Lumbar juxtafacet cyst


Neurosurgery Service, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain.

The term juxtafacet cyst (JFC) was originated by Kao et al in 1974 1) and includes both synovial cysts (those having a synovial lining membrane) and ganglion cysts (those lacking synovial lining) adjacent to a spinal facet joint or arising from the ligamentum flavum. The distinction between these two types of cysts may be difficult without histology and is clinically unimportant 2). JFC occurs primarily in the lumbar spine (although cysts in the cervical 3) 4) 5) and thoracic 6) spine have been described).

They were first reported in 1880 by von Gruker during an autopsy, 7) 8). and were first diagnosed clinically in 1968. Kao et al. later confirmed this in 1974 9).

They are relatively rare, only 3 cases were identified in a series of 1500 spinal CT exams 10) but the frequency of diagnosis may be on the rise due to the widespread use of MRI and an increasing awareness of the condition.

Eyster et al. reviewed approx. 1,800 MRIs and CTs over one and half year and found 11 (0.6% of) cases of lumbar synovial cysts of the spine 11). However Doyle et al., 12) found a prevalence of 2.3% anterior and 7.3% posterior spinal cyst in a review of 303 retrospective analyses of MRIs. Similarly Lemish et al. 13) identified 10 cysts in 2,000 reviews of CT lumbar spines.

The average age was 63 years in Sabo et al. series 14) and 58 years in a review of 54 cases in the literature 15).

Most of the patients with lumbar cysts tend to be in their sixth decade of life with a range that is varied from as early as 28 years to as late as 94 years 16). A female bias has been reported often 17) , but others refute that.

They are extremely rare in adolescence and young adulthood, only two pediatric cases have been reported in the literature, but they could be considered in the differential diagnosis in adolescent patients with low back pain and radiculopathy. Surgical removal of LSC could be considered as a treatment option to provide immediate and safe symptomatic relief 18).

They may be bilateral.

It is typically a process that only happens in the lumbar spine, and it almost always develops at the L4-L5 level 19) 20) (rarely at L3-L4).

The etiology is unknown (possibilities include: synovial fluid extrusion from the joint capsule, latent growth of a developmental rest, myxoid degeneration and cyst formation in collagenous connective tissue…), increased motion seems to have a role in many cysts, and the role of trauma in the pathogenesis is debated 21) 22) but probably plays a role in a small number (≈ 14%) 23).

Most occur in patients with severe spondylosis and facet joint degeneration 24) 25 % had degenerative spondylolisthesis 25)

Unknown, increased motion seems to have a role in many cysts and the role of trauma in the pathogenesis is debated 26) 27) but probably plays a role in a small number (= 14 %) 28).

There has been a general understanding that Cystic Formations of the Mobile Spine (CYFMOS) are associated with degenerative spine changes. More recent articles however have suggested that identifying detailed imaging characteristics can assist in determining outcomes when CYFMOS are treated with interventional percutaneous methods or surgical decompression with or without concomitant fusion. CYFMOS although uncommon are not a rare finding seen in the spine when there is a background of degenerative spine changes. These cystic lesions are generally symptomatic by exhibiting mass effect on adjacent structure. Most treatments are aimed at decompression by interventional percutaneous or surgical means. Various imaging characteristics of these CYFMOS including their signal intensity, presence of spinal instability, particular patterns of adjacent degenerative changes, and imaging changes following interventional treatments can help guide physicians when managing these cases 29).

see Juxtafacet cyst pathology

Lumbar juxtafacet cyst clinical.

Lumbar juxtafacet cyst diagnosis.

Lumbar juxtafacet cyst differential diagnosis.

Lumbar juxtafacet cyst treatment.

Giordan et al. performed a meta-analysis to assess the overall rates of favorable outcomes and adverse events for each available treatment and determine the outcome and complication rates concerning spine stability.

Multiple databases were searched for English-language studies involving adult patients with lumbar JFCs who had been followed for more than 6 months. Outcomes included the proportion of patients with a satisfactory outcome. Adverse events included recurrence and revision rates as well as intraoperative complications. They further stratified the analysis based on the spine's condition (lumbar degenerative spondylolisthesis vs without degenerative listhesis).

A total of 43 studies, including 2226 patients, were identified. Over 80% of patients experienced satisfactory improvement after surgical excision but only 66.2% after percutaneous cyst rupture and aspiration. Overall, recurrence and revision rates were almost double in patients with preoperative degenerative listhesis at the cyst level, especially in the minimally invasive group (2.1% vs 31.3% and 6.8% vs 13.1%, respectively). The rate of full-endoscopic satisfactory outcomes was approximately 90%, with low rates of adverse events (<2%).

They analyzed the outcome and adverse event rates for each kind of available treatment for JFC. Full endoscopy has outcomes and rates of adverse events that overlap with open and minimally invasive approaches 30)

Lumbar juxtafacet cyst case series.

Lumbar juxtafacet cyst case reports.

