A series of 60 juxtafacet cysts: clinical presentation, the role of spinal instability, and treatment

Abstract

✓ Spinal instability may be a cause of juxtafacet cyst formation and the pain and disability that occur after surgical excision of the cyst. To determine the role of instability, a retrospective review of charts identified 60 facet cysts in 56 patients treated over a 6-year period. Three patients developed an asynchronous cyst at the same level but on the opposite side of the previously resected cyst and one patient had a recurrent cyst in the same location. Forty-one cysts were present in patients with radiculopathy and 16 in patients with neurogenic claudication. Two patients presented with myelopathy and one had cauda equina syndrome. Thirty-six of the 60 cysts were located at L4–5, the most mobile segment. Fifteen patients had spondylolisthesis, of whom two experienced worsening spondylolisthesis postoperatively. Seven patients had scoliosis and 20 had systemic arthritis. Fifty-five cysts were resected via mesial facetectomy. Six of the patients undergoing this procedure had transverse process fusions at initial surgery for preoperative instability. Two others required fusion for postoperative instability and increased spondylolisthesis. Follow-up review was available in 95% of patients with an average duration of 12 months. Forty patients had excellent relief of symptoms, 12 had occasional back pain, and one patient did poorly. Flexion/extension views of the spine are recommended both pre- and postoperatively to identify the need for fusion in patients with juxtafacet cysts.

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report

“…Most of the intraspinal cyst reported are juxtraarticular cysts. Ligamentum flavum and juxta-articular cysts can be distinguished only by their pathological findings [20]. Indeed, we could diagnose the type of the resected cyst only after pathological diagnosis.…”

“…In our case, minor chronic trauma due to the microinstability of listhesis may explain the formation of the cyst. In most of the cases, intraspinal degenerative cysts in the lumbar spine occur at L4-L5, the most mobile segment within the lumbar spine and are frequently associated with lumbar degenerative spondylolisthesis [20]. Cervical degenerative cysts are preferentially located in the cervicothoracic junction.…”

“…Most of the intraspinal degenerative cysts are juxta-articular (synovial and ganglion) cysts, and have a similar radiologic appearance [8,12,15,16,20]. We report the unique neuroimaging and pathological findings obtained in a patient with a cyst of the ligamentum flavum in the cervical region associated with a C7-T1 subluxation.…”

Lumbar Synovial Cysts: Experience With Nine Cases

“…14) Cystic lesion located on the internal and posterolateral side of the spinal canal, continuous with the facet joints, and lined with epithelial tissue is classified as synovial cyst. 28,29) Cystic lesion located at the periarticular area but lacking epithelial lining and continuity with the synovial cavity is classified as ganglion cyst. 28) Cystic lesion embedded in the inner surface of the LF with no epithelial lining or continuity with the facet joint synovium is classified as LF cyst, 1,34) and cystic lesion located in the PLL with the same properties is classified as PLL cyst.…”

“…16) Possibly synovial cysts degenerate and lose the continuity with the joint and the synovial lining, thus confusing the distinction from ganglion cyst. 29) Two patients had LF cysts, and one patient had PLL cyst. The MR imaging findings of extradural lumbar spinal cysts reflect the content, but are usually iso/hypointense on T 1 -weighted images and hyperintense on T 2 -weighted images, with enhancement of the cyst wall after gadolinium injection.…”