scholarly journals Diagnosis and Safe Excision of Lumbar Synovial Cysts and Accompanying Pathology: A Perspective

2020 ◽  
Vol 11 ◽  
pp. 33
Author(s):  
Nancy E. Epstein
Keyword(s):  
Degenerative Spondylolisthesis ◽  
Cerebrospinal Fluid Fistula ◽  
Disc Disease ◽  
Nerve Roots ◽  
Partial Removal ◽  
Neural Tissues ◽  
Alternative Measures ◽  
Synovial Cysts ◽  
Far Lateral ◽  
Ct Studies

Background: Lumbar synovial cysts are often not sufficiently diagnosed prior to spine surgery. Utilizing both MR and CT studies is critical for recognizing the full extent/severity of these lesions. Methods: In patients with chronic, acute, or subacute lumbar disease, obtaining both MR and CT studies is critical to correctly diagnose; disc disease, hypertrophy/ossification of the yellow ligament (OYL), stenosis, with/without degenerative spondylolisthesis, and/or synovial cysts (SC). Results: MR T2 weighted images directly demonstrate hyperintensity within a SC. They initially cause lateral recess/caudad nerve root and/foraminal compromise, with larger extrusions causing significant lateral thecal sac, and far lateral/superior cephalad root compromise. CT 2 mm cuts often better demonstrate mid-vertebral level compression of cephalad nerve roots with/without SC calcification, along with the extent of mid-vertebral stenosis, hypertrophy/OYL, and DS. When CT studies directly document SC calcification, it alerts the surgeon to the increased potential risk of creating a cerebrospinal fluid fistula with full SC excision, and should prompt the adoption of alternative measures such as decompression/partial removal. Most critically, surgery for synovial cysts often warrants a 2-level laminectomy for fuller visualization of the cephalad and caudad nerve roots, and clearer differentiation of neural tissues from the large fibrotic SC capsule, to effect safer removal. Conclusions: Preoperatively, establishing the full cephalad and cauda extent of lumbar synovial cysts with both MR and CT studies is critical. Anticipation and better visualization of the foraminal/far lateral and superior extent of these lesions often warrants more extensive multilevel laminectomies for thecal sac and both cephalad and caudad root decompression.

The surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies

1994 ◽  
Vol 80 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Toyohiko Isu ◽  
Kyosuke Kamada ◽  
Nobuaki Kobayashi ◽  
Shoji Mabuchi
Keyword(s):  
Surgical Technique ◽  
Donor Site ◽  
Bone Grafts ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Disc Disease ◽  
Nerve Roots ◽  
Content Type ◽  
Vertebral Bodies

✓ The authors describe the surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies. This series consisted of 90 patients with cervical intervertebral disc disease suffering from cervical spondylotic myelopathy. Thirty-five patients were operated on at one level, 33 at two levels, and 22 at three levels. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 24 months (range 1 year to 3 years 6 months). Anterior angulation was found in four (4.4%) of the 90 patients. This surgical procedure has two major advantages: 1) there are no complications related to the iliac donor site, allowing early patient mobilization; and 2) the extensive posterior spur can be removed safely and easily under a wide operative field without damaging the spinal cord and nerve roots.

scholarly journals Lumbar stenosis: indications for fusion with and without instrumentation

1997 ◽  
Vol 3 (2) ◽  
pp. E6 ◽  
Author(s):  
Paul W. Detwiler ◽  
Frederick F. Marciano ◽  
Randall W. Porter ◽  
Volker K. H. Sonntag
Keyword(s):  
Facet Joint ◽  
Dynamic Instability ◽  
Lumbar Fusion ◽  
Rapid Development ◽  
Degenerative Spondylolisthesis ◽  
Lumbar Stenosis ◽  
Disc Disease ◽  
Diagnostic Categories ◽  
Number Of Factors ◽  
Failed Back Surgery

Although the efficacy of posterior decompression for symptomatic lumbar stenosis that is recalcitrant to conservative therapy is well proven, uniform agreement on the need for simultaneous arthrodesis is lacking. The variability in the rate of lumbar fusion with and without instrumentation has been attributed to a number of factors: advances in surgical technique; rapid development of instrumentation; radiographic advances in the diagnosis of disease entities of the lumbar spine; evolution in our understanding of bone healing; improved pre- and postoperative care; aggressive rehabilitation; patient compensation; hospital and surgeon reimbursement; better education of residents, fellows, and practicing neurosurgeons; and, most important, the lack of clear indications based on defined diagnostic categories. Based on review of the literature and their experience at the Barrow Neurological Institute, the authors have attempted to define indications for lumbar fusion with or without instrumentation based on defined diagnostic categories. Clear indications for fusion include trauma, tumor, or infection with two- or three-column injury, iatrogenic instability, and isthmic spondylolisthesis. Relative indications for fusion include degenerative spondylolisthesis, radiographically proven dynamic instability with pain or neurological findings, adult scoliosis, and mechanical back pain. Fusion is rarely indicated with discectomy, abnormal radiographs without appropriate findings (such as degenerative disc disease), facet joint syndrome, failed back surgery, or stable spinal stenosis.

