Lumbar laminectomy for the resection of synovial cysts and coexisting lumbar spinal stenosis or degenerative spondylolisthesis: an outcome study.

摘要

STUDY DESIGN: Surgeon- and patient-based (SF-36) outcome measures were used to assess the results of decompressive laminectomies for the excision of synovial cysts with coexistent lumbar spinal stenosis (45 patients) or for synovial cysts with coexistent lumbar stenosis and degenerative spondylolisthesis (35 patients). OBJECTIVES: To evaluate the results following laminectomy and the excision of synovial cysts/stenosis with or without olisthy. SUMMARY OF BACKGROUND DATA: SF-36 outcome studies evaluating these surgical results deserve further investigation. METHODS: Before surgery, patients with synovial cysts/ stenosis (45 patients) or cysts/stenosis/degenerative spondylolisthesis (35 patients), respectively, exhibited low back pain (40 and 33 patients), radiculopathy (43 and 33 patients), and neurogenic claudication (41 and 26 patients). Surgery required average 3.8 and 3.5 level laminectomies, respectively, for patients with cysts/stenosis and cysts/stenosis and olisthy. Outcomes were assessed 2 years after surgery. RESULTS: Five of 45 patients undergoing laminectomy alone for cysts/stenosis developed postoperative olisthy. Of 35 patients with cysts/stenosis and preoperative Grade 1 degenerative spondylolisthesis, olisthy increased after surgery to Grade 2 in 11 patients. Good/excellent results (58% and 63%) and SF-36 improvement on the Physical Function Scale (+44 and +38 points) were, respectively, documented for these two groups. CONCLUSIONS: Using both surgeon and SF-36 outcome measures, 2 years following laminectomy for synovial cysts/lumbar stenosis with or without olisthy, patients exhibited a moderate degree of improvement. As synovial cysts reflect disruption of the facet joint and some degree of instability, primary fusion should be considered to improve operative results for patients in both categories.