1) , 9)
Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. Case report. J Neurosurg. 1974 Sep;41(3):372-6. PubMed PMID: 4416019.
Freidberg SR, Fellows T, Thomas CB, et al. Experience with Symptomatic Epidural Cysts. Neurosurgery. 1994; 34:989–993
Cartwright MJ, Nehls DG, Carrion CA, et al. Synovial Cyst of a Cervical Facet Joint: Case Report. Neurosurgery. 1985; 16:850–852
4) , 21)
Onofrio BM, Mih AD. Synovial Cysts of the Spine. Neurosurgery. 1988; 22:642–647
Goffin J, Wilms G, Plets C, et al. Synovial Cyst at the C1-C2 Junction. Neurosurgery. 1992; 30:914–916
Lopes NMM, Aesse FF, Lopes DK. Compression of Thoracic Nerve Root by a Facet Joint Synovial Cyst: Case Report. Surg Neurol. 1992; 38:338–340
Heary RF, Stellar S, Fobben ES. Preoperative Diagnosis of an Extradural Cyst Arising from a Spinal Facet Joint: Case Report. Neurosurgery. 1992; 30:415–418
Pendleton B, Carl B, Pollay M. Spinal extradural benign synovial or ganglion cyst: case report and review of the literature. Neurosurgery. 1983 Sep;13(3):322-6. PubMed PMID: 6621847.
Mercader J, Muñoz Gomez J, Cardenal C. Intraspinal synovial cyst: diagnosis by CT. Follow-up and spontaneous remission. Neuroradiology. 1985;27(4):346-8. PubMed PMID: 4047392.
Eyster EF, Scott WR. Lumbar synovial cysts: report of eleven cases. Neurosurgery. 1989 Jan;24(1):112-5. PubMed PMID: 2927587.
Doyle AJ, Merrilees M. Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic resonance imaging. Spine (Phila Pa 1976). 2004 Apr 15;29(8):874-8. PubMed PMID: 15082987.
Lemish W, Apsimon T, Chakera T. Lumbar intraspinal synovial cysts. Recognition and CT diagnosis. Spine (Phila Pa 1976). 1989 Dec;14(12):1378-83. PubMed PMID: 2533404.
14) , 19) , 25) , 28)
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.
Liu SS, Williams KD, Drayer BP, Spetzler RF, Sonntag VK. Synovial cysts of the lumbosacral spine: diagnosis by MR imaging. AJNR Am J Neuroradiol. 1989 Nov-Dec;10(6):1239-42. PubMed PMID: 2512789.
16) , 17)
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 Jul;93(1 Suppl):53-7. PubMed PMID: 10879758.
Kalevski SK, Haritonov DG, Peev NA. Lumbar intraforaminal synovial cyst in young adulthood: case report and review of the literature. Global Spine J. 2014 Aug;4(3):191-6. doi: 10.1055/s-0034-1370694. Epub 2014 Feb 21. PubMed PMID: 25083362; PubMed Central PMCID: PMC4111946.
Gorey MT, Hyman RA, Black KS, Scuderi DM, Cinnamon J, Kim KS. Lumbar synovial cysts eroding bone. AJNR Am J Neuroradiol. 1992 Jan-Feb;13(1):161-3. PubMed PMID: 1595435.
Franck JI, King RB, Petro GR, et al. A Posttraumatic Lumbar Spinal Synovial Cyst. Case Report. J Neurosurg. 1987; 66:293–296
Sabo RA, Tracy PT, Weinger JM. A Series of 60 Juxtafacet Cysts: Clinical Presentation, the Role of Spinal Instability, and Treatment. J Neurosurg. 1996; 85:560–565
Silbergleit R, Gebarski SS, Brunberg JA, McGillicudy J, Blaivas M. Lumbar synovial cysts: correlation of myelographic, CT, MR, and pathologic findings. AJNR Am J Neuroradiol. 1990 Jul-Aug;11(4):777-9. PubMed PMID: 2136366.
Onofrio BM, Mih AD. Synovial cysts of the spine. Neurosurgery. 1988 Apr;22(4):642-7. PubMed PMID: 3374775.
Franck JI, King RB, Petro GR, Kanzer MD. A posttraumatic lumbar spinal synovial cyst. Case report. J Neurosurg. 1987 Feb;66(2):293-6. PubMed PMID: 3806212.
Anand A, Pfiffner TJ, Mechtler L. The Role of Imaging in the Management of Cystic Formations of the Mobile Spine (CYFMOS). Curr Pain Headache Rep. 2018 Aug 25;22(10):70. doi: 10.1007/s11916-018-0723-3. Review. PubMed PMID: 30145776.
Giordan E, Gallinaro P, Stafa A, Canova G, Zanata R, Marton E, Verme JD. A Systematic Review and Meta-Analysis of Outcomes and Adverse Events for Juxtafacet Cysts Treatment. Int J Spine Surg. 2022 Feb 25:8181. doi: 10.14444/8181. Epub ahead of print. PMID: 35217587.
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