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Lumbar juxtafacet cyst surgery

Lumbar juxtafacet cyst (JFC) surgery is largely recommended in all cases of intractable pain or neurological deficit 1) 2) 3) 4) 5).

If symptoms persist with conservative treatment, some authors recommend cyst aspiration or facet joint injection with steroids, while most surgeons prefer surgical excision of the cyst 6).

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).

Many authors reported that no difference in surgical outcome was found between patients having fusion and those who did not have it 9) 10).

While others concluded that, a concomitant fusion procedure may be performed in selected cases 11) 12).

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).

Minimally invasive spine surgery

Studies using minimally invasive techniques with tubular retractors for decompression and resection of synovial cysts have showed promising results in a limited number of patients 21) 22) 23) 24).

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).

1) , 27)
Sabo RA, Tracy PT, Weinger JM. A series of 60 juxtafacet cysts: clinical presentation, the role of spinal instability, and treatment. J Neurosurg. 1996 Oct;85(4):560-5. PubMed PMID: 8814156.
Hemminghytt S, Daniels DL, Williams AL, Haughton VM. Intraspinal synovial cysts: natural history and diagnosis by CT. Radiology. 1982 Nov;145(2):375-6. PubMed PMID: 7134440.
3) , 12)
Lyons MK, Atkinson JL, Wharen RE, Deen HG, Zimmerman RS, Lemens SM. Surgical evaluation and management of lumbar synovial cysts: The Mayo Clinic experience. J Neurosurg. 2000;93(1 Suppl):53–7.
Yarde WL, Arnold PM, Kepes JJ, O’Boynick PL, Wilkinson SB, Batnitzky S. Synovial cysts of the lumbar spine: Diagnosis, surgical management, and pathogenesis. Report of eight cases. SurgNeurol. 1995;43:459–64.
Hsu KY, Zucherman JF, Shea WJ, Jeffrey RA. Lumbar intraspinal synovial and ganglion cysts (facet cysts).Ten-year experience in evaluation and treatment. Spine (Phila Pa 1976) 1995;20:80–9.
6) , 7) , 8)
Kurz LT, Garfin SR, Unger AS, Thorne RP, Rothman RH. Intraspinal synovial cyst causing sciatica. J Bone Joint Surg Am. 1985 Jul;67(6):865-71. PubMed PMID: 4019534.
Boviatsis EJ, Stavrinou LC, Kouyialis AT, Gavra MM, Stavrinou PC, Themistokleous M, et al. Spinal synovial cysts: Pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. Eur Spine J. 2008;17:831–7.
10) , 15)
Pirotte B, Gabrovsky N, Massager N, Levivier M, David P, Brotchi J. Synovial cysts of the lumbar spine: Surgery-related results and outcome. J Neurosurg. 2003;99(1 Suppl):14–9.
11) , 13)
Métellus P, Fuentes S, Adetchessi T, Levrier O, Flores-Parra I, Talianu D, Dufour H, Bouvier C, Manera L, Grisoli F. Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome. Acta Neurochir (Wien). 2006 Jan;148(1):47-54; discussion 54. Epub 2005 Oct 31. PubMed PMID: 16258839.
Khan AM, Synnot K, Cammisa FP, Girardi FP. Lumbar synovial cysts of the spine: an evaluation of surgical outcome. J Spinal Disord Tech. 2005 Apr;18(2):127-31. PubMed PMID: 15800428.
Bydon A, Xu R, Parker SL, McGirt MJ, Bydon M, Gokaslan ZL, et al. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: Systematic review of reported postoperative outcomes. Spine J. 2010;10:820–6.
Tillich M, Trummer M, Lindbichler F, Flaschka G. Symptomatic intraspinal synovial cysts of the lumbar spine: Correlation of MR and surgical findings. Neuroradiology. 2001;43:1070–5.
Bydon M, Papadimitriou K, Witham T, Wolinsky JP, Sciubba D, Gokaslan Z, Bydon A. Treatment of spinal synovial cysts. World Neurosurg. 2013 Feb;79(2):375-80. doi: 10.1016/j.wneu.2012.08.016. Epub 2012 Sep 25. Review. PubMed PMID: 23022636.
Bydon A, Xu R, Parker SL, McGirt MJ, Bydon M, Gokaslan ZL, Witham TF. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. Spine J. 2010 Sep;10(9):820-6. doi: 10.1016/j.spinee.2010.04.010. Epub 2010 May 20. Review. PubMed PMID: 20488765.
Saavedra-Pozo FM, Deusdara RA, Benzel EC. Adjacent segment disease perspective and review of the literature. Ochsner J. 2014 Spring;14(1):78-83. Review. PubMed PMID: 24688337; PubMed Central PMCID: PMC3963057.
James A, Laufer I, Parikh K, Nagineni VV, Saleh TO, Hartl R. Lumbar juxtafacet cyst resection: the facet sparing contralateral minimally invasive surgical approach. J Spinal Disord Tech. 2012;25(2):E13–7.
22) , 25)
Sandhu FA, Santiago P, Fessler RG, Palmer S. Minimally invasive surgical treatment of lumbar synovial cysts. Neurosurgery. 2004;54(1):107–11. discussion 11-2.
Sehati N, Khoo LT, Holly LT. Treatment of lumbar synovial cysts using minimally invasive surgical techniques. Neurosurg Focus. 2006;20(3):E2.
Sukkarieh HG, Hitchon PW, Awe O, Noeller J. Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases. J Neurosurg Spine. 2015;23(4):444–50.
Armin SS, Holly LT, Khoo LT. Minimally invasive decompression for lumbar stenosis and disc herniation. Neurosurg Focus. 2008;25(2):E11. doi: 10.3171/FOC/2008/25/8/E11. Review. PubMed PMID: 18673040.
lumbar_juxtafacet_cyst_surgery.txt · Last modified: 2018/03/14 13:32 by administrador