Surgical treatment of special type of adjacent segment disease - lumbar intraspinal synovial cysts in patients with osteoporosis: A case report.

INTRODUCTION

This paper presents a case of lumbar intraspinal synovial cysts (LISCs) associated with secondary osteoporosis, contributing to current understanding of LISC pathogenesis and offering a safe, effective surgical strategy tailored to complex clinical conditions.

CASE REPORT: A 61-year-old woman with a history of rheumatoid arthritis and osteoporosis (lumbar spine T-score: -2.6) underwent posterior lumbar interbody fusion (PLIF) at the L4/5 segment for lumbar disc herniation and spondylolisthesis, as confirmed by MRI. Ten months postoperatively, she developed a synovial cyst at the L3/4 segment, accompanied by a fracture of the L5 pedicle screw. Therefore, she underwent a revision surgery involving cyst excision, bone cement-reinforced screw fixation, and Waveflex semi-rigid rod implantation. The postoperative recovery was smooth, and no neurological abnormalities were found during the 9-month follow-up.

DISCUSSION: The surgical strategy effectively addressed three major challenges: excision of the cyst in the context of compromised spinal stability, revision fixation in osteoporotic bone using cement augmentation, and mitigation of adjacent segment degeneration (ASD) through motion-preserving Waveflex semi-rigid stabilization.

CONCLUSION

The combination of cyst resection, Waveflex semi-rigid fixation, and cement-reinforced screw placement demonstrated favorable safety and efficacy in revision lumbar fusion for patients with secondary osteoporosis.