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Intraspinal extradural synovial cysts are quite common in the lumbar spine. With respect to clinical presentation and surgical treatment, juxta-facet cysts (ganglion and synovial cysts) share identical characteristics and results. Nowadays, current treatment strategies of intraspinal juxta-facet cysts continue to inspire controversy regarding appropriate surgical approaches, and include many technical options. The purpose of this report is to illustrate the advantage of minimally invasive approaches in 3 cases of lumbar synovial cysts. We performed a small flavectomy in the 1st case, a transarticular partial facectomy, followed by etherologous bone graft fusion in the 2nd case, and a flavectomy and partial facectomy in the 3rd case. In our cases, a microsurgical approach to lumbar synovial cysts yielded to complete excision of the lesions and excellent pain relief, with early mobilization and hospital discharge of the patients. In our opinion, minimally invasive approaches and microsurgical excision of lumbar juxta-facet cysts are advantageous over conventional lumbar laminectomy because they reduce later development of segmental instability at the operative level, and therefore a less invasive strategy for intraspinal synovial cysts removal should be recommended.
KEY WORDS: Cysts - Spinal instability - Microsurgery.
Benign extradural synovial cysts are quite common in the lumbar spine, resulting from mucoid-cystic degeneration of soft tissues adjacent to a joint space. Most of them are adjacent to the facet joints, whereas the lumbar synovial cysts that are located on the midline,1,2 intraforaminal,3 far lateral extraforaminal 4-6 or bilaterally,7-9 are veiy rare. Nevertheless, the incidence, prevalence and natural history of these lesions remain unknown. Age,10 hypermobility and/or instability of the facets joints,11 minor trauma and sport-related overactivity,9,12-14 facet arthropathy,15 urease-producing bacteria infection,16 rheumatoid arthritis,17 spondylolistesis and kissing spinous processes,9, 11, 12 complication of lumbar arthrodesis,18 may play a part in the etiology of facets joints synovial cysts.
With respect to clinical presentation and surgical treatment, juxta-facet cysts share identical characteristics and results.
Therefore, these degenerative lesions, can pose serious diagnostic and therapeutic problems clue to the presentation, which most often resembles a narrowed lateral recess syndrome, than a lumbar herniated disc or cauda equina syndrome.9,10,19-21
Moreover, different surgical and percutaneous procedures have been proposed, but no consent has been formed so far as to which approach should be used in the management of these...