[Surgical management of synovial cyst of the lumbar spine: retrospective study of 52 patients].
OBJECTIVE
Lumbar synovial cysts are an uncommon cause of radiculopathy, low back pain and neurogenic claudication. We report a retrospective analysis of the clinical presentation, radiological studies, operative findings and outcome in 52 patients surgically treated for symptomatic lumbar synovial cysts.


METHODS
Retrospective data from 52 consecutive patients treated from January 1996 to February 2006 were analyzed. We studied the clinical symptoms, diagnostic methods and radiological findings in all patients, reviewed the types of conservative therapy applied, the surgical findings and techniques, as well as the immediate and long-term results. Surgical outcomes were evaluated according to the Friedberg scale.


RESULTS
There were 35 women and 17 men with an average age of 63.2 years (range 36-84 years). The most common symptoms were radiculopathy (65,4%) and neurogenic multiroot claudication (34,6%). Forty-seven patients had back pain and 22 paresthesia. Preoperative neurological examination demonstrated motor weakness (5.7%), sensory loss (7.6%). The radiological work-up consisted in CT-scan and/or MRI for all patients. The correct preoperative diagnosis was established in 44 patients. A total of 56 cysts were found. Five patients had bilateral cysts. The L4-L5 level was affected in 66%. Total resection of the synovial cyst was possible for 46 patients. No fusion was performed as a first line procedure. However, subsequent fusion was necessary in one patient who developed delayed symptomatic spondylolisthesis. Mean follow up period was 14 months ranging from six to 24 months. Three recurrences occurred during the follow-up period. Functional outcome was excellent in 61.6%, good in 34.6% and poor in 3.8%.


CONCLUSIONS
Surgery should be proposed when synovial cysts fail to respond to conservative therapy. Recurrence and surgical complication rates are low. The usefulness of systematic fusion procedure is questionable.
Dagain
A
A
Service de neurochirurgie, HIA Val-de-Grâce, 74, boulevard Port-Royal, 75005 Paris, France. arnaud.dagain@aliceadsl.fr
Dulou
R
R
Dutertre
G
G
Delmas
J-M
JM
Pouit
B
B
de Soultrait
F
F
Pernot
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013581:Synovial Cyst / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome