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Perkutane CT-gesteuerte Destruktion vs. mikrochirurgische Resektion lumbaler Juxtafacettzysten

Percutaneous CT-guided destruction versus microsurgical resection of lumbar juxtafacet cysts

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Zusammenfassung

Hintergrund

Zur Behandlung lumbaler Juxtafacettzysten ist die mikrochirurgische Resektion etabliert. Perkutane Zystendestruktionen stellen u. U. eine Alternative dar. Die Wertigkeit der CT-gesteuerten Destruktion gegenüber der operativen Therapie ist bislang durch prospektive Untersuchungen nicht bestimmt worden.

Material und Methoden

Es handelt sich um eine prospektive, nichtrandomisierte Verlaufsstudie an 45 Patienten; 25 Patienten wurden operiert (Gruppe A), 20 Patienten perkutan durch Zystendestruktion behandelt (Gruppe B).

Ergebnisse

Die Behandlung verlief in allen 45 Fällen komplikationslos. In Gruppe A waren im medianen Nachuntersuchungsintervall von 27 Monaten alle Patienten beschwerdefrei. In Gruppe B waren im Nachuntersuchungsintervall von 23 Monaten 8 Patienten beschwerdefrei. Zwölf Patienten wurden wegen persistierender Radikulopathie im weiteren Verlauf operativ behandelt.

Schlussfolgerung

Hinsichtlich der dauerhaften Erfolgsquote stellt die minimalinvasive Zystendestruktion weder in unserer Untersuchung noch im Literaturreview eine Konkurrenz zur mikrochirurgischen Zystenresektion dar.

Abstract

Background

Microsurgical resection is the standard treatment of lumbar juxtafacet cysts. Percutaneous computed tomography (CT) guided destruction of the cyst could be an alternative modality for inoperable patients. Comparative prospective studies for both treatment strategies do not exist.

Materials and methods

This study involved a non-randomized, prospective trial on 45 patients suffering from sciatica or claudication caused by lumbar juxtafacet cysts. Of the patients 25 were operated on microsurgically and 20 patients were primarily treated using percutaneous CT-guided cyst destruction.

Results

The treatment in both groups was performed without complications in all patients. All patients treated microsurgically were pain-free (mean postoperative interval 27 months) but only 8 out of 20 patients treated percutaneously recovered completely (mean post-treatment interval 24 months). The remaining 12 out of 20 patients showed no relevant improvement and were operated on microsurgically.

Conclusion

Minimally invasive cyst destruction is not a viable alternative to microsurgical resection considering the long-term outcome, neither in this study nor in the reviewed literature.

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Schulz, C., Danz, B., Waldeck, S. et al. Perkutane CT-gesteuerte Destruktion vs. mikrochirurgische Resektion lumbaler Juxtafacettzysten. Orthopäde 40, 600–606 (2011). https://doi.org/10.1007/s00132-011-1744-3

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