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Ekşi MŞ, Hazneci J, Topçu A, Topaloğlu F, Tanriverdi N, Yeşilyurt SC, Duymaz UC, Sözen MB, Şişman A, Havyarimana D, Börekci A, Öztürk ÖÇ, Topal A, Hakan T, Özcan-Ekşi EE, Çelikoğlu E. Which vacuum phenomenon is more predictive for future junctional disorders?: Intradiscal or Intrafacet? J Clin Neurosci 2024; 129:110849. [PMID: 39303530 DOI: 10.1016/j.jocn.2024.110849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/18/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
Recent spine studies focused on identifying whether intradiscal vacuum phenomenon (VP) was associated with spinal instability. However, none of them reported a direct association between VP and spinal instability following fusion for degenerative lumbar spine disorders (DSDs), namely junctional disorders. In the present study, we aimed to evaluate whether the VP was predictive for junctional disorders in patients who underwent short-segment lumbar decompression and fusion for DSDs at a tertiary spine center. We retrospectively reviewed prospectively collected database of patients who underwent short-segment decompression and fusion for DSDs. Pre-operative sagittal and axial computed tomography (CT) scans were evaluated in terms of intradiscal and intrafacet VP at all lumbar levels, respectively. Each VP was scored as 1 point. Then, the total VP score was calculated as the sum of intradiscal VP score and intrafacet VP score. Then, we analyzed the possible predictivity of VP for junctional disorders at final follow-ups of the patients operated for short-segment lumbar decompression and fusion. Patients with junctional disorders had significantly higher total and intrafacet VP scores compared to those without junctional disorders. Total VP score had an OR of 1.217 (p = 0.014) and intrafacet VP score had an OR of 1.465 (p = 0.008). The ROC analysis depicted that the cut-offs value for total and intrafacet VP scores to predict junctional disorders following short-segment lumbar decompression and fusion were 1.5 points and 0.5 point, respectively. Vacuum phenomenon could be associated with junctional disorders in patients who underwent short-segment lumbar decompression and fusion for DSD. Intrafacet VP was more important than intradiscal VP in predicting junctional disorders. Proper surgical planning including the evaluation of both intrafacet and intradiscal VP at all lumbar levels is crucial to decrease the likelihood of junctional disorders.
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Affiliation(s)
- Murat Şakir Ekşi
- Health Sciences University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey; FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
| | - Jülide Hazneci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Arda Topçu
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Fatma Topaloğlu
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Nursena Tanriverdi
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | | | - Umut Can Duymaz
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Mehmet Berat Sözen
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Asya Şişman
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | | | - Ali Börekci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | | | - Arif Topal
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Tayfun Hakan
- Health Sciences University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey; FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Acıbadem Bağdat Caddesi Medical Center, Physical Medicine and Rehabilitation Unit, Istanbul, Turkey
| | - Erhan Çelikoğlu
- Health Sciences University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey; FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
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Wei Z, Lin Q, Zhang H, Zhang H, Ma X, Wang C. A rare gas-containing lumbar synovial cyst treated by percutaneous transforaminal endoscopic cystectomy: A case report and literature review. Front Surg 2023; 10:1095572. [PMID: 37025269 PMCID: PMC10070843 DOI: 10.3389/fsurg.2023.1095572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Spinal synovial cysts are rare entities for which standard surgical strategies are inconsistent. Here, we present an uncommon intraspinal gas-containing synovial cyst treated by percutaneous transforaminal endoscopic cystectomy. A 52-year-old man presented with radicular pain and intermittent claudication that had persisted for one month. Computed tomography revealed an intraspinal cystic lesion anteromedial to the left L4-L5 articular joint and the center of the lesion manifested gas contents. A transforaminal endoscopic procedure was performed and confirmed as a safe and minimally invasive technique for gas-containing lumbar synovial cysts. It provides a valuable substitution and supplementation to open surgery.
