1. 2019;22;E451-E456A Staged Treatment of Symptomatic Lumbar Intraspinal Synovial Cysts
   Retrospective Review
   Kyung-Hoon Kim, MD, PhD, Su-Young Kim, MD, Hwoe-Gyeong Ok, MD, and Tae-Kyun Kim, MD, PhD.

BACKGROUND: Lumbar intraspinal synovial cyst (LISC) refers to a cyst that arises from the zygapophyseal joint capsule of the lumbar spine and contains serous or gelatinous fluid. In cases of LISCs resistant to conservative treatments, various minimally invasive percutaneous spinal techniques (MIPSTs) may be applied prior to open surgery.

OBJECTIVES: The outcomes of 3-staged MIPSTs for the treatment of symptomatic LISCs resistant to conservative treatments were evaluated.

STUDY DESIGN: An institutional review board approved retrospective chart review.

SETTING: University hospital inpatients referred to our pain clinic.

METHODS: Review of charts of all patients who underwent MIPSTs for symptomatic LISCs resistant to conservative treatments during a time period of 13 years at a university hospital pain clinic. Patients with symptomatic LISCs resistant to conservative treatments were treated with 3-staged MIPSTs, including image-guided intraarticular aspiration, cyst distention and rupture, and injection of corticosteroids (ARI), endoscopic cyst enucleation (ECE), and endoscopic superior facetectomy (ESF) by a single pain specialist. A symptom-free period after each intervention was evaluated. Recurrence was defined as the same recurrent symptomatic radicular pain with confirmation of the LISC on magnetic resonance imaging. All patients with a minimum follow-up time of 3 years were included.

RESULTS: Of the 40 patients who underwent ARI, 3 patients failed to complete a follow-up and 19 patients (51.4%) who had recurring symptoms received ECE. Ten patients (52.6%) who had re-recurring symptoms after ECE received ESF. There was no recurrence after ESF.

LIMITATIONS: This retrospective and observational study with a limited number of patients does not represent a high level of evidence.

CONCLUSIONS: This information provided the recurrence rate after each intervention. Half of the patients who went on to receive ARI experienced recurrence, whereas half of the patients with recurrence who received ECE experienced re-recurrence. ESF treatment resulted in no recurrence within the 3-year study period.

KEY WORDS: Conservative treatment, endoscopic surgical procedures, facet joint, intraarticular injection, minimally invasive surgical procedures, needle biopsy, nerve root compression, radiculopathy, synovial cysts