OLIF combined with anterior fixation for lumbar synovial cysts with instability: a case report

Abstract Background The optimal management of lumbar synovial cysts (LSC) has always been controversial. Open or minimally invasive partial hemilaminotomy as a direct decompression approach has been widely studied. Whereas, to our knowledge, there has been no report of an indirect decompression method for LSC. Case presentation A 60-year-old male complained of chronic low back pain for 2 years. He reported that the pain had been getting worse and started radiating to the bilateral posterior thighs and right lateral calf for 6 months. An ovoid lesion with a hyperintense center attached to the medial side of the right facet joint at the L4-5 level as well as L4-5 dynamic instability were found with MRI and lumbar X-ray examinations, respectively. L4-5 oblique lumbar interbody fusion (OLIF) combined with anterior fixation was performed. After surgery, the patient felt distinct pain relief and was discharged on the 3rd day postoperatively. Three months later, lumbar MRI and 3D-CT were performed again. The L4-5 disk height (DH) and foraminal height (FH) recovered from 7.1 to 12.3 mm and 14.8 to 18.5 mm, respectively. No evidence of a cyst was disclosed. The patient did not complain of any low back pain or radicular pain during the 12-month follow-up. Conclusion Indirect decompression surgery may be a new option for the management of LSC, especially in those with lumbar instability and that communicate with the facet joint. Further research with a larger and more comprehensive sample population is required.