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Lumbar Synovial Cysts-Should You Fuse or Not? – Lumbar Spinal Stenosis

The article discusses a retrospective cohort study conducted to determine the effectiveness of instrumented spinal fusion in addition to lumbar decompression for the treatment of spinal synovial cysts. The study aimed to compare the risk of subsequent surgery (SS) between patients who underwent laminectomy alone and those who underwent laminectomy with fusion (LF). Using a propensity score-matching method, the study found that patients who received LF had a significantly lower risk of recurrent SS compared to those who had laminectomy alone. The results suggest that concomitant lumbar fusion may decrease the chance of cyst- or noncyst-related recurrence SS in patients with spinal synovial cysts

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: All patients who had concomitant lumbar fusion showed decreased chance of having a cyst- or noncyst-related recurrence SS when compared with all patients undergoing laminectomy alone, regardless of diagnosis at the time of SS.

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Neurosurgery. 2023 May 1;92(5):1013-1020. doi: 10.1227/neu.0000000000002314. Epub 2022 Dec 30.ABSTRACTBACKGROUND: Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown.OBJECTIVE: To test the hypothesis that select patients who underwent decompression with instrumented,

Neurosurgery. 2023 May 1;92(5):1013-1020. doi: 10.1227/neu.0000000000002314. Epub 2022 Dec 30.

ABSTRACT

BACKGROUND: Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown.

OBJECTIVE: To test the hypothesis that select patients who underwent decompression with instrumented fusion for lumbar synovial cysts would be less likely to have subsequent surgery (SS) in a 2-year period than patients treated with laminectomy alone.

METHODS: This retrospective cohort study was performed using IBM MarketScan Commercial Claims and Encounters Database. Patients who had a lumbar synovial cyst diagnosis and laminectomy surgery with or without fusion surgery were included in this study. Patients were tracked for SS 2 years after surgery. Laminectomy patients were propensity score-matched to laminectomy with fusion (LF) patients using a 2:1 ratio. The log-rank test and Cox regression were used to compare the cumulative incidence of SS between groups.

RESULTS: There were 7664 and 1631 patients treated with laminectomy and LF before matching. After matching, there were 2212 laminectomy and 1631 LF patients and patient characteristics were balanced. The 2-year incidence of recurrent SS was 3.1% ([CI]: 2.2%, 4.0%) and 1.7% (95% CI: 0.9%, 2.5%) laminectomy and LF, respectively. Compared with laminectomy, LF had a statistically significant lower risk of recurrent SS (hazard ratio: 0.56 [95% CI: 0.32-0.97]; P -value: .04).

CONCLUSION: All patients who had concomitant lumbar fusion showed decreased chance of having a cyst- or noncyst-related recurrence SS when compared with all patients undergoing laminectomy alone, regardless of diagnosis at the time of SS.

PMID:36700698 | DOI:10.1227/neu.0000000000002314

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Lumbar Synovial Cysts-Should You Fuse or Not?

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Neurosurgery. 2023 May 1;92(5):1013-1020. doi: 10.1227/neu.0000000000002314. Epub 2022 Dec 30.ABSTRACTBACKGROUND: Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown.OBJECTIVE: To test the hypothesis that select patients who underwent decompression with instrumented
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