Microendoscopic decompression for lumbar spinal stenosis caused by facet-joint cysts: a novel technique with a cyst-dyeing protocol and cohort comparison study

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  • 1 Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama;
  • 2 Spine Center, Department of Orthopaedic Surgery, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi;
  • 3 Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan; and
  • 4 Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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OBJECTIVE

Facet cysts may represent a sign of intrinsic facet disease and instability, increasing the importance of less-invasive approaches that limit tissue dissection and improve visualization. The authors developed an intraoperative cyst-dyeing technique, involving the injection of indigo carmine from the facet joint into the cyst, as an adjunct during decompression. This study aimed to evaluate the clinical outcomes and perioperative complication rates of microendoscopic spinal decompression for lumbar spinal stenosis (LSS) and lumbar foraminal stenosis (LFS), caused by facet cysts and to elucidate the efficacy of the cyst-dyeing method in microendoscopic surgery for facet cysts.

METHODS

Forty-eight consecutive patients who underwent surgical treatment with microendoscopic decompression for symptomatic LSS or LFS caused by facet cysts from 2011 to 2018 were reviewed. These patients were divided into two groups: a group that did not receive dye (N), with the patients undergoing surgery from April 2011 to May 2015; and a group that received dye (D), with patients undergoing surgery from June 2015 to March 2018. The authors evaluated the operative time, blood loss, perioperative complications, visual analog scale scores for low-back and leg pain, and Japanese Orthopaedic Association scores. Surgical outcome was evaluated 2 years postoperatively and was compared between groups D and N.

RESULTS

The clinical outcomes were generally excellent or good. Group N consisted of 36 patients and group D of 12 patients. Comparing the clinical results, it was found that the cyst-dyeing method reduced the perioperative complication rate, including reduction in dural tears to 0%, and shortened the average operative time by approximately 40 minutes.

CONCLUSIONS

In this study, the authors demonstrated that the clinical outcomes of microendoscopic spinal decompression in patients with LSS or LFS caused by facet-joint cysts are generally favorable. Additionally, the adjunctive cyst-dyeing method effectively delineated the cystic and dural boundaries, facilitating safer and more effective cyst separation and neural decompression. Microendoscopic surgery combined with this novel facet cyst-dyeing method is a safe and effective minimally invasive technique for facet-joint cysts.

ABBREVIATIONS JOA = Japanese Orthopaedic Association; LFS = lumbar foraminal stenosis; LSS = lumbar spinal stenosis; MCID = minimal clinically important difference; MED = microendoscopic decompression; MEL = microendoscopic laminotomy; VAS = visual analog scale.

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Contributor Notes

Correspondence Akihito Minamide: Wakayama Medical University, Wakayama, Japan. minamide@dokkyomed.ac.jp.

INCLUDE WHEN CITING Published online January 15, 2021; DOI: 10.3171/2020.8.SPINE201209.

Disclosures Dr. Schoenfeld: support of non–study-related clinical or research effort from NIH-NIAMS, OREF, and DoD; and receives royalties from Wolters Kluwer.

  • 1

    Epstein NE. Lumbar synovial cysts: a review of diagnosis, surgical management, and outcome assessment. J Spinal Disord Tech. 2004;17(4):321325.

    • Search Google Scholar
    • Export Citation
  • 2

    Mavrogenis AF, Papagelopoulos PJ, Sapkas GS, Lumbar synovial cysts. J Surg Orthop Adv. 2012;21(4):232236.

  • 3

    Onofrio BM, Mih AD. Synovial cysts of the spine. Neurosurgery. 1988;22(4):642647.

  • 4

    Xu R, McGirt MJ, Parker SL, Factors associated with recurrent back pain and cyst recurrence after surgical resection of one hundred ninety-five spinal synovial cysts: analysis of one hundred sixty-seven consecutive cases. Spine (Phila Pa 1976). 2010;35(10):10441053.

    • Search Google Scholar
    • Export Citation
  • 5

    Kotsenas AL. Imaging of posterior element axial pain generators: facet joints, pedicles, spinous processes, sacroiliac joints, and transitional segments. Radiol Clin North Am. 2012;50(4):705730.

    • Search Google Scholar
    • Export Citation
  • 6

    Chazen JL, Leeman K, Singh JR, Schweitzer A. Percutaneous CT-guided facet joint synovial cyst rupture: Success with refractory cases and technical considerations. Clin Imaging. 2018;49:711.

