Microsurgical resection of juxtafacet cysts without concomitant fusion-Long-term follow-up of 74 patients

Described first by Kao et al., 1). these cysts are adjacent to a spinal facet joint or arising from the ligamentum flavum.

Types

Synovial cyst

Ganglion cysts

Distinction of these types is difficult without histology and is clinically unimportant 2).


Cervical juxtafacet cyst

Lumbar juxtafacet cyst

Complications

Hemorrhage

Hemorrhage from a ganglion cyst is rare and the rate of hemorrhagic incidence is less than 10%.

Although the suspected causal factors such as anticoagulation therapy, trauma, and the presence of a vascular anomaly has been proposed, the etiology of the hemorrhage from the juxtafacet cysts is still unclear.

The similar conditions differently called a ligamentum flavum hematoma, juxtafacet cyst hematoma, hemorrhagic synovial cyst and facet apoplexy have been reported 3).

Case series

A retrospective study evaluates patients who underwent surgical resection of juxtafacet cysts without concomitant fusion from 2002 to 2013 with a minimum follow-up of one year.

Complete follow-up is available in 74 patients. Mean follow-up in all 74 patients was 69±34months (range, 14-140 months). Mean ODI was 14.9%. 68 patients (91.9%) were pleased with the results and would undergo surgery again. Three patients (4.1%) underwent secondary resection because of cyst recurrence at the same site. Four patients (5.4%) needed secondary fusion.

In patients without evident clinical and radiological criteria of instability we regard surgical resection of juxtafacet cysts without concomitant fusion as adequate primary treatment due to good outcome and low incidence of secondary symptomatic instability4).


1) Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. Case report. J Neurosurg. 1974 Sep;41(3):372-6. PubMed PMID: 4416019.
2) Freidberg SR, Fellows T, Thomas CB, Mancall AC. Experience with symptomatic spinal epidural cysts. Neurosurgery. 1994 Jun;34(6):989-93; discussion 993. PubMed PMID: 8084409.
3) Park JH, Im SB, Kim HK, Hwang SC, Shin DS, Shin WH, Kim BT. Histopathological findings of hemorrhagic ganglion cyst causing acute radicular pain: a case report. Korean J Spine. 2013 Dec;10(4):242-5. doi: 10.14245/kjs.2013.10.4.242. Epub 2013 Dec 31. PubMed PMID: 24891856; PubMed Central PMCID: PMC4040643.
4) Scholz C, Hubbe U, Kogias E, Roelz R, Klingler JH. Microsurgical resection of juxtafacet cysts without concomitant fusion-Long-term follow-up of 74 patients. Clin Neurol Neurosurg. 2016 Dec 16;153:35-40. doi: 10.1016/j.clineuro.2016.12.008. [Epub ahead of print] PubMed PMID: 28012354.

Leave a Reply