Clinical characteristics and surgical management for juxtafacet cysts of the lumbar spine
Terao, T.; Takahashi, H.; Taniguchi, M.; Ide, K.; Shinozaki, M.; Nakauchi, J.; Kubota, M.
Neurologia Medico-Chirurgica 47(6): 250-257; Discussion 257
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.