Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2017; 8(9): 697-704
Published online Sep 18, 2017. doi: 10.5312/wjo.v8.i9.697
Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review
Maurizio Domenicucci, Alessandro Ramieri, Daniele Marruzzo, Paolo Missori, Massimo Miscusi, Roberto Tarantino, Roberto Delfini
Maurizio Domenicucci, Daniele Marruzzo, Paolo Missori, Roberto Tarantino, Roberto Delfini, Department of Neurological and Psychiatric, Sapienza University of Rome, 00185 Rome, Italy
Alessandro Ramieri, Orthopedic Division, Don Gnocchi Foundation, 20148 Milan, Italy
Massimo Miscusi, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
Author contributions: All the authors contributed to this manuscript.
Institutional review board statement: This study was exempt from the Institutional Review Board standards.
Conflict-of-interest statement: None.
Data sharing statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Massimo Miscusi, MD, PhD, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy. massimo.miscusi@uniroma1.it
Telephone: +39-773-1757222
Received: January 23, 2017
Peer-review started: February 7, 2017
First decision: May 2, 2017
Revised: July 23, 2017
Accepted: August 2, 2017
Article in press: August 3, 2017
Published online: September 18, 2017
Processing time: 233 Days and 0.7 Hours
Abstract
AIM

To analyze different terms used in literature to identify lumbar extradural cysts and propose a common scientific terminology; to elaborate a new morphological classification of this pathology, useful for clinical and surgical purposes; and to describe the best surgical approach to remove these cysts, in order to avoid iatrogenic instability or treat the pre-existing one.

METHODS

We retrospectively reviewed 34 patients with symptomatic lumbar ganglion cysts treated with spinal canal decompression with or without spinal fixation. Microsurgical approach was the main procedure and spinal instrumentation was required only in case of evident pre-operative segmental instability.

RESULTS

The complete cystectomy with histological examination was performed in all cases. All patients presented an improvement of clinical conditions, evaluated by Visual Analogic Scale and Japanese Orthopaedic Association scoring.

CONCLUSION

Spinal ganglion cysts are generally found in the lumbar spine. The treatment of choice is the microsurgical cystectomy, which generally does not require stabilization. The need for fusion must be carefully evaluated: Pre-operative spondylolisthesis or a wide joint resection, during the operation, are the main indications for spinal instrumentation. We propose the terms “ganglion cyst” to finally identify this spinal pathology and for the first time its morphological classification, clinically useful for all specialists.

Keywords: Synovial cyst; Lumbar spine; Instability; Surgery; Ganglion

Core tip: This paper is an original study that analyzes for the first time the many words and acronyms used in literature to describe lumbar extradural cysts, suggesting the term “ganglion cyst” in clinical practice. It also propose a morphological classification of these cysts, which could be useful for clinicians and surgeons. Finally, a description of microsurgical approaches to resect the cyst and avoid spinal instability is reported: As a guide to a common therapeutical strategy, we report a flow-chart, evaluating clinical conditions, mechanical stability and the most suitable treatment.