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Die Wirbelsäule 2017; 01(02): 117-123
DOI: 10.1055/s-0043-103768
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Fazettgelenkzysten – Diagnose, Management und Outcome

Facet joint cyst of the lumbar spine – diagnosis, management and outcome
Sven O. Eicker
Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Publication History

Publication Date:
03 May 2017 (online)

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Zusammenfassung

Fazettgelenkzysten können radikuläre Beschwerden, neurogene Claudicatio, vertebrogenen Rückenschmerz und neurologische Defizite auslösen. Aufgrund der ubiquitären MRT Diagnostik werden Fazettgelenkzysten vermehrt diagnostiziert. Sollten die konservativen Therapiemaßnahmen nicht den gewünschten Erfolg bringen müssen invasivere Maßnahmen erwogen werden. Hierbei unterscheidet man perkutane Verfahren mit Reduktion der Zystengröße durch Aspiration von Zysteninhalt oder Ruptur der Zyste von operativen Verfahren zur Zystenresektion mit und ohne zusätzlicher Fusion des betroffenen Segmentes.

Die perkutanen Verfahren sind ambulant durchführbar und zeigen in den meisten Fällen eine sehr gute Kurzzeitwirkung. Dies kann unter anderem auch mit der häufig zusätzlich durchgeführten Applikation von Corticosteroiden zusammenhängen. Die Langzeitergebnisse sind weniger positiv da über 40 % der Patienten nicht erfolgreich therapiert werden können. Die operative Zystenresektion stellt die Therapie mit der höchsten Erfolgsrate auch im Langzeitverlauf dar (ca. 90 %). Operativ zu therapierende Rezidive sind bei der alleinigen Zystenresektion selten und kommen bei zusätzlicher Fusion nicht vor. Wann eine Fusion durchgeführt werden sollte ist vom Einzelfall abhängig. Wenn die Entscheidung zur alleinigen Dekompression gestellt wird, ist die Rate der Patienten, welche sekundär fusioniert werden müssen, sehr gering. Die Duraverletzung ist aufgrund der häufig nachzuweisenden Adhäsion als wichtige Komplikation zu nennen.

Abstract

Facet joint cyst can cause radiculopathy, neurogenic claudication, lower back pain and neurologic deficits. Due to the rising availability of MRI diagnostic facet joint cysts are increasingly often reported. Conservative treatment rarely results in regression of facet joint cysts with persistent of symptoms. More invasive interventions are required. Percutaneous procedures lead to a reduction of the cyst volume due to aspiration of fluid cyst content or rupture of the cyst. Decompressive surgery with or without additional fusion represents the surgical options.

Percutaneous procedures can be performed in an ambulant setting. Short term pain relief is very successful due to the decompressive effect and the often concomitant performed application of corticosteroids. Long term results showed a failure rate of more than 40 %. Decompressive surgery with or without additional fusion has the highest rate of symptom resolution (90 %). Recurrence rate after decompressive surgery is low and after additional fusion not existing. Decision to perform additional fusion or not has to be made on a case-by-case basis. If decision is drawn in favour to solely decompression, failure rate and secondary fusion due to clinical evident instability is rare. Dural adhesion of facet joint cyst is common with a high incidence of dural tears.

Schlüsselwörter

Fazettgelenkzysten - Synovialiszysten - Ganglionzysten - perkutane Therapie - Zystenaspiration - Zystenruptur

Key words

Facet joint cyst - synovial cyst - ganglion cyst - percutaneous therapy - cyst aspiration - cyst rupture
 

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