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Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts

van Dijke, Maarten BSc*; Janssen, Stein J. MD*; Cha, Thomas D. MD, MBA*; Wood, Kirkham B. MD; Borges, Lawrence F. MD; Harris, Mitchel B. MD, FACS§; Bono, Christopher M. MD§; Schwab, Joseph H. MD, MS*

doi: 10.1097/BSD.0000000000000449
Primary Research

Study Design: This is a retrospective study.

Objective: To compare (1) recurrence of radiculopathy and (2) back pain after decompression with and without fusion for patients with a symptomatic synovial cyst.

Background: Previous work described favorable outcomes following cyst excision with and without fusion. Because of the association of facet cysts with spinal instability it is hypothesized that a decompression with fusion will lead to better outcomes. However, previous studies present contradicting results.

Methods: We included 314 consecutive patients that underwent operative treatment for a facet cyst between 2003 and 2013 at 2 tertiary spine referral centers: 224 (71%) underwent decompression without fusion (35% spondylolisthesis), 90 (29%) underwent decompression with fusion (63% spondylolisthesis). Baseline data were compared between the groups. Bivariate log-rank analysis was used to compare outcomes between groups, followed by multivariable Cox regression analysis accounting for differences in baseline characteristics.

Results: Patients undergoing decompression with fusion presented with a higher incidence of back pain (P=0.004) and spondylolisthesis (P<0.001), had more often bilateral decompressions (P<0.001), more facetectomies (P<0.001), and more levels of decompression (P=0.004) than those who underwent decompression alone. We found a difference in recurrence of radiculopathy (no fusion: 25% vs. fusion: 9.4%, P=0.029) in bivariate analysis. However, this difference did not hold when accounting for confounders (hazard ratio, 0.50, 95% confidence interval, 0.19–1.31, P=0.16). There was no difference in recurrence of back pain in bivariate (no fusion: 29% vs. fusion: 22%, P=0.51) and multivariable analysis (hazard ratio 0.51, 95% confidence interval, 0.23–1.14, P=0.10).

Conclusions: We found, with the numbers evaluated, no difference in recurrence of radiculopathy or back pain between patients undergoing decompression with or without fusion after accounting for confounders. The decision for fusion should be considered in light of the extent of decompression and the existence of other pathology.

Level of Evidence: Level III—therapeutic study.

*Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA

Department of Orthopaedic Surgery, Orthopaedic Spine Service, Stanford University Medical Center, Stanford, CA

Department of Neurosurgery, Massachusetts General Hospital-Harvard Medical School

§Department of Orthopaedic Surgery, Orthopaedic Spine Service, Brigham and Women’s Hospital-Harvard Medical School, Boston, MA

This study was approved by the Partners Healthcare Institutional Review Board.

The authors declare no conflict of interest.

Reprints: Stein J. Janssen, MD, Room 3.946, Yawkey Building, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 (e-mail:

Received May 4, 2016

Accepted September 14, 2016

© 2017 by Lippincott Williams & Wilkins, Inc.