Original ArticleSurgical Treatment of Spinal Synovial Cysts in Elderly Patients: Symptoms, Treatment Course, and Outcome in Patients >75 Years of Age
Introduction
With the aging of our society, degeneration of the musculoskeletal system is increasingly the focus of surgical treatment, especially in regard to spinal disorders. Cystic joint adjacent lesions are a known problem of degeneration that were first described by Baker in 1877.1 Cystic lesions adjacent to joints of the spinal column, which were first described by Vosschulte and Borger in 1950,2 usually manifest with nerve root compression or stenosis of the spinal canal. The pathogenesis of these cysts is still a matter of discussion, but degeneration and destabilization seem to be common to all explanations.3, 4, 5 As conservative treatment options, such as physiotherapy, corticosteroid injection, percutaneous cyst rupture, and aspiration, do not sustain durable effects,6, 7, 8, 9 surgical resection of the cyst and decompression of the neural structures is the treatment of choice and enables immediate and long-lasting improvement of symptoms.10 However, comorbidities, such as cardiac disorders, increase with age,11 and older patients often present with multiple degenerative changes of the spinal column. Therefore, indicating surgery in older patients can be delicate. We performed a retrospective survey to compare patients ≥75 years old with younger patients focusing on symptoms, course of treatment, and results of surgically treated patients.
Section snippets
Materials and Methods
This study was approved by the local ethics committee. We reviewed all patients who underwent surgery in our department to treat synovial cysts of the spine between January 1997 and January 2014.10 Of 141 patients, 28 patients (20%) were ≥75 years old and classified as elderly. These patients were compared with 96 patients who were 50–74 years old. Clinical data were retrospectively obtained by reviewing medical reports and outpatient charts. The medical reports and outpatient charts were
Patient Characteristics, Symptoms, and Radiologic Findings
Of all patients treated between 1997 and 2014, 20% were ≥75 years old at the time of operation of a spinal synovial cyst. Mean age of the elderly group was 78.7 ± 2.6 years, and 57.1% of patients were female. A comparison of preoperative symptoms is shown in Figure 1. Most patients in the elderly group (85.7%) had leg pain, of either femoral or sciatic type, and lumbago (82.1%). Half of the patients (53.6%) presented with motor deficits. Sensory deficits were present in 35.7% of patients. Rates
Discussion
The progressive aging of society results in a rising number of degenerative diseases of the spinal column secondary to years of physical stress. The incidence of cystic lesions of the spine based on surgical findings is 0.5%–2.2%.14, 15, 16 The mean age reported in the literature is 63 years.10 The youngest reported patient was an 8-year-old boy, and the oldest reported patient was a 92-year-old woman, both with a retrodental cyst.17, 18 The youngest patient with a juxtafacet cyst was 14 years
Conclusions
The clinical course of elderly patients with surgical treatment of spinal synovial cysts does not differ compared with younger patients, and good or excellent results can be achieved. In >80% of cases, good results persisted during long-term follow-up. Use of fusion procedures should be restricted to cases of severe instability. Nonaggressive cyst removal in cases of dural attachment enables low cerebrospinal fluid fistula rates without increasing the rate of recurrent cysts.
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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.
Matthias Setzer and Gerhard Marquardt are co–last authors.