Application of the Full-endoscopic Ventral Facetectomy Technique for Postoperative Lumbar Facet Joint Cyst Resection:...

A lumbar facet joint cyst is a relatively uncommon lumbar spinal disease that includes synovial and ganglion cysts associated with the adjacent facet joint. Some studies have suggested that posterior decompression surgery is linked to the development of facet joint cysts due to postoperative local instability. Although an interlaminar approach may be anatomically suitable for resecting lumbar facet joint cysts, it can be technically challenging after interlaminar decompression surgery because of epidural adhesions and scar tissue. Full-endoscopic surgery via a transforaminal approach under local anesthesia is 1 of the least invasive spine surgery techniques. A 52-year-old woman presented with right leg radicular pain caused by a facet joint cyst at the L4-5 level following a partial laminectomy. Conservative treatment was not effective, and she opted for additional surgery. To minimize invasiveness, we performed a full-endoscopic ventral facetectomy and resection of the facet joint cyst via a transforaminal approach under local anesthesia. At the beginning of the procedure, facet joint arthrography with indigo carmine injection was performed to stain the facet joint cyst blue for easier visualization during the full-endoscopic procedure. Following the resection of the facet joint cyst, the patient's right leg resolved immediately. One year post-surgery, there has been no recurrence of the facet joint cyst or evidence of intervertebral instability. When resecting lumbar facet joint cysts after laminectomy, the full-endoscopic ventral facetectomy technique using a transforaminal approach under local anesthesia, combined with intraoperative facet joint arthrography and indigo carmine injection, can be a useful method to make the surgery less invasive and safer.