Background:

Spinal synovial cysts are acquired, fluid-filled lesions of the facet joint, that most commonly occur in the lumbar spine, thought to arise from degenerative changes and are thought to be a proponent of segmental instability. Although the treatment of these lesions have been studied, the long-term implications and impact of the different strategies for surgical intervention, namely decompression and fusion versus decompression alone, have not yet been elucidated nor established.

Methods:

Using an all-payer database comprised of 53 million patient records, MARINER-53, patients with the diagnosis of lumbar synovial cysts were identified. Patients undergoing lumbar fusion versus laminectomy were matched in a 1:1 fashion on the basis of binomial and gaussian logistic regression models that were used to evaluate the need for future lumbar surgery within 5-years following their index procedure.

Results:

No significantly differences were noted between the 5-year rates of subsequent interventions (p=.39), additional laminectomies, or fusions among patients who underwent index decompression and fusion (n=51, 10.5%) versus decompression alone (n=43, 8.8%). Furthermore, no significant differences were found in the odds of intervention-type following index decompression and fusion versus decompression alone (Subsequent laminectomy= Odds Ratio [OR] 0.59, 95% Confidence Interval [CI] .32-1.09, Subsequent fusion= OR 1.14 95%CI 0.64-2.02).

Conclusions:

Patient-specific factors and surgeon-patient shared decision making should be implored when planning interventions for these lesions. However, synovial cyst may not require a fusion procedure for presumed instability. Further study should be undertaken, on a randomized and prospective basis to further evaluate the effective treatment of this entity.