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Affiliation(s)
- Ziran Wei
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Lin
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hao Zhang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haoyun Zhang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Correspondence: Chao Wang ; Xuexiao Ma
| | - Chao Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Correspondence: Chao Wang ; Xuexiao Ma
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Cunha B, Rodrigues A, Gonçalves J, Conceição C. Imaging of intraspinal cystic lesions: A review. J Neuroimaging 2022; 32:1044-1061. [PMID: 35942824 DOI: 10.1111/jon.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022] Open
Abstract
Several distinct conditions present as cystic or pseudocystic lesions within the spinal canal. Some of the most common spinal cystic lesions include spinal meningeal cysts, juxtafacet cysts, dermoid/epidermoid cysts, nerve sheath tumors, and syringohydromyelia. Clinical presentation is usually nonspecific and imaging characteristics are frequently overlapping, which may pose a challenging presurgical diagnosis. We provide a pictorial review of cystic intraspinal lesions and discuss the main imaging features that can aid the neuroradiologist in the differential diagnosis. First, we propose a categorization of the lesions according to their location as extradural, intradural extramedullary, and intramedullary. This is a crucial initial step in the diagnostic workup and surgical planning. Second, for each of these locations, we organize the lesions according to their etiology: congenital and developmental disorders, degenerative disorders, traumatic or postsurgical collections, infectious conditions, neoplastic lesions, and other miscellaneous disorders. Finally, we summarize the clinical highlights and MR features that provide important insights for the differential diagnosis. MR is the technique of choice in presurgical evaluation and postsurgery follow-up. It provides accurate lesion localization and characterization and, most of the times, it will allow a confident differential diagnosis. High-resolution three-dimensional T2-weighted sequences and diffusion-weighted imaging can provide important hints in specific cases. Signal correlation with T1-weighted and fat-saturated sequences allows to differentiate true cystic lesions from hemorrhage or fat tissue.
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Affiliation(s)
- Bruno Cunha
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alexandra Rodrigues
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.,Unidade de Neurorradiologia, Hospital Central do Funchal, Funchal, Portugal
| | - João Gonçalves
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.,Unidade de Neurorradiologia, Hospital Central do Funchal, Funchal, Portugal
| | - Carla Conceição
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Sagoo NS, Bhatti H, Rowe SE, Sharma I, Haider AS. Lumbar Facet Joint Cyst Treated With Decompression and Interlaminar Stabilization. Cureus 2020; 12:e9391. [PMID: 32850257 PMCID: PMC7445097 DOI: 10.7759/cureus.9391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Spinal facet joint cysts (FJCs) are an increasingly reported cause of lower back pain, radiculopathy, and neurological deficits owing to their proximity to adjacent nerve roots. The etiology of these cysts has not yet been fully elucidated, although they appear to be related to degenerative changes in the facet joints themselves. Conservative management strategies including physical therapy and oral analgesics rarely result in spontaneous regression of an FJC, often providing only short-term relief. The current treatment modalities reported for FJCs generally range from percutaneous cyst aspiration to decompression surgery with or without instrumented spinal fusion. However, instrumented fusion often results in a higher rate of complications such as pseudoarthrosis and adjacent segment disease. The Coflex® (Paradigm Spine, LLC, New York, NY) interlaminar stabilization (ILS) implant is a novel titanium, U-shaped device which acts as a motion-preserving stabilizer and has proven to be a viable alternative to instrumental fusion. Here, we discuss a case of an FJC treated with both decompression and placement of a Coflex ILS device.
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Affiliation(s)
- Navraj S Sagoo
- Orthopedic Surgery, The University of Texas Medical Branch at Galveston, Galveston, USA
| | | | - Scott E Rowe
- Neurosurgery, University of Texas Southwestern, Dallas, USA.,Neurosurgery, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Ishaan Sharma
- Orthopedic Surgery, Ross University School of Medicine, Bridgetown, USA
| | - Ali S Haider
- Neurosurgery, Texas A&M University College of Medicine, Houston, USA.,Neurosurgery, Baylor Scott & White Medical Center, College Station, USA
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