[Juxta-facet cysts as a differential diagnosis for lumbar neuralgia]

The aim of the current investigation it was to evaluate the incidence, clinical symptoms and the results of surgical treatment of lumbar juxta-facet cysts.

Between January 2002 and July 2003 305 patients underwent decompression of the lumbar spinal canal. In 3.6 % of these (n = 11) juxta-facet cyst were found to be responsible for the complaints and resection of the cyst was performed. All patients underwent standardized clinical examination and pain evaluation by the means of a visual analogue scale in a follow-up of 6.8 month on average.

The average history of lumbar pain was 26 months, that of leg pain 23 weeks, respectively. Radicular symptoms appeared in 7 patients, and 9 of 11 patients complained about spinal claudication. Clinical examination showed a typical pain provocation during reclination of the lumbar spine. However none showed a segmental instability. Preoperative MRI revealed facet cysts with an average diameter of 9 mm (4-18 mm). All of the patients showed signs of degenerative spondylarthritis. Postoperative examination revealed in 8 cases a very good and in 2 cases a good result. One patient complained about persisting sciatica in spite of MR-tomographic demonstration of complete resection of the cyst. The walking-distance improved by least 50 % in 10 cases. Although no spinal fusion was performed, no patient developed a postoperative segmental instability.

Juxta-facet cysts represent a not uncommon differential diagnosis in patients with lumbar radiculopathy. In the case of missing signs of segmental instability, resection of the cyst without simultaneous spinal fusion seems to be an appropriate therapy.