Treatment of lumbar synovial cysts using minimally invasive surgical techniques.
OBJECTIVE
Lumbar synovial cysts are a potential cause of radiculopathy and back pain, and the definitive treatment is the complete excision of the cyst. This report summarizes the authors' preliminary clinical experience with the minimally invasive resection of lumbar synovial cysts.


METHODS
Nineteen patients (nine men and 10 women) with symptomatic synovial cysts underwent minimally invasive resection. The mean patient age was 64 years of age (range 43-80 years). The presenting symptom was radiculopathy in 16 patients, low-back pain in two, and lower-extremity weakness in one. There were 16 cases of a cyst located at the L4-5 level, two at L3-4, and one at L5-S1. The mean cyst diameter was 13.7 mm (range 3-30 mm). The mean follow-up time was 16 months (range 4-29 months). Clinical outcomes were graded, based on the Macnab modified criteria, as excellent, good, fair, or poor. Eighteen patients (95% of cases) reported either excellent (10 patients) or good (eight patients) results, and a fair result was reported by one patient (5% of cases). The mean operative time was 158 minutes (range 75-270 minutes), and the average intraoperative blood loss was 31 ml (range 10-100 ml). Two patients had intraoperative dural tears that resulted in cerebrospinal fluid leaks that resolved following primary closure.


CONCLUSIONS
Synovial cysts can be safely and effectively treated using minimally invasive surgical techniques. Long-term follow up is required to determine whether this approach results in less need for fusion than conventional surgical approaches.
Sehati
Nouzhan
N
Division of Neurosurgery, David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California 90095, USA.
Khoo
Larry T
LT
Holly
Langston T
LT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D013581:Synovial Cyst / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome