Fazettgelenkzysten – Diagnose, Management und Outcome

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

• Referenzen

• 1 Eyster EF, Cott WR. Lumbar synovial cyst: report of eleven cases. Neurosurgery 1989; 24: 112-115
• 2 Salmon B, Martin D, Lenelle J. et al. Juxtafacet cyst of the lumbar spine. Clinical, radiological and therapeutic aspects in 28 cases. Acta Neurochir 2001; 143: 129-134
• 3 Doyle AJ, Merrilees M. Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic resonance imaging. Spine 2004; 29: 874-878
• 4 Campball RJ, Mobbs RJ, Rao PJ. et al. Interventions for Lumbar Synovial Facet Joint Cysts: A Comparision of Percutaneous, Surgical Decompression and Fusion Approaches. World Neurosurg 2017; 98: 492-502
• 5 Epstein NE. Lumbar Synovial Cysts: a review of diagnosis, surgical management, and outcome assessment. J Spinal Disord Tech 2004; 17: 321-325
• 6 Cambron SC, McIntyre JJ, Guerin SJ. et al. Lumbar Facet Joint Synovial Cysts : Does T2 Signal Intensity Predict Outcomes after Percutaneous Rupture ?. AJNR Am J Neuroradiol 2013; 34: 1661-1664
• 7 Christophis P, Asamoto S, Kuchelmeister K. et al. „Juxtafacet cysts“, a misleading name for cystic formations of mobile spine (CYFMOS). Eur Spine J 2007; 16: 1499-1505
• 8 James A, Laufer I, Parikh K. et al. Lumbar Juxtafacet Cyst resection: The Facet Sparing Contralateral Minimally Invasive Surgical Approach. J Spinal Disord tech 2012; 25: E13-E17
• 9 Lauwers A, Coutois I, Duthel R. et al. Cauda equina sydrome due to a facet joint synovial cyst. Rev Rhum Engl Ed 1997; 64: 856-857
• 10 Delank KS, Fürderer S, Popken F. et al. Facettengelenkzysten als Differenzialdiagnose bei Lumboischalgien. Z Orthop 2004; 142: 410-414
• 11 Wilby MJ, Fraser RD, Vernon-Roberts B. et al. The Prevalence and Pathogenesis of Synovial Cysts Within the Ligamentum Flavum in Patients With Lumbar Spinal Stenosis and Radiculopathy. Spine 2009; 34: 2518-2514
• 12 Oertel MF, Ryang YM, Gilsbach JM. et al. Lumbar foraminal and far lateral juxtafacet cyst of intraspinal origin. Surgical Neurology 2006; 66: 197-199
• 13 Métellus P, Fuentes S, Adetchessi T. et al. Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome. Acta Neurochir (Wien) 2006; 148: 47-54
• 14 Kasliwal MK, Deutsch H. Completely calcified lumbar synovial cyst. Neurol India 2011; 59: 315-316
• 15 Tofuku K, Koga H, Komiya S. Facet arthrography of a cervical synovial cyst. J NeuroIntervent Surg 2012; 4: e17
• 16 Pirotte B, Gabrovsky N, Massager N. et al. Synovial cysts of the lumbar spine: surgery-related results and outcome. J Neurosurg 2003; 99: 14-19
• 17 Shah RV, Lutz GE. Lumbar intraspinal synovial cysts: conservative management and review of the world’s literature. Spine J 2003; 3: 479-488
• 18 Illerhaus B, Scholz M, Pechlivanis I. et al. MRT-Verlaufsbeobachtungen einer sponatnen Regression einer lumbalen Facettengelenkszyste. Rofo 2005; 177: 171-1719
• 19 Maezawa Y, Baba H, Uchida K. et al. Spontaneous remission of a solitary intraspinal synovial cyst of the lumbar spine. Eur Spine J 2000; 9: 85-87
• 20 Ewald C, Kalff R. Resolution of a synovial cyst of the lumbar spine without surgical therapy – A case report. Zentralbl Neurochir 2005; 66: 147-151
• 21 Mattei TA, Goulart CR, McCall TD. Pathophysiology of regression of synovial cysts of the lumbar spine : The ‘anti-inflammatory hypothesis’. Medical Hypotheses 2012; 79: 813-818
• 22 Houten JK, Sanderson SP, Cooper PR. Spontaneous regression of symptomatic lumbar synovial cysts. Report of three cases. J Neurosurg 2003; 99: 235-238
• 23 Parlier-Cuau C, Wybier M, Nizard R. et al. Symptomatic lumbar facet joint synovial cysts: clinical assessment of facet joint steroid injection after 1 and 6 months and long-term follow-up in 30 patients. Radiology 1999; 210: 509-513
• 24 Lin TL, Chung CT, Lan HH. et al. Ultrasound-guided facet joint injection to treat a spinal cyst. J Chin Med Assoc 2014; 77: 213-216
• 25 Kursumovic A, Bostelmann R, Gollwitzer M. et al. Intraspinal Lumbar Juxtaarticular Cyst Treatment Through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome. Clin Pract 2016; 6: 866
• 26 Epstein NE, Baisden J. The diagnosis and management of synovialis cysts: Efficacy of surgery versus cyst aspiration. Surg Neurol Int 2012; 3: 157-166
• 27 Komp M, Hahn P, Ozdemir S. et al. Operation of lumbar zygoapophyseal joint cysts using a full-endoscopic interlaminar and transforaminal approach: prospective 2-year results of 74 patients. Surg Innov 2014; 21: 605-614
• 28 Epstein NE. Lumbar Laminectomy for the Resection of Synovial Cysts and Coexisting Lumbar Spinal Stenosis or Degenerative Spondylolisthesis: An Outcome Study. Spine 2004; 9: 1049-1056
• 29 Bydon A, Xu R, Parker SL. et al. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. Spine J 2010; 10: 820-826
• 30 Scholz C, Hubbe U, Kogias E. et al. Incomplete resection of lumbar synovial cysts – Evaluating the risk of recurrence. Clin Neurol Neurosurg 2015; 136: 29-32
• 31 Klessinger S. The incidence of dural tears after complete resection of lumbar synovial cysts and the relation to the outcome. Clin Neurol Neurosurg 2016; 144: 14-19
• 32 Kahn AM, Synnot K, Cammisa FP. et al. Lumbar synovial cyst of the spine: an evaluation of surgical outcome. J Spinal Disord Tech 2005; 18: 127-131
• 33 Xu R, McGirt MJ, Parker SL. et al. Factors associated with recurrent back pain and cyst recurrence after surgical resection of one hundred ninety-five spinal synovial cysts: analysis of one hundred sixty-seven consecutive cases. Spine 2010; 35: 1044-1053