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Original title:
Postoperative Langzeitergebnisse bei intraspinalen lumbalen Wirbelgelenkszysten
Translated title:
Long-Term results in intraspinal lumbar facet joint cysts
Pohl, Eva Maria Alexandra
Document type:
Fakultät für Medizin
Trappe, Anna-Elisabeth (Univ.-Prof. Dr.)
Trappe, Anna-Elisabeth (Univ.-Prof. Dr.); Gerdesmeyer, Ludger J. (Priv.-Doz. Dr.); Meyer, Bernhard (Univ.-Prof. Dr.)
Subject group:
MED Medizin
Wirbelgelenkszysten; intraspinal; Facettgelenkszysten
Translated keywords:
Facet joint cysts; intraspinal; Juxtafacet-Cysts
Intraspinale lumbale Wirbelgelenkszysten stellen eine nicht alltägliche Ursache einer Nervenwurzelkompressionssymptomatik dar und unterscheiden sich klinisch nicht von den Symptomen eines Bandscheibenvorfalls. Die Zysten haben ihren Ursprung an den kleinen Wirbelgelenken und üben je nach Größe eine Nervenwurzelkompression bzw Kompression der Cauda equina aus. Die betroffenen Wirbelgelenke weisen bei allen Patienten immer stärkere degenerative Veränderungen auf, welche in etwa 50% der Fälle mit e...    »
Translated abstract:
Intraspinal lumbar facet joint cysts are a non common cause of nerval root compression and appear clinically similar to a nucleus pulposus herniation. Those cysts originate from small facet joints and are majorly responsible for compression of nerve roots and the cauda equine, thus clinical symptomatology seems to be alterated by cyst size and location. Strong degenerative changes seem to be more common in affected joints. Roughly half of those patients show additional minor spondylolisthesis. In most cases, definitive clinical diagnosis is established by MRI or CT scans. However, not much is yet known about the exact etiology; several factors like chronic stress to strong degenerative modified facet joints in the most mobile segment L4/5 appear to take essential cause. Aim of this study was to show a comparison between pre- and postoperative conditions of the patients as well as a to do a comparison of different conservative treatment plans. . The initial clinical presentation, radioimaging (X-rays, magnetic resonance imaging, computed tomography), intraoperative findings, histopathology and postoperative follow-up were reviewed. We further sent a questionnaire to all patients. The long-term results of this study refer to an average follow up of 4.8 years. In 49 % of our study patients, spondylolisthesis of the facet joints was diagnosed. Additional to common clinical symptoms of Sponylolisthesis all patients showed a symptomatology of radiculopathy, in some cases combined with lumbalgia. Further clinical symptoms included neurogenic claudication, senosomotoric palsy and loss of sensory in 73.6%, 46.4% and 18.2% respectively. One Third of all patients showed a treatment resistant chronic pain syndrome, thus not showing other neurologic deficits. All patients were treated by cyst-resection (via partial hemilaminectomy.) Due to a visual analogue scale (range 1 to 10, 1=no pain, 10 = strongest pain), 51 % of all study patients complained of severe non-tolerable pain (10 points). The most favourable preoperative self-assessment was 6 points out of 10 in 3 study patients. Postoperative self-assessment showed that 86.7% of all patients rated their outcome with 1 to 5 points on the visual analogue scale. The clinical benefit of this procedure proved to be statistically significant (p< 0.01). Compared to preoperative findings, only 5.5% of all study patients presented postoperatively with clinical symptoms of neurogenic claudication and only 21 out of 110 (27.5%) still complained about radiculopathy. Contrary to our results, the majority of studies investigating conservative treatment plans of facet joint cysts (intra-articular injections of corticosteroids or local anaesthesia) showed an insufficient decrease of clinical symptoms within the first 6 months after therapeutic intervention and therefore a high rate of conservative treatment failure. We therefore conclude that patients with facet joint cysts and a treatment resistant chronic pain syndrome in combination with neurologic symptomology, should be treated surgically. Additionally many studies with a long follow up period showed an excellent postoperative outcome.
Publication :
Universitätsbibliothek der Technischen Universität München
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