of the surgeon. Outcomes were reported by using modified MacNab criteria. RESULTS The average patient age was 64 years (range, 46–82 yr). The L4–L5 level was most commonly affected (82% of cases). Grade 1 spondylolisthesis at the level harboring the synovial cyst was observed for 47% of the patients; all cases of spondylolisthesis involved the L4–L5 level. The mean operative time was 97 minutes, and the average blood loss was 35 ml. Excellent or good results were achieved for 94% of the patients. A dural tear that did not violate the arachnoid membrane occurred during surgery for one patient but did not require further treatment. CONCLUSION Synovial cysts can be effectively treated with a tubular retractor system in conjunction with an endoscope or microscope. Use of the tubular retractor minimizes soft-tissue trauma, incision length, blood loss, and disruption of ligamentous and bony structures. This may be particularly significant when synovial cysts are associated with spondylolisthesis, minimizing the risk of progressive instability and the need for fusion.

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Minimally Invasive Posterior Tubular Microsurgical Approach for the Management of Symptomatic Synovial Cysts of the Lumbar and Cervical Spine

The International Journal of Spine Surgery ◽

10.14444/8134 ◽

2021 ◽

pp. 8134

Author(s):

José Antonio Soriano Sánchez ◽

Kai Uwe Lewandrowski ◽

José Alfonso Franco Jímenez ◽

Manuel Eduardo Soto Garcia ◽

Sergio Soriano Solís ◽

...

Keyword(s):

Cervical Spine ◽

Minimally Invasive ◽

Microsurgical Approach ◽

Synovial Cysts

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Treatment of lumbar synovial cysts using minimally invasive surgical techniques

Neurosurgical FOCUS ◽

10.3171/foc.2006.20.3.3 ◽

2006 ◽

Vol 20 (3) ◽

pp. 1-6 ◽

Cited By ~ 24

Author(s):

Nouzhan Sehati ◽

Larry T. Khoo ◽

Langston T. Holly

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Surgical Techniques ◽

Definitive Treatment ◽

Surgical Approaches ◽

Lower Extremity Weakness ◽

Minimally Invasive Surgical ◽

Synovial Cysts ◽

The Mean

Object Lumbar synovial cysts are a potential cause of radiculopathy and back pain, and the definitive treatment is the complete excision of the cyst. This report summarizes the authors' preliminary clinical experience with the minimally invasive resection of lumbar synovial cysts. Methods Nineteen patients (nine men and 10 women) with symptomatic synovial cysts underwent minimally invasive resection. The mean patient age was 64 years of age (range 43–80 years). The presenting symptom was radiculopathy in 16 patients, low-back pain in two, and lower-extremity weakness in one. There were 16 cases of a cyst located at the L4–5 level, two at L3–4, and one at L5–S1. The mean cyst diameter was 13.7 mm (range 3–30 mm). The mean follow-up time was 16 months (range 4–29 months). Clinical outcomes were graded, based on the Macnab modified criteria, as excellent, good, fair, or poor. Eighteen patients (95% of cases) reported either excellent (10 patients) or good (eight patients) results, and a fair result was reported by one patient (5% of cases). The mean operative time was 158 minutes (range 75–270 minutes), and the average intraoperative blood loss was 31 ml (range 10–100 ml). Two patients had intraoperative dural tears that resulted in cerebrospinal fluid leaks that resolved following primary closure. Conclusions Synovial cysts can be safely and effectively treated using minimally invasive surgical techniques. Long-term follow up is required to determine whether this approach results in less need for fusion than conventional surgical approaches.

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Minimally Invasive Surgery for Lumbar Synovial Cysts

Contemporary Neurosurgery ◽

10.1097/01.cne.0000437421.05494.bd ◽

2013 ◽

Vol 35 (18) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Olatilewa Awe ◽

Patrick W. Hitchon

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Synovial Cysts

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Minimally Invasive Versus Open Surgery for Lumbar Synovial Cysts

World Neurosurgery ◽

10.1016/j.wneu.2017.09.039 ◽

2017 ◽

Vol 108 ◽

pp. 555-559 ◽

Cited By ~ 4

Author(s):

Pierluigi Vergara ◽

Christopher Yusuf Akhunbay-Fudge ◽

Mark Robert Kotter ◽

Rodney John Charles Laing

Keyword(s):

Minimally Invasive ◽

Open Surgery ◽

Synovial Cysts

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Arthroscopic Resection of Wrist Volar Synovial Cyst: Technique Description and Case Series

Journal of Wrist Surgery ◽

10.1055/s-0040-1721438 ◽

2021 ◽

Author(s):

Ricardo Kaempf de Oliveira ◽

João Pedro Farina Brunelli ◽

Vicente Carratalá ◽

Márcio Aita ◽

Gustavo Mantovani ◽

...

Keyword(s):

Minimally Invasive ◽

Case Series ◽

Invasive Procedure ◽

Synovial Cyst ◽

Good Alternative ◽

Open Technique ◽

Small Joint ◽

Safe Technique ◽

Synovial Cysts

Abstract Background Arthroscopy nowadays has become a widespread technique for the treatment of orthopaedic pathologies. Small-joint arthroscopy has evolved and, through direct visualization, enables diagnosis and immediate treatment of intra-articular lesions. The arthroscopic resection has become a minimally invasive alternative for the open technique. We intend to describe the technique, literature review, and results of arthroscopy for the surgical treatment of wrist volar synovial cysts. Methods Thirty-nine patients submitted to arthroscopy for the treatment of wrist volar synovial cyst were included and assessed in this study, during the period of January 2015 to May 2017 with a complete assessment in minimum follow-up of 6 months. The technique was indicated for patients with pain and functional impairment for longer than 4 months, with no improvement with conservative measures, or for patients with cosmetic complaints, or those who presented the cyst for more than 3 months. Results We demonstrated good outcomes in regard to pain, range of motion, and complications in arthroscopic resection of volar wrist ganglion. Conclusion Arthroscopic resection of volar synovial is a useful and safe technique. It is a low-morbidity, minimally invasive procedure that carries few complications and is a good alternative to the open technique.

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