Clinical characteristics of intraspinal facet cysts following microsurgical bilateral decompression via a unilateral approach for treatment of degenerative lumbar disease

Abstract

Purpose Primary intraspinal facet cysts in the lumbar spine are uncommon, but it is unclear whether cyst incidence increases following decompression surgery and if these cysts negatively impact clinical outcome. We examined the prevalence, clinical characteristics, and the risk factors associated with intraspinal facet cysts after microsurgical bilateral decompression via a unilateral approach (MBDU). Methods We studied 230 patients treated using MBDU for lumbar degenerative disease (133 men and 97 women; mean age 70.3 years). Clinical status, as assessed by the Japanese Orthopedic Association (JOA) score and findings on X-ray and magnetic resonance images, was evaluated prior to surgery and at both 3 months and 1 year after surgery. The prevalence of intraspinal facet cysts was determined and preoperative risk factors were defined by comparing presurgical findings with clinical outcomes. Results Thirty-eight patients (16.5 %) developed intraspinal facet cysts within 1 year postoperatively, and 24 exhibited cysts within 3 months. In 10 patients, the cysts resolved spontaneously 1 year postoperatively. In total, 28 patients (12.2 %) had facet cysts 1 year postoperatively. The mean JOA score of patients with cysts 1 year postoperatively was significantly lower than that of patients without cysts. This poor clinical outcome resulted from low back pain that was not improved by conservative treatment. Most cases with spontaneous cyst disappearance were symptom-free 1 year later. The preoperative risk factors for postoperative intraspinal facet cyst formation were instability (OR 2.47, P = 0.26), scoliotic disc wedging (OR 2.23, P = 0.048), and sagittal imbalance (OR 2.22, P = 0.045). Conclusions Postoperative intraspinal facet cyst formation is a common cause of poor clinical outcome in patients treated using MBDU.

Radiographic Risk Factors of Reoperation Following Minimally Invasive Decompression for Lumbar Canal Stenosis Associated With Degenerative Scoliosis and Spondylolisthesis

“…These techniques focus on the preservation of posterior elements such as the paraspinal muscles, supraspinatus and intraspinous ligaments, and intervertebral joints, for which favorable clinical outcomes have been reported in lumbar canal stenosis (LCS) patients. 2 , 6 , 7 , 8 , 10 , 11 , 14 , 15 Because impairment of scoliosis or instability after decompression can be minimized by posterior element preservation, MIS decompression indications have expanded to lumbar disease, including DLS or degenerative lumbar spondylolisthesis (DS). However, no consensus has yet been reached regarding these indications.…”

“…Microsurgical bilateral decompression via a unilateral approach (MBDU) has been performed for numerous degenerative lumbar diseases, including DLS or DS, at our institution. 10 , 14 The MIS decompression method was previously reported by McCulloch and Young for complete decompression on the contralateral side to treat degenerative lumbar spine disease ( Figure 1 ). 16 Although we achieved satisfactory results in several patients, we experienced some unfavorable postoperative outcomes that required revision postoperatively because of degenerative changes in the decompressed disc.…”

Classification, mechanism and surgical treatments for spinal canal cysts

“…Conservative treatment consists of bed rest, analgesics plus anti-inflammatory drugs, physical therapy, bracing, transcutaneous electrical stimulation, epidural or intra-articular steroid injections [14].…”

Unilateral Laminotomy for Bilateral Microdecompression of Stenosis of the Lumbar Canal

“…four (4) patients required drainage of abundant wound secretions, one of which, when cultured, tested positive for s. aureus. 6 In a prospective analysis, Kato et al 11 identified facet joint synovial cysts in 38 (16.5%) out of 230 patients who had undergone ULBM during one year of follow-up. Twenty-four (24) of them had Figure 3.…”

“…The preoperative risk factors for cyst formation were instability, anterior-posterior translation greater than 3 mm in flexion-extension (or 2.47, p=0.26), scoliotic disc with wedge >5° in Ap radiograph (or 2.23, p=0.048), and change in sagittal balance, and distance >50mm from the promontory to the C7 plumb line (or 2.22, p=0.045). 11 In a 5-year follow-up published in 2011, Toyoda h et al presented the following findings from a series of 57 patients (27 with LSS without instability, 20 with degenerative spondylolisthesis (dS), and 10 with degenerative lumbar scoliosis (dLS) with neurogenic claudication who underwent ULMB. The average JoA score was 13.8 ± 3.6 points prior to surgery, improving to 24.9 ± 3.1 points after three months and 22.6 ± 4.7 points at the end of follow-up.…”