scholarly journals The Effect of Lumbar Lordosis on Screw Loosening in Dynesys Dynamic Stabilization: Four-Year Follow-Up with Computed Tomography

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Chao-Hung Kuo ◽  
Peng-Yuan Chang ◽  
Tsung-Hsi Tu ◽  
Li-Yu Fay ◽  
Hsuan-Kan Chang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Outcomes ◽  
Lumbar Lordosis ◽  
Degenerative Spondylolisthesis ◽  
Dynamic Stabilization ◽  
Leg Pain ◽  
Screw Loosening ◽  
Disc Disease ◽  
Radiographic Outcomes

Introduction. This study aimed to evaluate the effects of Dynesys dynamic stabilization (DDS) on clinical and radiographic outcomes, including spinal pelvic alignment.Method. Consecutive patients who underwent 1- or 2-level DDS for lumbar spondylosis, mild degenerative spondylolisthesis, or degenerative disc disease were included. Clinical outcomes were evaluated by Visual Analogue Scale for back and leg pain, Oswestry Disability Index, and the Japanese Orthopedic Association scores. Radiographic outcomes were assessed by radiographs and computed tomography. Pelvic incidence and lumbar lordosis (LL) were also compared.Results. In 206 patients with an average follow-up of 51.1 ± 20.8 months, there were 87 screws (8.2%) in 42 patients (20.4%) that were loose. All clinical outcomes improved at each time point after operation. Patients with loosened screws were 45 years older. Furthermore, there was a higher risk of screw loosening in DDS involving S1, and these patients were more likely to have loosened screws if the LL failed to increase after the operation.Conclusions. The DDS screw loosening rate was overall 8.2% per screw and 20.4% per patient at more than 4 years of follow-up. Older patients, S1 involvement, and those patients who failed to gain LL postoperatively were at higher risk of screw loosening.

Synovial Cysts of the Spine

Neurosurgery ◽  
1988 ◽  
Vol 22 (4) ◽  
pp. 642-647 ◽  
Author(s):  
Burton M. Onofrio ◽  
Alexander D. Mih
Keyword(s):  
Degenerative Change ◽  
Degenerative Spondylolisthesis ◽  
Signs And Symptoms ◽  
Positive Contrast ◽  
Surgical Excision ◽  
Anatomical Location ◽  
Computed Tomographic ◽  
Presenting Symptoms ◽  
Dural Sac ◽  
Synovial Cysts

Abstract A series of 13 patients with synovial or ganglion cysts of the spinal facet joints causing nerve root compression is reported. These cysts were found in both the cervical and the lumbar spine, and the anatomical location of each cyst corresponded to the patient's signs and symptoms. In no case was there evidence of intervertebral disc abnormality found at operation. The patients ranged from 49 to 77 years of age and included 4 men and 9 women. Radiographic evidence of facet degenerative change and degenerative spondylolisthesis was frequently but not invariably noted. The extradural defects defined with positive contrast myelography or postmyelography computed tomographic scanning were usually posterior or posterolateral to the common dural sac and were misinterpreted as extruded discs in the majority of cases. Treatment consisted of laminectomy and surgical excision of cysts. All patients reported improvement or resolution of their presenting symptoms.

Lumbar nerve root compression by synovial cysts of the ligamentum flavum

1984 ◽  
Vol 60 (3) ◽  
pp. 617-620 ◽  
Author(s):  
Adel F. Abdullah ◽  
Robert W. Chambers ◽  
Dennis P. Daut
Keyword(s):  
Nerve Root ◽  
Ligamentum Flavum ◽  
Nerve Root Compression ◽  
Nerve Roots ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Synovial Cysts ◽  
Fine Print

✓ Synovial cysts of the ligamentum flavum, measuring 1 cm in diameter, caused compression of the lumbar nerve roots in four patients. The authors discuss the association of these cysts with advanced focal spondylosis, and speculate on their etiology.

Computed tomography–guided percutaneous facet screw fixation in the lumbar spine

2007 ◽  
Vol 7 (1) ◽  
pp. 95-98 ◽  
Author(s):  
Ho Yeong Kang ◽  
Sang-Ho Lee ◽  
Sang Hyeop Jeon ◽  
Song-Woo Shin
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Screw Fixation ◽  
Degenerative Spondylolisthesis ◽  
Pedicle Screw Fixation ◽  
Invasive Technique ◽  
Primary Therapy ◽  
Disc Disease ◽  
Ct Guided ◽  
Minimally Invasive Surgical

✓ The authors describe a new minimally invasive technique for posterior supplementation using percutaneous trans-laminar facet screw (TFS) fixation with computed tomography (CT) guidance. Oblique axial images were used to determine facet screw fixation sites. After the induction of local anesthesia and conscious sedation, a guide pin was inserted and guided with a laser mounted on the CT gantry. Cannulated TFSs were placed via a percutaneous approach. From December 2002 to August 2003, 18 patients underwent CT-guided TFS. In 17 of these patients this procedure was supplementary to anterior lumbar interbody fusion, which had been performed several days earlier; in the remaining patient, CT-guided TFS fixation was undertaken as the primary therapy. Twelve patients had painful degenerative disc disease or unstable degenerative spondylolisthesis, three had infections, and three had deformities. All screws were inserted accurately and there were no complications. This new minimally invasive surgical technique may offer an alternative to pedicle screw fixation as a method of posterior supplementation.

