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Efficacy of minimally invasive tubular approaches for management of the lumbar spinal synovial cysts: a meta-analysis – Lumbar Fusion

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This article discusses the treatment options for lumbar spinal synovial cysts (LSCs), which can cause neurogenic dysfunction and severe pain. Surgical excision is the standard treatment when conservative approaches fail. The article presents a meta-analysis that compares the clinical outcomes of minimally invasive approaches (microscopic and endoscopic) using tubular retractors with traditional percutaneous approaches for LSCs. The analysis found that the minimal groups had similar pain improvement, dural tear, residual cyst, recurrence, and operation time compared to the traditional groups. However, the minimal groups showed better functional improvement, lower reoperation rates, shorter hospital stay, and less intraoperative bleeding. Subgroup analysis also showed that endoscopic groups had a shorter operation time. The authors conclude that for patients with LSCs and no evidence of vertebral instability, minimally invasive tubular approaches without fusion may provide the best surgical outcome

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

The treatment of lumbar spinal synovial cysts (LSCs) which are relatively rare but can cause neurogenic dysfunction and intractable pain has been a controversial topic for many years. Surgical excision of LSCs is the standard treatment for patients in whom conservative treatment options fail. This meta-analysis was undertaken to compare clinical outcomes between minimally invasive approaches using tubular retractors (microscopic vs. endoscopic) and traditional percutaneous approaches for LSCs….

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Eur J Med Res. 2023 Nov 8;28(1):494. doi: 10.1186/s40001-023-01481-0.ABSTRACTThe treatment of lumbar spinal synovial cysts (LSCs) which are relatively rare but can cause neurogenic dysfunction and intractable pain has been a controversial topic for many years. Surgical excision of LSCs is the standard treatment for patients in whom conservative treatment options fail. This meta-analysis was,

Eur J Med Res. 2023 Nov 8;28(1):494. doi:10.1186/s40001-023-01481-0.

ABSTRACT

The treatment of lumbar spinal synovial cysts (LSCs) which are relatively rare but can cause neurogenic dysfunction and intractable pain has been a controversial topic for many years. Surgical excision of LSCs is the standard treatment for patients in whom conservative treatment options fail. This meta-analysis was undertaken to compare clinical outcomes between minimally invasive approaches using tubular retractors (microscopic vs. endoscopic) and traditional percutaneous approaches for LSCs. Studies reporting surgical management of LSCs were searched in the Cochrane Library, PubMed and Web of Science database. This meta-analysis was reported following the PRISMA Statement, registered in Prospero (CRD42021288992). A total of 1833 patients were included from both the related relevant studies (41 studies, n = 1831) and the present series (n = 2). Meta-analysis of minimally invasive tubular approaches revealed no statistically significant difference in pain improvement, dural tear, residual cyst, recurrence and operation time between minimal groups with traditional groups (p > 0.05). Minimal groups had better Functional improvement of 100% (95% CI 1.00-1.00; p < 0.001, I2 = 75.3%) and less reoperation rates of 0% (95% CI – 0.00-0.00; p = 0.007, I2 = 47.1%). Postoperative length of hospital stay and intraoperative bleeding in minimal groups were also less than traditional groups (p < 0.05). Subgroup analysis revealed endoscopic groups had less operation time (p = 0.004), and there was no significant difference in the rest. For patients with LSCs but without obvious clinical and imaging evidence of vertebral instability, even when preoperative stable grade 1 spondylolisthesis is present, minimally invasive tubular approaches without fusion may provide the best outcome in surgical management.

PMID:37941083 | DOI:10.1186/s40001-023-01481-0

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Efficacy of minimally invasive tubular approaches for management of the lumbar spinal synovial cysts: a meta-analysis

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Eur J Med Res. 2023 Nov 8;28(1):494. doi: 10.1186/s40001-023-01481-0.ABSTRACTThe treatment of lumbar spinal synovial cysts (LSCs) which are relatively rare but can cause neurogenic dysfunction and intractable pain has been a controversial topic for many years. Surgical excision of LSCs is the standard treatment for patients in whom conservative treatment options fail. This meta-analysis was

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