{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T22:38:56Z","timestamp":1648679936025},"reference-count":15,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background:<\/jats:title>\n<jats:p>Lumbar synovial cysts are often not sufficiently diagnosed prior to spine surgery. Utilizing both MR and CT studies is critical for recognizing the full extent\/severity of these lesions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods:<\/jats:title>\n<jats:p>In patients with chronic, acute, or subacute lumbar disease, obtaining both MR and CT studies is critical to correctly diagnose; disc disease, hypertrophy\/ossification of the yellow ligament (OYL), stenosis, with\/without degenerative spondylolisthesis, and\/or synovial cysts (SC).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results:<\/jats:title>\n<jats:p>MR T2 weighted images directly demonstrate hyperintensity within a SC. They initially cause lateral recess\/caudad nerve root and\/foraminal compromise, with larger extrusions causing significant lateral thecal sac, and far lateral\/superior cephalad root compromise. CT 2 mm cuts often better demonstrate mid-vertebral level compression of cephalad nerve roots with\/without SC calcification, along with the extent of mid-vertebral stenosis, hypertrophy\/OYL, and DS. When CT studies directly document SC calcification, it alerts the surgeon to the increased potential risk of creating a cerebrospinal fluid fistula with full SC excision, and should prompt the adoption of alternative measures such as decompression\/partial removal. Most critically, surgery for synovial cysts often warrants a 2-level laminectomy for fuller visualization of the cephalad and caudad nerve roots, and clearer differentiation of neural tissues from the large fibrotic SC capsule, to effect safer removal.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusions:<\/jats:title>\n<jats:p>Preoperatively, establishing the full cephalad and cauda extent of lumbar synovial cysts with both MR and CT studies is critical. Anticipation and better visualization of the foraminal\/far lateral and superior extent of these lesions often warrants more extensive multilevel laminectomies for thecal sac and both cephalad and caudad root decompression.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_54_2020","type":"journal-article","created":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T08:53:21Z","timestamp":1582880001000},"page":"33","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis and Safe Excision of Lumbar Synovial Cysts and Accompanying Pathology: A Perspective"],"prefix":"10.25259","volume":"11","author":[{"given":"Nancy 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