Clinical Characteristics and Surgical Management for Juxtafacet Cysts of the Lumbar Spine

Abstract

Retrospective analysis of 10 cases of resection of symptomatic lumbar juxtafacet cysts in nine patients (mean age 65.4 years) investigated the relationship between surgical method and progression of spinal spondylolisthesis or cyst recurrence. Patient characteristics, surgical methods, and postoperative course were reviewed. The most common preoperative symptom, painful radiculopathy, occurred in all cases, followed by motor weakness in five, sensory loss in four, and intermittent claudication in four. All patients underwent bilateral total (n ＝ 6) or partial laminectomy (n ＝ 4), with minimal (n ＝ 3) or no (n ＝ 7) facetectomy. Cysts were gross totally resected in eight cases and partially resected in two. Concomitant fixation was not performed. Painful radiculopathy, motor weakness, and sensory disturbance all resolved, resulting in good or excellent outcome in all patients. Postoperative symptomatic spondylolisthesis had not been noted at mean 52.1 months postoperatively. However, new juxtafacet cysts were later detected on the contralateral side to the initial lesion in two patients. Surgical removal of juxtafacet cysts is recommended for immediate symptomatic relief. Concomitant spinal fixation to prevent progression of spinal spondylolisthesis or cyst recurrence depends on cyst size, involvement of surrounding structures, degree of preoperative spondylolisthesis, and facet joint destruction.

Extraforaminal Lumbar Synovial Cyst Causing Sudden Foot Drop -Case Report-

“…Surgical removal of the juxtafacet cyst was sufficient for immediate symptomatic relief. 35) Whether to perform concomitant fusion or not should depend on the individual patient characteristics, especially the degree of instability. 35) Therefore, minimally invasive or less invasive surgical techniques are preferred unless fusion is planned to prevent postoperative joint instability.…”

“…35) Whether to perform concomitant fusion or not should depend on the individual patient characteristics, especially the degree of instability. 35) Therefore, minimally invasive or less invasive surgical techniques are preferred unless fusion is planned to prevent postoperative joint instability. 6) In the present case, cyst excision was successfully performed using the microdecompression technique via a lateral transmuscular route.…”

Synovial Cysts of the Lumbar Spine

“…Conservative attitude may be justified by the possible spontaneous resolution of LSC, as reported by some authors, however, the chances for progression of symptoms are much higher and indicate the need for invasive treatment of such cysts. 38) In fact, only seven cases of spontaneous resolution of LSC have been reported, while up to date 271 patients have undergone percutaneous cyst aspiration with or without intraarticular steroid injection. In those patients, relief of pain was often transient, ranging between 33% 30) and 72% 1) at 6-12 months, and more than half of them required subsequent surgery.…”

“…Since no differences in clinical outcome emerge comparing many reports of cyst excision with or without primary fusion, despite the higher risk of perioperative complications, 12,26) we may conclude that the decision to perform concomitant spinal arthrodesis, to prevent spinal instability or cyst recurrence, should depend on cyst size, involvement of surrounding structures, degree of preoperative spondylolisthesis, and facet joint degeneration. 38) …”

A modified “far-lateral” approach for safe resection of retroodontoid dural cysts

“…Spinal cystic mass lesions most frequently occur in the lumbar region adjacent to the facette joints [17]. If symptomatic, they can cause radicular symptoms mimicking a lumbar disc herniation.…”