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 a...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 preoperative 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:Preoperative 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.展开更多
BACKGROUND To discuss the rare event of spontaneous resolution of a lumbar ganglion cyst,a personal case report and 25 cases culled from the literature were described in detail.We focused on demographic,classification...BACKGROUND To discuss the rare event of spontaneous resolution of a lumbar ganglion cyst,a personal case report and 25 cases culled from the literature were described in detail.We focused on demographic,classification,clinical and radiological findings,treatment,outcome and radiological resolution.CASE SUMMARY A 51-year-old man presented to our observation with complaints of low back and right leg pain.Lumbar magnetic resonance imaging(MRI).showed a L4-L5 ganglion cyst.The patient was referred to medical therapy and bracing.After 4 wk,he showed a complete resolution of pain.The complete spontaneous resolution of the cyst was demonstrated by the followed-up MRI.CONCLUSION Spontaneous resolution of lumbar ganglion is very rare and only 26 cases,including ours,were reported in literature.Different degrees of biomechanical impairment seem to play a fundamental role in the pathogenesis.Related symptoms are essentially represented by low back and/or radicular pain,without significant neurological disorders.Anti-inflammatory drugs,light unloading exercises and brace could be recommended to administrated pain and decrease facet loads.Mean time for clinical improvement was 7 mo,while MRI disappearance occurred in an average time of 11 mo.Therefore,surgery should be applied when conservative treatment,prolonged at least 6 mo,fails.展开更多
BACKGROUND All surgical specialties have been influenced by the coronavirus disease 2019(COVID-19)pandemic,and substantial changes have been determined in medical assistance,especially in elective surgery.Several spin...BACKGROUND All surgical specialties have been influenced by the coronavirus disease 2019(COVID-19)pandemic,and substantial changes have been determined in medical assistance,especially in elective surgery.Several spine societies have published recommendations to provide optimal care during this unique situation.AIM To discuss the recommendations by many spine societies for the management of spinal diseases during the COVID-19 pandemic.METHODS The present study was performed according to the PRISMA guidelines.A review of the MEDLINE database(PubMed–National Library of Medicine),Google,and Google Scholar was performed from March 2020 to date for articles published in the English Language.RESULTS Spine associations and societies worldwide were divided into three groups:Continental,specialty and country-based societies.A total of 27 spine associations were included in this review.There were eight major continental associations,but only one-third of these had published guidelines and recommendations on this topic.On the other hand,the specialty-based societies have not addressed the topic,except in two cases.CONCLUSION The national spine societies showed the deepest concern on this topic with several publications in scientific journals influenced by the local epidemiological severity.Contrarily,continental and specialty-based societies showed less interest in this topic.展开更多
文摘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 preoperative 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:Preoperative 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.
文摘BACKGROUND To discuss the rare event of spontaneous resolution of a lumbar ganglion cyst,a personal case report and 25 cases culled from the literature were described in detail.We focused on demographic,classification,clinical and radiological findings,treatment,outcome and radiological resolution.CASE SUMMARY A 51-year-old man presented to our observation with complaints of low back and right leg pain.Lumbar magnetic resonance imaging(MRI).showed a L4-L5 ganglion cyst.The patient was referred to medical therapy and bracing.After 4 wk,he showed a complete resolution of pain.The complete spontaneous resolution of the cyst was demonstrated by the followed-up MRI.CONCLUSION Spontaneous resolution of lumbar ganglion is very rare and only 26 cases,including ours,were reported in literature.Different degrees of biomechanical impairment seem to play a fundamental role in the pathogenesis.Related symptoms are essentially represented by low back and/or radicular pain,without significant neurological disorders.Anti-inflammatory drugs,light unloading exercises and brace could be recommended to administrated pain and decrease facet loads.Mean time for clinical improvement was 7 mo,while MRI disappearance occurred in an average time of 11 mo.Therefore,surgery should be applied when conservative treatment,prolonged at least 6 mo,fails.
文摘BACKGROUND All surgical specialties have been influenced by the coronavirus disease 2019(COVID-19)pandemic,and substantial changes have been determined in medical assistance,especially in elective surgery.Several spine societies have published recommendations to provide optimal care during this unique situation.AIM To discuss the recommendations by many spine societies for the management of spinal diseases during the COVID-19 pandemic.METHODS The present study was performed according to the PRISMA guidelines.A review of the MEDLINE database(PubMed–National Library of Medicine),Google,and Google Scholar was performed from March 2020 to date for articles published in the English Language.RESULTS Spine associations and societies worldwide were divided into three groups:Continental,specialty and country-based societies.A total of 27 spine associations were included in this review.There were eight major continental associations,but only one-third of these had published guidelines and recommendations on this topic.On the other hand,the specialty-based societies have not addressed the topic,except in two cases.CONCLUSION The national spine societies showed the deepest concern on this topic with several publications in scientific journals influenced by the local epidemiological severity.Contrarily,continental and specialty-based societies showed less interest in this topic.
