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Neurospine > Volume 19(2); 2022 > Article |
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Conflict of Interest
Michael Finn is a consultant for K2M/Stryker. The other authors have nothing to disclose.
Variable | All patients | Initial-surgery | Conservative-only | Conservative followed by surgery |
---|---|---|---|---|
No. of patients | 36 | 18 (50.0) | 11 (30.6) | 7 (19.4) |
Sex | ||||
Male | 16 (44.4) | 8 (44.4) | 5 (45.5) | 3 (42.9) |
Female | 20 (55.6) | 10 (55.6) | 6 (54.5) | 4 (57.1) |
Age at diagnosis (yr) | ||||
Mean ± SD | 49.4 ± 16.7 | 51.4 ± 16.3 | 47.2 ± 20.0 | 47.7 ± 13.7 |
Range | 22–81 | 24–79 | 22–81 | 26–64 |
Location | ||||
Intradural | 29 (80.6) | 17 (58.6) | 6 (20.7) | 6 (20.7) |
Extradural | 7 (19.4) | 1 (14.3) | 5 (71.4) | 1 (14.3) |
Duration of symptoms (mo)† | ||||
Mean ± SD | 30.35 ± 38.02 | 13.64 ± 23.63 | 55.04 ± 27.58 | 38.04 ± 56.28 |
Range | 1.14–171.57 | 1.14–79.43 | 14.77–89.94 | 2.17–171.57 |
Preoperative MNS | 2.26 ± 0.95 | 2.67 ± 1.03 | 1.60 ± 0.70 | 2.14 ± 0.38 |
Postoperative MNS at 1 year | 2.46 ± 1.32 | 2.75 ± 1.14 | 1.17 ± 0.41 | 2.80 ± 1.30 |
Length of stay (day) | 6.10 ± 4.44 | 5.82 ± 4.98 | N/A | 6.58 ± 3.10 |
Study | No of patients | Female sex (%) | Mean age (yr) | Presenting symptoms (% pts) | Diagnostic imaging | Spinal level | Location | Treatment type (% pts) | Mean follow-up (mo) | Outcome % pts |
---|---|---|---|---|---|---|---|---|---|---|
Fam et al. [2], 2018 | 16 | 75% | 57 | Pain (63%), falls (31%), paresthesia (6%), weakness (44%), gait ataxia (50%), sphincter dysfunction (25%) | MRI, CT myelogram (n = 5) | 10 Dorsal thoracic, 2 ventral thoracic, 1 ventral cervical, 1 dorsal lumbar, 1 ventral lumbar | Intradural (n = 11, 50%), extradural (n = 6, 27%) ventral spinal cord herniation (n = 2, 9%) | Total cyst excision (79%), fenestration/marsupialization (14%), fenestration & ligation (8%) | 8.2 | Complete radiographic resolution in 14 of 16 patients, improved patient reported outcomes (SF-36 parameters) across all quality-of-life parameters |
Sadek et al. [3], 2019 | 17 | 35.3% | 58 | Paresthesia (76%), neuropathic pain (76%), weakness (47%), unsteadiness (53%) | MRI with CSF flow studies | 17 Thoracic | Intradural (n = 17, 100%) | Marsupialization | 17 | All patients experienced improvement in at least one of their presenting symptoms and or clinical signs |
Eroglu et al. [1], 2018 | 13 | 62% | 42 | Pain (80%), sensory changes (70%), extremity weakness (62%), gait disturbance (15%), bowel/bladder dysfunction (23%) | CT, MRI, CSF flow analysis | 2 Cervical, 7 thoracic, 4 lumbar | Intradural (n = 7, 54%), extradural (n = 5, 38%) | Total cyst excision (38%), f enestration (54%) | 55 | Most patients with improvement or complete resolution of symptoms |
Viswanathan et al. [20], 2017 | 14 | 35.7% | 52.1 | Myelopathy with combination of extremity weakness (78.6%), gait disturbance (100%), paresthesias (85.7%), urinary incontinence (28.6%), upper motor neuron signs (71.4%) | MRI | 1 Cervicothoracic, 12 thoracic, 1 thoracolumbar | Intradural (n = 14, 100%) | Cyst fenestration and partial wall resection | 22 | Stable or improved neurologic symptoms in all patients starting at 6-week postoperative follow-up |
Moses et al. [21], 2018 | 21 | 42.9% | 55.1 | Weakness (67%), sensory disturbances (67%), pain (57%), gait changes (52%), bowel and/or bladder dysfunction (24%) | MRI, CT Myelogram (n = 12) | 15 Thoracic, 4 cervicothoracic, 2 lumbosacral | Intradural (n = 21, 100%) | Laminectomy (86%), laminoplasty (14.3%), duraplasty (38%) | 18 | 60%–70% of patients experienced postoperative improvement in symptoms. Those who underwent duroplasty were more likely to have relief of pain symptoms. |
Schmutzer et al. [4], 2020 | 72 | 66.7% | 53.1 | Gait disturbance (80%), dysesthesia (64%), paresis (80%) | MRI, myelography (n = 17) | 10 Cervical, 45 thoracic, 17 lumbosacral | Intradural (n = 72, 100%) | Complete resection (25%), fenestration (66.7%), cystoperitoneal shunt (5.5%), marsupialization (2.8%) | 44.8 | For cysts without internal septations, both fenestration and resection resulted in significant clinical improvement and reduction in cyst size. |
Garg et al. [22], 2017 | 11 | 26.4% | 32.9 | Weakness (73%), pain (64%), quadriparesis (11%) | MRI | 9 Thoracic | Intradural (n = 1, 9%), extradural (n = 10, 91%) | Cyst excision (82%), marsupialization (9%), fenestration (9%) | 56.4 | Complete resolution of symptoms in 2 patients and substantial improvement in 5. |
French et al. [23], 2017 | 10 | 75% | 57 | Gait ataxia (90%), lower limb sensory disturbance (60%), radicular pain (30%), lower limb weakness (10%), urinary incontinence (10%), sphincter disturbance (10%), thoracic back pain (10%) | MRI (bSSFP MRI in 3 patients) | 10 Thoracic | Intradural (n = 10, 100%) | Cyst excision (40%), fenestration (60%) | 4.4 | The majority of patients experienced resolution of pain and improvement in neurologic function. However, recovery of gait ataxia and myelopathy were less consistent. |
Shi et al. [6], 2021 | 41 | 59% | 41.1 | Lumbar back pain (85.4%), radicular lower limb pain (46.3%), buttock and perineum pain (4.8%) | MRI+CT | 12 Thoracic, 26 thoracolumbar, 3 lumbar | Extradural (n = 41, 100%) | Cyst excision (95%), dural defect repairs (88%) | 52.3 | The majority of patients had positive outcomes according to Odom’s criteria. |
Cai et al. [24], 2021 | 34 | 44% | 45 | Back pain (53%), sensory deficits (41%), weakness (12%), gait ataxia (12%) | MRI | 4 Cervical, 6 thoracic, 10 thoracolumbar, 14 lumbar | Extradural (n = 34, 100%) | Laminoplasty (71%), laminectomy with pedicle screw fixation (29%), fistula ligation 68%) | 80 | Improvement in patients’ symptoms and complete resections achieved confirmed with imaging. |