Open AccessA Staged Treatment of Symptomatic Lumbar Intraspinal Synovial Cysts
Author(s) -
Kyung-Hoon Kim,
SuYoung Kim,
Hwoe-Gyeong Ok,
Taekyun Kim
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.e451
Subject(s) - medicine , facetectomy , surgery , radicular pain , retrospective cohort study , cyst , lumbar , magnetic resonance imaging , radiology , laminectomy , psychiatry , spinal cord
Background: Lumbar intraspinal synovial cyst (LISC) refers to a cyst that arises from thezygapophyseal joint capsule of the lumbar spine and contains serous or gelatinous fluid. In casesof LISCs resistant to conservative treatments, various minimally invasive percutaneous spinaltechniques (MIPSTs) may be applied prior to open surgery.Objectives: The outcomes of 3-staged MIPSTs for the treatment of symptomatic LISCs resistantto 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 resistantto 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-stagedMIPSTs, including image-guided intraarticular aspiration, cyst distention and rupture, and injectionof 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 ofthe LISC on magnetic resonance imaging. All patients with a minimum follow-up time of 3 yearswere included.Results: Of the 40 patients who underwent ARI, 3 patients failed to complete a follow-up and19 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 doesnot represent a high level of evidence.Conclusions: This information provided the recurrence rate after each intervention. Half of thepatients who went on to receive ARI experienced recurrence, whereas half of the patients withrecurrence who received ECE experienced re-recurrence. ESF treatment resulted in no recurrencewithin the 3-year study period.Key words: Conservative treatment, endoscopic surgical procedures, facet joint, intraarticularinjection, minimally invasive surgical procedures, needle biopsy, nerve root compression,radiculopathy, synovial cysts