Abstract
Introduction: This study is a retrospective review of patients who underwent corticosteroid spinal injections and/or surgery for lumbar juxtafacet cysts to determine the effectiveness of corticosteroid injection and/or surgery for the treatment of lumbar juxtafacet cysts.
Methods: The charts of 40 patients who underwent corticosteroid injection and/or surgery for the treatment of symptomatic juxtafacet cysts were reviewed and an outcome questionnaire was sent to each patient. All patients responded to the questionnaire (100%).
Results: Forty-four juxtafacet cysts were treated in 40 patients. 28 cysts were initially treated with corticosteroid injection. 18 facet joints adjacent to the cysts were injected (4 were injected on two or more occasions), 13 underwent epidural injection and 5 underwent nerve sheath exit foraminal blocks. 18 obtained no Benefit from the use of corticosteroid injections and proceeded to surgical treatment. Of the 10 patients that did not undergo surgery, at follow-up 2 reported no clinical change and were considering surgical treatment. This represents a 71% failure rate for non-operative treatment with corticosteroid injections.
34 cysts were resected from 31 patients. Two (6%) were ligamental and 32 were facetal. 31 cysts were resected by laminectomy alone and 3 patients underwent laminectomy and bone only fusion. One cyst (3%) recurred and was managed by repeat laminectomy. One patient required instrumented lumbosacral fusion for increasing anterolisthesis. Incidental dural tear was the most common surgical complication occurring in two cases (6%). One patient demonstrated significant weakness of ankle and foot dorsiflexion which recovered incompletely. Average follow-up for the surgical group was 18 months (5–72 months). 27 scored an excellent or good outcome (79%), 3 scored a fair outcome, 3 were considered poor and one patient was worse. 30 (88%) patients were satisfied having complete improvement or improved with residual back or leg symptoms. Three responded as no change and one was worse.
Discussion: Juxtafacet cysts are an uncommon cause of radiculopathy. Corticosteroid injection into the adjacent facet joints, epidural space or exit foraminae of the spine produces disappointing results. Surgical resection is the treatment of choice with low rates of complications, recurrences and residual complaints.
The abstracts were prepared by I. B. McPhee. Correspondence should be addressed to the Spine Society of Australia Secretariat, The Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 5000, Australia.