Microsurgical Resection of a Lumbar Synovial Cyst: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Brian J A Gill ◽  
Kyle Lindsey McCormick ◽  
Paul C McCormick
Keyword(s):  
Degenerative Spondylolisthesis ◽  
Synovial Cyst ◽  
Radicular Pain ◽  
Surgical Anatomy ◽  
Neurogenic Claudication ◽  
Presenting Symptoms ◽  
Patient Consent ◽  
Synovial Cysts ◽  
Cyst Recurrence ◽  
Microsurgical Resection

Abstract Lumbar spine synovial cysts develop from degenerated zygapophyseal joints. Symptomatic patients present with radicular pain and weakness or neurogenic claudication.1 In the absence of significant concomitant degenerative spondylolisthesis, symptomatic patients can be managed with a laminectomy and microsurgical resection of the cyst, without the need for instrumented fusion.2,3 In this video, we present the microsurgical resection of a left-sided L4-5 synovial cyst in a 68-yr-old man with radicular pain refractory to conservative management. The radiographical features, relevant surgical anatomy, and salient operative steps are reviewed, and strategies for preventing cyst recurrence are emphasized. There were no complications, the postoperative course was unremarkable, and the patient was discharged on postoperative day 1 with significant improvement in his presenting symptoms. No identifying information is present, and patient consent was obtained for the procedure and for publishing the material included in this video.

Surgical treatment of 63 cases of conjoined nerve roots

1982 ◽  
Vol 56 (1) ◽  
pp. 114-117 ◽  
Author(s):  
James G. White ◽  
Timothy A. Strait ◽  
Joseph R. Binkley ◽  
Samuel E. Hunter
Keyword(s):  
Surgical Treatment ◽  
Lumbar Disc ◽  
Disc Disease ◽  
Nerve Roots ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Operative Results ◽  
Conjoined Nerve Roots ◽  
Conjoined Nerve Root ◽  
Fine Print

✓ The operative results of 63 cases of lumbar disc disease with surgically confirmed conjoined nerve roots are reviewed. The first 55 patients were treated by standard hemilaminectomy and discectomy, with only 30% reporting a good result. Of the last eight patients treated by hemilaminectomy, pediculectomy, and discectomy, seven patients returned to work. The rationale for and the technique of pediculectomy are discussed in detail. Clinical, radiological, and surgical clues indicating the presence of the conjoined nerve root anomaly are reviewed.

Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results

1995 ◽  
Vol 83 (4) ◽  
pp. 648-656 ◽  
Author(s):  
Nancy E. Epstein
Keyword(s):  
Lumbar Disc ◽  
Degenerative Spondylolisthesis ◽  
Lateral Compartment ◽  
Surgical Approaches ◽  
Content Type ◽  
Direct Exposure ◽  
Disc Herniations ◽  
Complicating Factors ◽  
Far Lateral ◽  
Fine Print

✓ This study was undertaken to determine and compare indications and relative benefits of various surgical approaches in 170 patients (average age 55 years) with far-lateral herniated lumbar discs, identified by magnetic resonance (MR) imaging and computerized tomography (CT) and operated on between 1984 and 1994. Essentially three surgical procedures were performed: complete facetectomy in 73 patients, laminotomy with medial facetectomy in 39 patients, and intertransverse discectomy (also known as ITT) in 58 patients. Follow-up periods averaged 5 years (range 0.5–10 years). Outcomes were scored as excellent (no deficit), good (mild radiculopathy), fair (moderate radiculopathy), and poor (unchanged or worse). Overall, excellent and good results were achieved in 73 and 51 patients, respectively, and fair and poor results in 26 and 20, respectively. There was little difference among the results encountered for the three major surgical groups: 79% of the intertransverse (ITT) group had good-to-excellent outcomes, as compared with 70% of the facetectomy group, and 68% of the group who underwent at minimum laminotomy, and additional hemilaminectomy or laminectomy with medial facetectomy. Results were the same for the 121 patients followed for more than 2 years and for the 49 patients studied for under 2 years. In the management of far-lateral discs, total facetectomy provides the best exposure, but increases the risk of instability. Laminotomy and medial facetectomy uncover the lateral and subarticular recess and preserve stability, but visualization of the far-lateral compartment is often inadequate. The intertransverse approach offers extensive far-lateral but not medial intraforaminal exposure, while also preserving stability. Full facetectomy, laminotomy with medial facetectomy, and the intertransverse approaches yielded nearly comparable outcomes in far-lateral disc surgery. Only the full facetectomy exposes the entire course of the nerve root both medially and laterally, whereas the intertransverse procedure provides direct exposure of the far-lateral compartment alone. It is important to select the correct approach or combination of approaches to address attendant complicating factors such as spinal stenosis, spondyloarthrosis, and degenerative spondylolisthesis identified on CT and MR studies.

Sign in / Sign up

Export Citation Format

Share Document