Removal of intracanal joint synovial cyst without arthrodesis

Thearthrosis of the facet jointsis almost always accompanied by painful and often disabling symptoms. When you are then in the presence of aintracanal joint synovial cyst, isymptomsare even more evident, requesting to proceed witharthrodesis proceduresparticularly invasive. However, thanks to a timely and accurate diagnosis, it is possible to address thisArthropathies NOSwith less invasive interventions,but equally decisive. 

This is demonstrated by the case of a patient of ourneurosurgery centerwho has agreed to undergo an intervention ofremoval of the intracanal cystminimally invasive, no longer experiencing pain and motor difficulties.

Clinical history and diagnostic path of the patient

The patient, about 50 years old, suffers from achronic low back pain, especially in the morning, but with movement it improves.After some timedevelops aradicular syndrome with pain irradiationto the lower limbs prevailing on the right, reporting fatigue when walking. 

At first he decides, with the help of the general practitioner, to undergo aAnti-inflammatory therapy

Not findingbenefits, try undergoing aPhysical Health Services / Rehabilitationwhich, however, is not prosecutable for the increase in pain during the exercises. Having no improvements, he decides independently to perform alumbosacral MRI. 

The examimmediately shows a picture ofarthrosis of the facet jointsat the level of the fourth and fifth vertebrae, with the presence of aCyst – synovial,joint and intrachanneloccupying a part of the vertebral canal. 

The patient then decides to contactto a neurosurgeon who, after evaluating the exams, suggests a vertebral canal decompression surgeryand stabilization with screws and transpeduncular bars.

As it is a very invasive intervention, the patient is induced to look for other solutions, including a Infiltrative therapywhich, however, is not successful, as the cyst waspiùcompact and with almost complete intra-canal development. The infiltration techniquein fact, it is useful and decisive where the joint cysts have an important liquid component. 

Arrival at our neurosurgery centerthanks to word of mouth,the patient has been subject to a new diagnosis, starting with a sacral loin scan, essential to be able to reconstruct exactly the type ofjoint malformation.

The diagnosis and proposed surgical treatment

Based on the outcome of the CT scan, the need to proceed with adecompression of the vertebral canal, but without the need to stabilise with screws and bars. 

The patient, reassured by the minor invasiveness, then decided to undergo the surgery suggested by Dr. Sacchelli.  

In fact, the type of intervention proposed can be addressedwith aless invasive access to the vertebral canalin L4-L5, by removing a flavo hypertrophic ligament, removing the mesial part of the monolateral joint and the part of theCyst – synovial, certainly compact, which occupied the vertebral canal and came into conflict with the nerve root radiated to the right lower limb. 

At the end of the operation, the tests do not show gross instability, despite having removed a mesial part of the diseased joint.The joint download in fact by entering ainterspinous devicewithout the need for transpeduncular screws and bars. 

Upon awakening, the patient had resolved the pains in her limbs, without experiencing any difficulties on the way. One month after the surgery, he reported an improvement in back pain, without any more problems related to instability o5 years have now passed and the patient has no longer had any particular low back pain as well as not having developed any type of problem with the operated spinal section.