The Variability of Lumbar Facet Joint Synovial Cyst Recurrence Requiring Revision Surgery After Decompression-only...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Symptomatic spinal juxtafacet synovial cysts are increasingly diagnosed due to advanced imaging.
• Conservative management offers limited durable relief for spinal synovial cysts.
• Surgical options include decompression alone or decompression with fusion, with decompression alone carrying a higher recurrence risk.

Purpose of the Study:

• To compare lumbar spine synovial cyst recurrence rates between decompression-alone and decompression/fusion procedures.
• To evaluate revision surgery rates for recurrent spinal synovial cysts based on initial surgical approach.

Main Methods:

• Retrospective review of 87 patients undergoing surgery for lumbar spinal juxtafacet synovial cysts over 20 years.
• Comparison of recurrence and revision rates between decompression-only and decompression/fusion groups.
• Analysis of preoperative symptoms, cyst location (L4-L5 most common), and follow-up duration.

Main Results:

• Decompression-only was performed in 63% of patients, decompression/fusion in 37%.
• Recurrence occurred in 11.5% of the decompression-only group versus 0% in the decompression/fusion group.
• Symptomatic improvement was significant in both groups, with similar outcomes regardless of surgical approach.

Conclusions:

• Decompression and cyst excision is a common and effective treatment for lumbar spinal synovial cysts.
• While recurrence rates for decompression-only are low and comparable to literature, fusion may be indicated for instability.
• Both surgical approaches provide durable, effective treatment with acceptable recurrence and revision rates.