Highlights
- •Epidemiological and clinical patterns of symptomatic SSC are similar to those of other degenerative spinal diseases.
- •Surgical outcome was excellent with immediate symptom relief and recovery, which further improved over time.
- •Low complication rate further supports surgery as a good treatment option for patients with SSC.
Abstract
Spinal synovial cysts (SSC) are a rare but important differential diagnosis for degenerative
or space-occupying spinal lesions. There is controversy about the most beneficial
treatment, which can be conservative or surgical. We provide a review of our surgical
data for purposes of quality assessment and improvement.
5313 patients with surgically treated degenerative spinal diseases were analyzed retrospectively.
The incidence of SSC was 1.14%. 61 patients (31 women, 30 men; mean age 65.3 years)
with SSC were included in this study. The charts, surgical reports, and radiographic
data were reviewed for demographics, duration of symptoms, size of SSC, anatomical
site, surgical approach, Visual Analog Scale (VAS), and neurological performance including
the Japanese Orthopedic Association Score (JOA score) and the Frankel score.
Laminotomy was the most common surgical approach in 93.4% of the patients followed
by hemilaminectomy in 6.6%. The predominant site of SSC was the lumbar spine in 86.9%.
95.1% had experienced local and radicular pain as the predominant symptom and 47.5%
preoperative sensory and motor deficits. At discharge, the JOA score was significantly
increased compared to admission (median value of 17). At follow-up, 94.4% had normal
neurological function and 5.6% showed grade 1 neurological deficits. Leg pain had
decreased in 94.4% and back pain in 70.6%. At long-term follow-up, all patients presented
neurologically stable. The median value for pain classified with the VAS had decreased
from 6 at admission to 1 at long-term follow-up. During long-term follow-up, 6 patients
(9.8%) had developed spinal instability requiring stabilization, 5 patients had received
facet joint infiltration due to symptomatic facet joint syndrome.
The epidemiological and clinical patterns of symptomatic SSC are similar to those
of other degenerative spinal diseases. Thus, SSC should always be considered as a
rare but important differential diagnosis. Surgical outcome was excellent with immediate
symptom relief and recovery, which further improved over time. Our data support the
benefit of surgical treatment and may be useful in recommending neurosurgical therapy
to patients with SSC.
Keywords
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Article info
Publication history
Published online: December 20, 2018
Accepted:
December 11,
2018
Received:
August 14,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
