Intraspinal Juxtaarticular Cysts of the Lumbar Spine


Authors: D. Bludovský 1;  D. Štěpánek 1;  S. Žídek 1;  M. Choc 1;  O. Hes 2;  J. Kastner 3;  V. Přibáň 1
Authors‘ workplace: LF UK a FN Plzeň Neurochirurgické oddělení 1;  LF UK a FN Plzeň Šiklův patologicko-anatomický ústav 2;  LF UK a FN Plzeň Klinika zobrazovacích metod 3
Published in: Cesk Slov Neurol N 2014; 77/110(1): 82-87
Category: Short Communication

Overview

Objective:
Our focus is on pathology and anatomy of the juxtaarticular intraspinal cysts, stability of the involved spinal segment and long-term outcome data in a group of surgically treated patients.

Material and methods:
Data from 49 patients treated surgically at the Department of Neurosurgery of the Charles University Teaching Hospital in Plzen, Czech Republic, from 2003 until 2010 were evaluated. We assessed the degree of degenerative changes of the facet joint and intervertebral discs and morphology of juxtaarticular cysts. Stability of the spinal segment was evaluated using the X-rays. We assessed changes in the Oswestry Score Index (ODI) and a visual analog scale (VAS) in 18 prospectively followed patients.

Results:
Intraspinal juxtaarticular cysts were mostly spherical (41%) with a thin wall. Histological findings were uncertain in 47% of patients. Degenerative changes of the disc were of a lower degree than degeneration of the facet joint in 63% of patients. Microsurgical resection of the cyst was the surgical procedure used. Lumbar spine instability was found in 16% of cases. Improvement in VAS and ODI was statistically highly significant with lower back VAS p = 0.0205, lower extremity VAS p = 0.0001 and ODI with p = 0.0009.

Conclusion:
A unilateral intraspinal juxtaarticular cyst of the lumbar spine is not necessarily a sign of instability. Histological findings do not determine treatment modality. Surgical resection of the cyst is a good treatment option with very good clinical results. Because of unclear terminology, we suggest to use the term “intraspinal juxtaarticular cyst”.

Key words:
synovial cyst – ganglion cyst – intraspinal juxtaarticular cyst – facet joint

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Häckel M, Vaněk P. Intraspinální synoviální cysty I. Přehled problematiky. Cesk Slov Neurol N 2009; 72/105(1): 18–23.

2. Kao CC, Uihlein A, Bickel WH, Soule EH. Lumbar intraspinal extradural ganglion cyst. J Neurosurg 1968; 29(2): 168–172.

3. Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. Case report. J Neurosurg 1974; 41(3): 372–376.

4. Banning CS, Thorell WE, Leibrock LG. Patient outcome after resection of lumbar juxtafacet cysts. Spine (Phila Pa 1976) 2001; 26(8): 969–972.

5. Bozzao A, Floris R, Fraioli C, Ticca L, Simonetti G. “Relapsing-remitting” bilateral synovial cysts of the lumbar spine. A case report. Neuroradiology 2001; 43(12): 1076–1078.

6. Heary RF, Stellar S, Fobben ES. Preoperative diagnosis of an extradural cyst arising from a spinal facet joint: case report. Neurosurgery 1992; 30(3): 415–418.

7. Pendleton B, Carl B, Pollay M. Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery 1983; 13(3): 322–326.

8. Pirotte B, Gabrovsky N, Massager N, Levivier M, David P, Brotchi J. Synovial cyst of the lumbar spine: surgery-related results and outcome, J Neurosurg 2003; 99 (Suppl 1): 14–19.

9. Sova M, Smrčka M, Hušek K. Synoviální cysty bederní páteře – vzácná příčina lumboischialgií. Cesk Slov Neurol N 2000; 63/96(5): 297–298.

10. Lyons MK, Atkinson JLD, Wharen RE, Deen HG, Zimmerman RS, Lemens SM. Surgical evaluation and management of lumbal synovial cysts: the Mayo Clinic experience. J Neurosurg 2000; 93 (Suppl 1): 53–57.

11. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983; 16(1): 87–101.

12. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000; 25(22): 2940–2952.

13. Wiltse LL, Winter RB. Terminology and measurement of spondylolisthesis. J Bone Joint Surg Am 1983, 65(6): 768–772.

14. Chaloupka R, Neubauer J. Zobrazovací metody u spondylolistézy. In: Suchomel P, Krbec M et al (eds). Spondylolistéza. Diagnostika a terapie. 1st ed. Praha: Galén 2007: 23–27.

15. Kusakabe T, Kasama F, Aizawa T, Sato T, Konkubun S. Facet cyst in the lumbar spine: radiological and histopathological findings and possible pathogenesis. J Neurosurg Spine 2006; 5(5): 398–340.

16. Doyle AJ, Merrilees M. Synovial cysts of the lumbar facet joints in symptomatic population: Prevalence on magnetic resonance imaging. Spine (Phila Pa 1976) 2004; 29(8): 874–878.

17. Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 1999; 28(4): 215–219.

18. Friedberg SR, Fellows T, Thomas CB, Mancall AC. Experience with symptomatic spinal epidural cyst. Neurosurgery 1994; 34(6): 989–993.

19. Christophis P, Asamoto S, Kuchelmeister K, Schachenmayr W. “Juxtafacet cysts”, a misleading name for cystic formation of mobile spine (CYFMOS). Eur Spine J 2007; 16(9): 1499–1505.

20. Grantham M, Richmond B. Unusual facet cyst containing struvite and hydroxyapatite. Skeletal Radiol 2001; 30(1): 57–59.

21. Nijensohn E, Russel EJ, Milan M, Brown T. Calcified synovial cyst of the cervical spine: CT and MR evaluation. J Comput Assist Tomogr 1990; 14(3): 473–476.

22. Tatter SB, Cosgrove GR. Hemorrhage into lumbar synovial cyst causing an acute cauda equina syndrome. Case report. J Neurosurg 1994; 81(3): 449–452.

23. Hrabálek L, Wanek T, Adamus M. Léčba juxtaintervertebrálních cyst bederní páteře perkutánní dynamickou interspinózní stabilizací: prospektivní studie. Acta Chir Orthop Traum Cech; 2012: 144–149.

24. Vaněk P, Häckel M. Intraspinální lumbální synoviální cysty II – chirurgická léčba 13 nemocných. Cesk Slov Neurol N 2009; 72/105(1): 61–64.

25. Cohen-Gadol AA, White JB, Lynch JJ, Miller GM, Krauss WE. Synovial cyst of the thoracic spine. J Neurosurg Spine 2004; 1(1): 52–57.

26. Hodges SD, Fronczak S, Zindrick MR, Lorenz MA, Vrbos LA. Extradural synovial thoracic cyst. Spine 1994; 19(21): 2471–2473.

27. Sabo RA, Tracy PT, Weiniger JM. A series of 60 juxtafacet cysts: clinical presentation, the role of spinal instability, and treatment. J Neurosurg 1996; 85(4): 560–565.

28. Finckh A, Gerster J, So AK. Association of spondylarthropathies with lumbar synovial cysts. Clin Rheumatol 2003; 22(1): 67–69.

29. Lattig F, Fülöp Fekete T, Kleinstück FS, Porchet F, Jeszensky D, Mannion AF. Lumbar Facet Joint Effusion on MRI as a Sign of Unstable Degenerative Spondylolisthesis: Should it Influence the Treatment Decision? J Spinal Disord Tech. In print 2012.

30. Imai K, Nakamura K, Inokuchi K, Oda H. Aspiration of intraspinal synovial cyst: recurrence after temporal improvement. Arch Orthop Trauma Surg 1998; 118(1–2): 103–105.

31. Vanneroy F, de Caen C. The value of facet joint arthrography. Spine (Phila Pa 1976) 1991; 16(4): 483.

32. Pirotte B, Gabrovsky N, Massager N, Levivier M, David P, Brotchi J. Synovial cyst of the lumbar spine: surgery-related results and outcome, J Neurosurg 2003; 99 (Suppl 1): 14–19.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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