Transarticular Facet Fixation In The Treatment Of Synovial Cysts Of The Lumbar Spine

Presented at SMISS Annual Forum 2014
By Michal Woznica MD
With Wojciech Kloc MD, PhD, Witold Libionka MD, Miroslaw Niedbala MD, Wojciech Skrobot MSc, Stanislaw Adamski MD,

Disclosures: Michal Woznica MD None Wojciech Kloc MD, PhD None, Witold Libionka MD None, Miroslaw Niedbala MD None, Wojciech Skrobot MSc None, Stanislaw Adamski MD None,

Introduction:
Standard approach in lumbar spine synovial cysts include resection and decompression through fenestration and foraminotomy. Addition of stabilization is proposed to improve recovery and prevent recurrence.

Aims/Objectives:
Evaluation of two different surgical treatment methods for lumbar synovial cyst.

Methods:
The results of two different surgical treatments of patients suffering from synovial cysts of the lumbar region were compared. The experimental group consisted of ten consecutive patients who were treated between March 2012 and January 2013 using the technique of a microsurgical fenestration with a resection of synovial cysts and a simultaneous percutaneous transarticular facet fixation using VIPER F2 Facet Fixation System manufactured by DePuy Spine. The control group was comprised of ten consecutive patients diagnosed with a synovial cyst and whose treatment involved a microsurgical fenestration with a resection of synovial cysts, which were carried out between 2011 and 2012. Before the surgery, three months and one year after surgery all the patients’ neurological condition was assessed, an increase of radicular pain and back pain were measured on a visual analogue scale (VAS), and their improved quality of life was measured with mRS (the modified Rankin Scale). The position of the screws was verified through a tomographic examination of the spine.

Results:
Three months and 1 year after the surgery all the patients from the experimental group reported a decreased radicular pain (from an average of 7.8 on the VAS to 0.2 three months after surgery and to 1.3 one year after surgery; p < 0.01) and back pain from 4.8 to 1.2 and to 2.2 on the VAS (p < 0.05). Computer tomographic examination of the spine showed a correct placement of the screws in all patients. In the control group a significant reduction of the radicular pain from an average of 9.1 on the VAS to 0.3 and to 2.4; (p < 0.05), however, the observed improvement of the back pain was not statistically valid (from an average of 5.6 on the VAS to 4.3 and to 3.8).

Conclusions:
The results indicate that microsurgical fusion significantly reduces back pain in patients diagnosed with synovial cysts. Therefore, transarticular facet fixation is recommended as a relatively simple and quick technique for this group of patients.