A SERIES OF 60 JUXTAFACET CYSTS - CLINICAL PRESENTATION, THE ROLE OF SPINAL INSTABILITY, AND TREATMENT

Spinal instability may be a cause of juxtafacet cyst formation and the pain and disability that occur after surgical excision of the cyst. T o determine the role of instability, a retrospective review of charts identified 60 facet cysts in 56 patients treated over a 6-year period. Three patients developed an asynchronous cyst at the same level but o n the opposite side of the previously resected cyst and one patient ha d a recurrent cyst in the same location. Forty-one cysts were present in patients with radiculopathy and 16 in patients with neurogenic clau dication. Two patients presented with myelopathy and one had cauda equ ina syndrome. Thirty-six of the 60 cysts were located at L4-5, the mos t mobile segment. Fifteen patients had spondylolisthesis, of whom two experienced worsening spondylolisthesis postoperatively. Seven patient s had scoliosis and 20 had systemic arthritis. Fifty-five cysts were r esected via mesial facetectomy. Six of the patients undergoing this pr ocedure had transverse process fusions at initial surgery for preopera tive instability. Two others required fusion for postoperative instabi lity and increased spondylolisthesis. Follow-up review was available i n 95% of patients with an average duration of 12 months. Forty patient s had excellent relief of symptoms, 12 had occasional back pain, and o ne patient did poorly. Flexion/extension views of the spine are recomm ended both pre- and postoperatively to identify the need for fusion in patients with juxtafacet cysts.