{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:18:29Z","timestamp":1788808709302,"version":"build-2803163510"},"reference-count":16,"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 (LSC), best diagnosed on MR studies, may cause symptoms\/signs ranging from unilateral radiculopathy to cauda equina compressive syndromes. Attempts at percutaneous treatment of LSC typically fail. Rather, greater safety\/efficacy is associated with direct surgical resection with\/without fusion.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>Treatment of LSC with percutaneous techniques, including cyst aspiration\/perforation, injection (i.e., with\/without steroids, saline\/other), dilatation, and\/or disruption\/bursting, classically fail. This is because LSCs\u2019 tough, thickened, and adherent fibrous capsules cause extensive thecal sac\/nerve root compression, and contain minimal central \u201cfluid\u201d (i.e., \u201ccrank-case\u201d and non-aspirable). Multiple percutaneous attempts at decompression, therefore, typically cause several needle puncture sites risking dural tears (DT)\/cerebrospinal fluid (CSF) leaks, direct root injuries, failure to decompress the thecal sac\/nerve roots, infections, hematomas, and over the longer-term, adhesive arachnoiditis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>Alternatively, many studies document the success of direct or even partial resection of LSC (i.e., partial removal with marked cyst\/dural adhesions with shrinking down the remnant of capsular tissue). Surgical decompressions of LSC, ranging from focal laminotomies to laminectomies, may or may not warrant additional fusions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusions: <\/jats:title>\n<jats:p>Symptomatic LSC are best managed with direct or even partial operative resection\/decompression with\/without fusion. The use of varying percutaneous techniques classically fails, and increases multiple perioperative risks.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_95_2024","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T13:19:16Z","timestamp":1709299156000},"page":"65","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Perspective: Operate on lumbar synovial cysts and avoid ineffective percutaneous techniques"],"prefix":"10.25259","volume":"15","author":[{"given":"Nancy E.","family":"Epstein","sequence":"first","affiliation":[{"name":"Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook and Editor-in-Chief Surgical Neurology International NY, USA, and c\/o Dr. Marc Agulnick, 1122 Franklin Avenue Suite 106, Garden City, NY, USA,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc 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