Symptomatic Lumbar Juxtafacet Cyst Treated by Full Endoscopic Surgery

Abstract Background Juxtafacet cyst (JFC) included both synovial and ganglion cysts adjacent to a spinal facet joint or arising from the ligamentum flavum of the spinal facet joints. Various treatments have been proposed; however, surgical approach appeared to be the most effective. Here, we reviewed patients with lumbar JFCs treated using full endoscopic approach in our hospital. We then elaborate the details of the surgical routes and techniques and their merits and pitfalls. Methods Eight patients who visited the neurosurgical department of Changhua Christian Hospital, Taiwan, and diagnosed with lumbar JFCs were included. All patients underwent complete endoscopic cyst removal. The outcomes we followed-up were muscle power, visual analog scale score(VAS), modified MacNab criteria score and MRI. Results A total of eight patients were enrolled in this study. Five patients received interlaminar approach, 2 patients received transforaminal approach, and 1 patient received transfacet approach. Their VAS had significantly reduced [range, 5–10 (mean 7.75) prior to surgery and 0–2 (mean 0.625) post-surgery], and the modified MacNab criteria score ranked from good to excellent post-surgery. No neurological injuries were observed. Conclusion JFCs could be effectively treated by full endoscopic technique. The type of approach should be based on the anatomical site of the lesion and the condition of the patient. Interlaminar approach is appropriate for cysts located in the lower segment with larger interlaminar space. The transforaminal or transfacet approach is preferred for patients with high risk of general anesthesia.