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Trauma

SURGICAL TREATMENT OF LUMBAR JUXTAFACET CYST WITH FULL ENDOSCOPIC INTERLAMINAR AND TRANS-/EXTRAFORAMINAL APPROACH-PROSPECTIVE RANDOMIZED CONTROLLED STUDY WITH 60 PATIENTS

European Federation of National Associations of Orthopaedics and Traumatology (EFORT) - 12th Congress



Abstract

Objectives

Juxtafacet cysts of the spine can cause radicular pain, neurological symptoms and are often associated with spinal degeneration. The mainstay of treatment of juxtafacet cysts is surgical resection with laminotomy and resection of the cyst. Other methods, including epidural steroid and facet injections are mostly temporarily effective. The aim of this study is the sufficient decompression with reduced traumatization and destabilization with the full-endoscopic interlaminar and transforaminal technique.

Methods

60 patients with unilateral, single-level juxtafacet cysts were included in this study. 30 Patients (group 1) were operated in full-endoscopic technique (22 interlaminar, 8 trans-/extraforaminal) and 30 Patients (group 2) with conventional microscopic-assisted technique. The full-endoscopic operation was performed with 6.9-mm endoscopes with 4.1-mm intra-endoscopic working canal. The follow-up was 18 months. 27 (91%) patients were followed. Additionally to general parameters validated scores were used.

Results

No intraoperative complications occurred. 2 patient in group 1 and 4 patients in group 2 showed transient dysaesthesia. The mean operation time in group 1 was 32 minutes, in group 2 56 minutes. There was no measurable blood loss in group 1, and a mean blood loss of 85 ml in group 2. The follow-up showed satisfactory subjective results in 53 patients. There were no significant differences between the two groups or within group 1 between the transforaminal and interlaminar technique in the clinical results. Group 1 showed significant advantages in different clinical, technical and economical parameters. The maximum time in hospital for group 1 patients was 3 days and 6 days in group 2. No recurrence of the cyst was found in the follow up.

Conclusion

The full-endoscopic operation of lumbar facet cysts with full-endoscopic technique is an alternative to the conventional microscopic-assisted procedure for sufficient decompression of juxtafacet cyst. It enables selective procedure with direct visualization, sufficient decompression and less traumatization of the access pathway and the spinal canal structures.