Awake transforaminal endoscopic lumbar facet cyst resection: technical note and case series

Matthew J. HaganDepartment of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;

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Albert E. TelfeianDepartment of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;

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Rahul SastryDepartment of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;

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Rohaid AliDepartment of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;

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Kai-Uwe LewandrowskiCenter for Advanced Spine Care of Southern Arizona, Tucson, Arizona;

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Sanjay KonakondlaDepartment of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania; and

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Sean BarberHouston Methodist Department of Neurosurgery, Houston, Texas

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Kendall LaneDepartment of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;

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Ziya L. GokaslanDepartment of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island;

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OBJECTIVE

The aim of this study was to describe a minimally invasive transforaminal surgical technique for treating awake patients presenting with lumbar radiculopathy and compressive facet cysts.

METHODS

Awake transforaminal endoscopic decompression surgery was performed in 645 patients over a 6-year period from 2014 to 2020. Transforaminal endoscopic decompression surgery utilizing a high-speed endoscopic drill was performed in 25 patients who had lumbar facet cysts. All surgeries were performed as outpatient procedures in awake patients. Nine of the 25 patients had previously undergone laminectomies at the treated level. A retrospective chart review of patient-reported outcome measures is presented.

RESULTS

At the 2-year follow-up, the mean (± standard deviation) preoperative visual analog scale leg score and Oswestry Disability Index improved from 7.6 ± 1.3 to 2.3 ± 1.4 and 39.7% ± 8.1% to 13.0% ± 7.4%, respectively. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period.

CONCLUSIONS

A minimally invasive awake procedure is presented for the treatment of lumbar facet cysts in patients with lumbar radiculopathy. Approximately one-third of the treated patients (9 of 25) had postlaminectomy facet cysts.

ABBREVIATIONS

ESS = endoscopic spine surgery; ODI = Oswestry Disability Index; SAP = superior articulating process; VAS = visual analog scale.
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Illustrations from Hagan et al. (pp 843–850). © Albert Telfeian, published with permission.

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