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

Wun, Kelly MD; Hashmi, Sohaib Z. MD; Maslak, Joseph MD; Schneider, Andrew D. MD; Katchko, Karina M. MD; Singh, Gurmit MD; Patel, Alpesh A. MD; Hsu, Wellington K. MD

doi: 10.1097/BSD.0000000000000870
Primary Research

Study Design: This is a retrospective study.

Objective: The objective of this study was to evaluate lumbar spine synovial cyst recurrence rates of decompression-alone versus decompression/fusion procedures.

Background: Improvements in imaging modalities allow for increased diagnosis and surgical treatment of symptomatic spinal juxtafacet synovial cysts. Conservative management may be used as a first-line management strategy, however rarely provides durable, effective relief of symptoms. Surgical treatment of spinal synovial cysts ranges from decompression and cyst excision to decompression with fusion procedures. Decompression procedures alone have a higher risk of recurrence of spinal synovial cysts.

Methods: We retrospectively reviewed 87 patients undergoing surgical treatment of lumbar spinal juxtafacet synovial cysts as a single institution over 20 years. Surgical treatment consisted of either decompression versus decompression/fusion procedures. Preoperative symptoms included back pain, radiculopathy, motor deficits, or sensory deficits. The incidence of recurrence of spinal synovial cysts at the same-site or differing sites was compared between 2 categories of surgical treatment. Revision surgical procedure rates were also evaluated.

Results: A total of 55 (63%) patients were treated with an index decompression-only procedure for the lumbar spinal synovial cyst compared with 32 (37%) patients treated with an index decompression and fusion procedure. Fifty-eight (68%) of the lumbar spinal cysts occurred at the L4–L5 level. There were 10 (11.5%) spinal synovial cyst recurrences in the decompression-only group, and 0 recurrences in the decompression/fusion group. Revision decompression procedures were performed in 4 of the 10 (4.6%) recurrences, and 6 of 10 (6.9%) recurrences had subsequent decompression and fusion surgery. The mean time to recurrence was 23.9±17.3 months. The mean length of follow-up was 65.1±48.6 months. Both recurrence and nonrecurrence cohorts had significant symptomatic improvement using Odom criteria.

Conclusions: Decompression and cyst excision was the more common surgical treatment of lumbar spinal synovial cysts compared with decompression/fusion procedure in our study. The rate of synovial cyst recurrence and revision surgery in patients undergoing index decompression was relatively low and comparable to current literature. Symptomatic improvement of patients undergoing decompression versus decompression/fusion was similar in our study. Although the fusion may be required for the extent of pathology or coexisting instability, decompression and excision of spinal synovial cysts provide durable, effective treatment with a known, appropriate risk of recurrence and subsequent revision surgery.

Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

W.K.H.: AgNovos Healthcare, AlloSource, Bioventus, LLC, Journal of Bone and Joint Surgery Inc., Medtronic Inc., MicroMedicine Inc., Mirus Bio LLC, OrthoCarolina, St. Louis Spine Society, Stryker Corporation, Wright Medical Technology Inc. A.A.P.: AO North America, Aetna Life Insurance (a division of Aetna Inc.), American Academy of Orthopaedic Surgeons (AAOS), Contemporary Spine Surgery (Wolters Kluwer Health Inc.), Encompass Home and Auto Insurance Co. (a subsidiary of Allstate Corporation), Thomas Jefferson University, Zimmer Biomet, nView Medical Inc., Amedica Corporation, Cytonics Corporation, Nocimed LLC, Vital 5 LLC, Amedica Corporation. The remaining authors declare no conflict of interest.

Reprints: Sohaib Z. Hashmi, MD, Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611(e-mail:

Received December 16, 2018

Accepted July 2, 2019

Online date: August 23, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.