Study Design: Retrospective cohort and review of the literature.
Objective: to compare surgical strategies for the management of spinal synovial cysts
Summary of Background Data: The recent multiplication of retrospective series of patients with spinal synovial cysts has led to a reappraisal of their incidence and clinical significance. Although surgery is considered the treatment of choice, there is still no agreement over which surgical technique should be used.
Methods: We retrospectively reviewed 23 consecutive patients undergoing surgery for a spinal synovial cyst in our department between 2004 and 2010. Surgical procedures were classified into the four following categories: cystectomy via an inter-laminar approach, via hemi-laminectomy, via laminectomy or associated with instrumented spinal fusion. Clinical outcome, cyst recurrence, need for subsequent fusion and perioperative complications were compared between these groups.
Results: Of the patients included in the present cohort, 11 underwent cyst excision via an inter-laminar approach, 8 had a hemi-laminectomy, 2 had a laminectomy and 2 underwent instrumented fusion. "Excellent" or "good" clinical outcome on the Macnab modified scale were achieved for 16 patients (69.6%), and there were 2 perioperative complications, 2 cyst recurrences and 1 secondary fusion. Of the 519 patients reported in the literature, overall clinical outcome was either "excellent" or "good" for 83% of all patients. However, unfavorable outcome was more likely in patients treated with decompression alone (80/396) than decompression with fusion (10/123) (20.2% v. 8.1%, P=0.003), as well as cyst recurrence (13/396 against 0/123, P=0.028). On the other hand, the rate of perioperative complications was significantly higher in the fusion group (23/123) compared with decompression alone (11/396) (18.7% v. 2.8%; P<0.0001).
Conclusions: In patients with spinal synovial cyst, spinal fusion seems to decrease the risk of unfavorable clinical outcome and cyst recurrence but was also associated with a considerably higher rate of perioperative complications.
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