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Die lumbalen Synovialzysten: Literaturreview und originäre Langzeitergebnisse nach mikrochirurgischer Resektion

Lumbar synovial cysts: literature review and original long-term results after microsurgical resection

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Zusammenfassung

Hintergrund

Intraspinale lumbale Wirbelgelenkszysten stellen eine nicht alltägliche Ursache einer Nervenwurzelkompressionssymptomatik dar und unterscheiden sich klinisch nicht wesentlich von den Symptomen eines Bandscheibenvorfalls.

Pathogenese

Die Zysten haben ihren Ursprung an den kleinen Wirbelgelenken und üben je nach Größe eine Kompression auf nervale Strukturen aus. Die betroffenen Wirbelgelenke weisen bei allen Patienten arthrotische Veränderungen auf, welche in etwa 50 % der Fälle mit einer degenerativen Spondylolisthese verbunden sind. Mittels MRT und CT ist in den allermeisten Fällen eine diagnostische Zuordnung möglich. Die exakte Ätiologie ist bisher noch nicht vollständig geklärt. Verschiedene Faktoren, wie eine aktivierte Arthritis bei stark degenerativ veränderten Wirbelgelenken, scheinen eine wesentliche Ursache darzustellen.

Therapie

Die Therapieoptionen beinhalten die konservative, die semiinvasive und die operative Therapie. Konservative und semiinvasive Behandlungsmethoden führen zu temporärer Besserung. Das Ergebnis der operativen Therapie ist demgegenüber jedoch bei einer kompletten Resektion der Synovialzyste exzellent. Eine primäre Fusion ist in seltenen Fällen notwendig.

Abstract

Background

Intraspinal lumbar vertebral joint cysts are an unusual cause of nerve root compression symptoms and do not differ clinically from the symptoms of a herniated disc.

Pathogenesis

The cysts originate from the small vertebral joints and, depending on their size, compress the nerval structures. The affected vertebral joints typically show activated arthritic circumstances, which are associated with degenerative spondylolisthesis in about 50% of cases. In the majority of cases, MRT and CT can be used for diagnostic purposes. The exact etiology has not been fully clarified; various factors such as activated arthritis of the vertebral joints appear to be the major cause.

Treatment

Treatment options include conservative, semi-invasive and surgical therapy. Conservative and semi-invasive treatment methods lead to temporary improvement. The result of surgical treatment, however, is excellent in a complete resection of synovial cysts. In In rare cases, an initial fusion is necessary in rare cases.

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Abbreviations

CT:

Computertomographie

FAB :

Facettenblockade

LWS:

Lendenwirbelsäule

MRT :

Magnetresonanztomographie

PLIF :

„Posterior lumbar interbody fusion“

PRT :

Periradikuläre Therapie

TLIF :

„Transforaminal lumbar interbody fusion“

VAS :

Visuelle Analogskala

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Authors and Affiliations

  1. Neurochirurgische Gemeinschaftspraxis Wiesbaden, Rheinstr. 31, 65185, Wiesbaden, Deutschland

    T. Rahim

  2. Wirbelsäulenorthopädie und Rekonstruktive Orthopädie, Sana Klinikum Offenbach, Offenbach, Deutschland

    J. M. Vinas Rios, M. Rauschmann & M. Arabmotlagh

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Correspondence to T. Rahim.

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Interessenkonflikt

T. Rahim, J.M. Vinas Rios, M. Arabmotlagh und M. Rauschmann geben an, dass kein Interessenkonflikt besteht.

Alle ethischen, rechtlichen und wissenschaftlichen Anforderungen an klinische Prüfungen wurden erfüllt. Vor der Teilnahme an der Studie wurde jeder Patient umfassend über den Untersuchungsablauf, rechtliche Grundlagen, ethische Voraussetzungen und Vertraulichkeit der Daten aufgeklärt. Ein Ethikkommissionsvotum existiert jedoch nicht.

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T Rahim und JM Vinas-Rios haben zu gleichen Teilen zu der Arbeit beigetragen.

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Rahim, T., Vinas Rios, J.M., Rauschmann, M. et al. Die lumbalen Synovialzysten: Literaturreview und originäre Langzeitergebnisse nach mikrochirurgischer Resektion. Orthopäde 48, 849–857 (2019). https://doi.org/10.1007/s00132-019-03758-x

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