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Published on: February 14, 2025
Risk of Subsequent Fusion After Isolated Decompression of Lumbar Facet Cysts
Vincent P Federico1, Enrico M Forlenza, Alexander J Acuna
1From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Federico, Forlenza, Acuna, Vucicevic, Conaway, Nie, Butler, Lopez, An, Colman, and Phillips), and the Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Gabriel).
Isolated decompression for lumbar facet cysts led to subsequent lumbar fusion in 6.79% of patients within 5 years. Chronic kidney disease, hypertension, and osteoarthritis were identified as risk factors for fusion.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Orthopedics
Background:
- Lumbar facet cysts can cause nerve root compression, particularly in elderly patients.
- Isolated decompression without fusion is a viable treatment for select patients.
- The risk of requiring lumbar fusion after isolated facet cyst decompression is not well-defined.
Purpose of the Study:
- To determine the rate of subsequent lumbar fusion after isolated decompression for lumbar facet cysts.
- To identify risk factors associated with the need for fusion following this procedure.
Main Methods:
- Retrospective review of the PearlDiver database (2015-2018) for patients undergoing isolated laminectomy for lumbar facet cysts.
- Exclusion of patients with concomitant fusion, additional decompression, pre-existing spondylolisthesis, or less than 5-year follow-up.
- Analysis of subsequent fusion rates and risk factors using descriptive statistics, chi-square tests, and multivariate logistic regression.
Main Results:
- 10,707 patients were included; 6.79% (727) underwent subsequent lumbar fusion within 5 years.
- 2.81% of all patients (301) had fusion within the first year post-decompression.
- Chronic kidney disease, hypertension, and osteoarthritis were significant risk factors for subsequent fusion (P < 0.033).
Conclusions:
- Approximately 6.79% of patients require lumbar fusion within 5 years after isolated decompression for facet cysts.
- Specific comorbidities (CKD, hypertension, osteoarthritis) increase the likelihood of needing subsequent fusion.
- Findings aid surgeons in patient counseling regarding postoperative expectations and fusion risks.
