• Filip Samal, Albert Sterba, Pavel Haninec, Radovan Zubcek, Petr Waldauf, Johana Klasova, and Petr Linzer.
• Neurosurgical Clinic, University Hospital Kralovske Vinohrady, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
• World Neurosurg. 2023 Jun 30.

BackgroundFacet joint cysts (FJCs) are a cause of radiculopathy, back pain, cauda equina syndrome, and/or claudication. They mostly affect the lumbar spine in the elderly, prevailing in women, and are connected to spinal degeneration and instability. We aimed to evaluate the safety and efficacy of open surgical decompression and cyst excision without a subsequent fusion.MethodsWe evaluated neurologic symptoms and potential signs of spinal instability on preoperative versus postoperative radiological examination. We performed a histological assessment of the extirpated cysts. Statistical analysis was then performed.ResultsOf a total of 66 patients, 44 were included in the present study. The average age was 61.2 years. Female patients prevailed (61.4%). The mean follow-up was 5.3 years. The segment most frequently affected by a FJC was L4-L5 (65.9%). Cyst resection led to significant relief from neurologic symptoms for most patients. Thus, 95.5% of our patients reported their postoperative outcome as excellent. Preoperatively, 43.2% and 47.4% of patients had had radiographic signs of instability on magnetic resonance imaging and signs of spondylolisthesis on dynamic radiographs in the operated segment, respectively, with 54.5% manifesting signs of spondylolisthesis in the same segment on a postoperative dynamic radiograph. Despite spondylolisthesis progression, no patient required reoperation. Histologically, pseudocysts without synovium were more frequent than were synovial cysts.ConclusionsSimple FJC extirpation is a safe and effective method for resolving radicular symptoms, with excellent long-term outcomes. It does not lead to the development of clinically significant spondylolisthesis in the operated segment; thus, no supplementary fusion with instrumented stabilization is required.Copyright © 2023 Elsevier Inc. All rights reserved.

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