Perspective: Operate on lumbar synovial cysts and avoid ineffective percutaneous techniques.

Area of Science:

• Neurosurgery
• Spinal Surgery
• Radiology

Background:

• Lumbar synovial cysts (LSC) are diagnosed via MRI and can cause significant neurological deficits, including radiculopathy and cauda equina syndrome.
• Percutaneous treatments for LSC frequently fail due to the cysts' tough, adherent capsules and minimal non-aspirable fluid.
• These failed percutaneous attempts increase risks of dural tears, CSF leaks, nerve injury, infection, and arachnoiditis.

Purpose of the Study:

• To evaluate the efficacy and safety of different treatment modalities for symptomatic lumbar synovial cysts.
• To compare surgical resection with percutaneous techniques for LSC management.

Main Methods:

• Review of studies documenting outcomes of percutaneous treatments (aspiration, injection, dilatation) for LSC.
• Analysis of literature reporting results of direct or partial surgical resection of LSC.
• Assessment of surgical decompression techniques including laminotomies and laminectomies, with or without spinal fusion.

Main Results:

• Percutaneous interventions for LSC, including aspiration, perforation, and injection, are consistently associated with high failure rates.
• Surgical resection, even partial removal of LSC, demonstrates significant success in decompressing neural structures.
• Surgical decompression may necessitate spinal fusion depending on the extent of the procedure and spinal stability.

Conclusions:

• Direct surgical resection, with or without fusion, is the preferred and most effective treatment for symptomatic lumbar synovial cysts.
• Percutaneous techniques for LSC are largely ineffective and carry substantial risks of complications.
• Minimally invasive approaches increase perioperative risks without achieving successful decompression.