{"id":"84342590-9596-4c56-a6b6-d7ec3f140b22","slug":"perspective-operate-on-lumbar-synovial-cysts-and-avoid-ineffective-percutaneous-techniques","title":"Perspective: Operate on lumbar synovial cysts and avoid ineffective percutaneous techniques","authors":["Nancy E. Epstein","Marc A. Agulnick"],"abstract":"Background: Lumbar synovial cysts (LSC), best diagnosed on MR studies, may cause symptoms/signs ranging from unilateral radiculopathy to cauda equina compressive syndromes. Attempts at percutaneous treatment of LSC typically fail. Rather, greater safety/efficacy is associated with direct surgical resection with/without fusion. Methods: Treatment of LSC with percutaneous techniques, including cyst aspiration/perforation, injection (i.e., with/without steroids, saline/other), dilatation, and/or disruption/bursting, classically fail. This is because LSCs’ tough, thickened, and adherent fibrous capsules cause extensive thecal sac/nerve root compression, and contain minimal central “fluid” (i.e., “crank-case” and non-aspirable). Multiple percutaneous attempts at decompression, therefore, typically cause several needle puncture sites risking dural tears (DT)/cerebrospinal fluid (CSF) leaks, direct root injuries, failure to decompress the thecal sac/nerve roots, infections, hematomas, and over the longer-term, adhesive arachnoiditis. Results: Alternatively, many studies document the success of direct or even partial resection of LSC (i.e., partial removal with marked cyst/dural adhesions with shrinking down the remnant of capsular tissue). Surgical decompressions of LSC, ranging from focal laminotomies to laminectomies, may or may not warrant additional fusions. Conclusions: Symptomatic LSC are best managed with direct or even partial operative resection/decompression with/without fusion. The use of varying percutaneous techniques classically fails, and increases multiple perioperative risks.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/84342590-9596-4c56-a6b6-d7ec3f140b22/featured/hero-cropped-1781559709694.jpg","publishDate":"2024-03-01T00:00:00.000Z","doi":"10.25259/SNI_95_2024","categories":["Spine","Review Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/84342590-9596-4c56-a6b6-d7ec3f140b22/pdf"}