title: Surgical Management of Spinal Synovial Cysts: A Series of 23 Patients and Systematic Analysis of the Literature.
abstract: METHODS
  Retrospective cohort and review of the literature.
  
  
  OBJECTIVE
  To compare surgical strategies for the management of spinal synovial cysts.
  
  
  BACKGROUND
  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 following 4 categories: cystectomy by an interlaminar approach, hemilaminectomy, 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 by an interlaminar approach, 8 had a hemilaminectomy, 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% vs. 8.1%; P=0.003) and cyst recurrence (13/396 vs. 0/123; P=0.028). In contrast, the rate of perioperative complications was significantly higher in the fusion group (23/123) compared with decompression alone (11/396) (18.7% vs. 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 and associated with a considerably higher rate of perioperative complications.
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, Université Paris-Descartes, Paris, France.
authors.forename: Steven
authors.initials: S
authors.lastname: Knafo
authors.forename: Philippe
authors.initials: P
authors.lastname: Page
authors.forename: Johan
authors.initials: J
authors.lastname: Pallud
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Roux
authors.forename: Georges
authors.initials: G
authors.lastname: Abi-Lahoud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000639:trends*; D009985:Orthopedics / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D013581:Synovial Cyst / Q000601:surgery*; D016896:Treatment Outcome