The cyst may be adherent to the dura. The cyst may also collapse during the surgical approach and may be missed.
A JFC may indicate possible instability, which must be evaluated. Some recommend primary spinal fusion in conjunction with surgical excision of the JFC. However, it appears that in many cases fusion is not required for a good result 7).
Therefore it is suggested that consideration for fusion be made on the basis of any instability and not merely on the basis of the presence of a JFC.
Few reports have described the long-term follow-up of the surgical excision of JFC.
The treatment was surgical excision of the cyst, as well as complete laminectomy if there was concomitant spinal stenosis. Follow-up, ranging from eighteen to twenty-five months, revealed complete resolution of the sciatica in all patients 8).
Métellus et al. 13) has concluded that there is no reliable criterion that allows the development of a symptomatic spinal instability to be predicted in patients with preoperative spondylolisthesis, and therefore, fusion as a first line procedure is still debatable. Others have mentioned an association between spinal cysts and spondylolisthesis/instability and better surgical outcomes in patients having fusion than in those who did not have it 14) 15) 16) 17).
Due to concerns about progressive instability, laminectomy with lumbar fusion has been advocated as the best treatment option for synovial cysts with spondylolithesis 18) 19). However lumbar fusion procedures involve increased operative time and blood loss as well as the risk of developing adjacent segment disease 20).
This type of approach decreases damage to surroundings muscular, bony and ligamentous structures and could potentially minimize segmental instability, particularly in the presence of preexisting spondylolisthesis 25) 26) However there is no published study on minimally invasive resection of lumbar synovial cysts that compares outcomes between patients with and without spondylolisthesis.
A 15 mm entry incision is made 1,5 cm lateral to midline.
Following surgical treatment, symptomatic JFCs may recur or may develop on the contralateral side 27).