This is a retrospective study.
The objective of this study was to evaluate lumbar spine synovial cyst recurrence
rates of decompression
-alone versus decompression
Improvements in imaging modalities allow for increased diagnosis and surgical treatment of symptomatic spinal juxtafacet synovial cysts. Conservative management may be used as a first-line management strategy, however rarely provides durable, effective relief of symptoms. Surgical treatment of spinal synovial cysts ranges from decompression
and cyst excision to decompression
procedures alone have a higher risk of recurrence
of spinal synovial cysts.
We retrospectively reviewed 87 patients undergoing surgical treatment of lumbar spinal juxtafacet synovial cysts as a single institution over 20 years. Surgical treatment consisted of either decompression
procedures. Preoperative symptoms included back pain, radiculopathy, motor deficits, or sensory deficits. The incidence of recurrence
of spinal synovial cysts at the same-site or differing sites was compared between 2 categories of surgical treatment. Revision surgical procedure rates were also evaluated.
A total of 55 (63%) patients were treated with an index decompression
-only procedure for the lumbar spinal synovial cyst compared with 32 (37%) patients treated with an index decompression
procedure. Fifty-eight (68%) of the lumbar spinal cysts occurred at the L4–L5 level. There were 10 (11.5%) spinal synovial cyst recurrences in the decompression
-only group, and 0 recurrences in the decompression
group. Revision decompression
procedures were performed in 4 of the 10 (4.6%) recurrences, and 6 of 10 (6.9%) recurrences had subsequent decompression
surgery. The mean time to recurrence
was 23.9±17.3 months. The mean length of follow-up was 65.1±48.6 months. Both recurrence
and nonrecurrence cohorts had significant symptomatic improvement using Odom criteria.
and cyst excision was the more common surgical treatment of lumbar spinal synovial cysts compared with decompression
procedure in our study. The rate of synovial cyst recurrence
and revision surgery in patients undergoing index decompression
was relatively low and comparable to current literature. Symptomatic improvement of patients undergoing decompression
was similar in our study. Although the fusion
may be required for the extent of pathology or coexisting instability, decompression
and excision of spinal synovial cysts provide durable, effective treatment with a known, appropriate risk of recurrence
and subsequent revision surgery.