    • Search Google Scholar
    • Export Citation
  • 7

    Oertel JM, Burkhardt BW. Endoscopic surgical treatment of lumbar synovial cyst: detailed account of surgical technique and report of 11 consecutive patients. World Neurosurg. 2017;103:122132.

    • Search Google Scholar
    • Export Citation
  • 8

    Minamide A, Yoshida M, Yamada H, Endoscope-assisted spinal decompression surgery for lumbar spinal stenosis. J Neurosurg Spine. 2013;19(6):664671.

    • Search Google Scholar
    • Export Citation
  • 9

    Minamide A, Yoshida M, Simpson AK, Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy: 5-year follow-up study. J Neurosurg Spine. 2017;27(4):403409.

    • Search Google Scholar
    • Export Citation
  • 10

    Perez-Cruet MJ, Foley KT, Isaacs RE, Microendoscopic lumbar discectomy: technical note. Neurosurgery. 2002;51(5)(suppl):S129S136.

  • 11

    Yamada H, Yoshida M, Hashizume H, Efficacy of novel minimally invasive surgery using spinal microendoscope for treating extraforaminal stenosis at the lumbosacral junction. J Spinal Disord Tech. 2012;25(5):268276.

    • Search Google Scholar
    • Export Citation
  • 12

    Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery. 2002;51(5)(suppl):S146S154.

    • Search Google Scholar
    • Export Citation
  • 13

    Izumida S, Inoue S. Assessment of treatment for low back pain. Article in Japanese. J Jpn Orthop Assoc. 1986;60:391394.

  • 14

    Minamide A, Simpson AK, Okada M, Microendoscopic decompression for lumbar spinal stenosis with degenerative spondylolisthesis: the influence of spondylolisthesis stage (disc height and static and dynamic translation) on clinical outcomes. Clin Spine Surg. 2019;32(1):E20E26.

    • Search Google Scholar
    • Export Citation
  • 15

    Parker SL, Mendenhall SK, Shau DN, Minimum clinically important difference in pain, disability, and quality of life after neural decompression and fusion for same-level recurrent lumbar stenosis: understanding clinical versus statistical significance. J Neurosurg Spine. 2012;16(5):471478.

    • Search Google Scholar
    • Export Citation
  • 16

    Reulen HJ, Müller A, Ebeling U. Microsurgical anatomy of the lateral approach to extraforaminal lumbar disc herniations. Neurosurgery. 1996;39(2):345351.

    • Search Google Scholar
    • Export Citation
  • 17

    Ozeki N, Aota Y, Uesugi M, Clinical results of intrapedicular partial pediculectomy for lumbar foraminal stenosis. J Spinal Disord Tech. 2008;21(5):324327.

    • Search Google Scholar
    • Export Citation
  • 18

    Tender GC, Baratta RV, Voorhies RM. Unilateral removal of pars interarticularis. J Neurosurg Spine. 2005;2(3):279288.

  • 19

    Choi KC, Kim JS, Lee DC, Park CK. Outcome of decompression alone for foraminal/extraforaminal entrapment of L5 nerve root through Wiltse paraspinal approach. Clin Spine Surg. 2017;30(9):E1220E1226.

    • Search Google Scholar
    • Export Citation
  • 20

    Hallett A, Huntley JS, Gibson JN. Foraminal stenosis and single-level degenerative disc disease: a randomized controlled trial comparing decompression with decompression and instrumented fusion. Spine (Phila Pa 1976). 2007;32(13):13751380.

    • Search Google Scholar
    • Export Citation
  • 21

    Khan AM, Synnot K, Cammisa FP, Girardi FP. Lumbar synovial cysts of the spine: an evaluation of surgical outcome. J Spinal Disord Tech. 2005;18(2):127131.

    • Search Google Scholar
    • Export Citation
  • 22

    Xie T, Xiu P, Yang Z, OLIF combined with anterior fixation for lumbar synovial cysts with instability. World Neurosurg. 2020;135:7679.

    • Search Google Scholar
    • Export Citation
  • 23

    Knafo S, Page P, Pallud J, Surgical management of spinal synovial cysts: a series of 23 patients and systematic analysis of the literature. J Spinal Disord Tech. 2015;28(6):211217.

    • Search Google Scholar
    • Export Citation
  • 24

    Deyo RA, Mirza SK, Martin BI, Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):12591265.

    • Search Google Scholar
    • Export Citation

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