Elsevier

World Neurosurgery

Volume 94, October 2016, Pages 188-196
World Neurosurgery

Original Article
Minimally Invasive Tubular Resection of Lumbar Synovial Cysts: Report of 40 Consecutive Cases

https://doi.org/10.1016/j.wneu.2016.06.125Get rights and content

Background

Lumbar synovial cysts are a relatively common clinical finding. Surgical treatment of symptomatic synovial cysts includes computed tomography–guided aspiration, open resection and minimally invasive tubular resection. We report our series of 40 consecutive minimally invasive microscopic tubular lumbar synovial cyst resections.

Methods

Following Institutional Review Board approval, a retrospective analysis of 40 cases of minimally invasive microscopic tubular retractor synovial cyst resections at a single institution by a single surgeon (B.D.B.) was conducted. Gross total resection was performed in all cases.

Results

Patient characteristics, surgical operating time, complications, and outcomes were analyzed. Lumbar radiculopathy was the presenting symptoms in all but 1 patient, who presented with neurogenic claudication. The mean duration of symptoms was 6.5 months (range, 1–25 months), mean operating time was 58 minutes (range, 25–110 minutes), and mean blood loss was 20 mL (range, 5–50 mL). Seven patients required overnight observation. The median length of stay in the remaining 33 patients was 4 hours. There were 2 cerebrospinal fluid leaks repaired directly without sequelae. The mean follow-up duration was 80.7 months. Outcomes were good or excellent in 37 of the 40 patients, fair in 1 patient, and poor in 2 patients.

Conclusions

Minimally invasive microscopic tubular retractor resection of lumbar synovial cysts can be done safely and with comparable outcomes and complication rates as open procedures with potentially reduced operative time, length of stay, and healthcare costs. Patient selection for microscopic tubular synovial cyst resection is based in part on the anatomy of the spine and synovial cyst and is critical when recommending minimally invasive vs. open resection to patients.

Section snippets

Data Collection

Institutional Review Board approval was obtained for this retrospective case series analysis. All patients with a symptomatic lumbar synovial cyst who had undergone a minimally invasive microscopic tubular retractor synovial cyst resection were considered for inclusion. No exclusion criteria were implemented.

Several data points were collected, systematized, and subsequently analyzed. These included patient demographic data, clinical presentation, preoperative workup, preoperative imaging,

Results

Between 1999 and 2015, a total of 40 patients underwent a minimally invasive microscopic tubular retractor synovial cyst resection procedure at our institution. No patients were excluded. All procedures were performed by a single surgeon (B.D.B.). Patient demographic data are summarized in Table 2. The cohort comprised 27 females and 13 males, with a mean age of 65 years (range, 45–82 years). The most common level was L4/L5 (73%; n = 29), followed by L5/S1 (20%; n = 8) and L3/L4 (7%; n = 3).

Overview and Management

The minimally invasive tubular approach for spinal surgery using a tubular retractor was originally described in 1997 for herniated lumbar disc disease.15 We began using this modality for synovial cyst treatment in 1999. The original methodology incorporated endoscopic modalities. Combining the operating microscope with the tubular retractor system, as is done in our practice, offers much improved lighting and magnification.16, 17 There are also significant additional advantages of direct

Conclusions

The minimally invasive microscopic tubular retractor technique to resect juxtafacet lumbar spinal synovial cysts is an effective, safe, and potentially cost-saving procedure. This series represents the largest cohort of patients treated using such a modality with the longest follow-up period reported to date. This surgical procedure can be done with comparable outcomes and complication rates to those of open procedures. In addition, this approach can lead to potentially reduced operating time

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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