Radiologic Features and Surgical Outcome of Juxtafacet Cyst Associated with Degenerative Lumbar Disease

Whoan Jeang Kim; Shann Haw Chang; Hwa Yeol Yang; Won Jo Kwon; Hwan Il Sung; Kyung Hoon Park; Won Sik Choy

doi:10.4055/jkoa.2017.52.1.65

Journal List > J Korean Orthop Assoc > v.52(1) > 1013570

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Chang, Yang, Kwon, Sung, Park, and Choy: Radiologic Features and Surgical Outcome of Juxtafacet Cyst Associated with Degenerative Lumbar Disease

Original Article

Journal of the Korean Orthopaedic Association 2017; 52(1): 65-72.

Published online: 16 February 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.1.65

Radiologic Features and Surgical Outcome of Juxtafacet Cyst Associated with Degenerative Lumbar Disease

Whoan Jeang Kim, M.D., Shann Haw Chang, M.D., Hwa Yeol Yang, M.D., Won Jo Kwon, M.D., Hwan Il Sung, M.D., Kyung Hoon Park, M.D., Won Sik Choy, M.D.

Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.

Correspondence to: Shann Haw Chang, M.D. Department of Orthopaedic Surgery, Eulji University Hospital, 95 Dunsanseo-ro, Seogu, Daejeon 35233, Korea. TEL: +82-42-611-3283, FAX: +82-42-611-3283, chang2016@eulji.ac.kr

Received 9 February 2016 Revised 2 May 2016 Accepted 5 July 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the radiologic features of juxtafacet cyst and determine the correlation between these features and clinical outcome.

Materials and Methods

We analyzed a total of 23 patients. The degree of facet joint degeneration was classified using the Fujiwara method. The facet joint angles were measured with an magnetic resonance imaging to determine whether there was a difference between the cystic lesion that was occupied and the cystic lesion that was not occupied. Disc degeneration was measured by the Pfirrmann classification method. The clinical result was evaluated using the Oswestry disability index score and visual analogue scale.

Results

The L4–5 level of juxtafacet cyst was mostly affected, as found in previous studies. Facet joint arthritis was more severe within the side with the cystic lesion. Significant correlation was found between disc degeneration and juxtafacet joint cyst. All patients underwent wide decompression and fusion. Clinical result was excellent. No patients had signs of recurrence during the follow-up periods.

Conclusion

Juxtafacet cyst has a significant correlation with facet joint degeneration. Therefore, aggressive surgical treatment—not just simple cyst excision—should be considered as the treatment option for juxtafacet cyst associated with degenerative lumbar disease.

Keywords: juxtafacet cyst, degenerative lumbar disease, wide decompression and fusion

Figures and Tables

Figure 1

Four grades of facet joint osteoarthritis on magnetic resonance imaging (grade classification according to the Fujiwara methods). (A) Grade 1: normal facet joint. (B) Grade 2: narrowed both facet joint space and left facet joint shows mild osteophyte. (C) Grade 3: narrowed both facet joint space and right facet joint shows moderate osteopytes. (D) Grade 4: not only marked osteophytes but also sclerotic changes are observed within both facet joint.

Figure 2

Measurement of facet joint angle.

Table 1

Summary of the Clinical and Radiological Findings of Patients

BP, back pain; RP, radiating pain; C, claudication; DD, disc degeneration.

Table 2

The Comparison of Both Sides of Facet Joint Arthritis and Facet Joint Angle

SD, standard deviation; SE, standard error; CI, confidence interval.

Table 3

The Comparison of ODI and VAS Score* between Preoperative and Postoperative

^*Grade 0: no pain, Grade 1: mild, annoying pain, Grade 2: uncomfortable, troublesome pain, Grade 3: distressing, miserable pain, Grade 4: intense, horrible pain, Grade 5: worst possible, unbearable pain. ODI, Oswestry low back pain disability questionnaire; VAS, visual analogue scale; POD, postoperative day.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

1. Epstein NE. Lumbar synovial cysts: a review of diagnosis, surgical management, and outcome assessment. J Spinal Disord Tech. 2004; 17:321–325.

2. Onofrio BM, Mih AD. Synovial cysts of the spine. Neurosurgery. 1988; 22:642–647.

3. Choi JY, Kim SH, Sung KH. Synovial cyst forming encircling mass around the traversing nerve root in a patient with faradvanced degenerative spondylolisthesis. Korean J Spine. 2004; 1:540–542.

4. Min JH, Chung BJ, Lee SH. Endoscopically managed synovial cyst of the lumbar spine. A case report. Korean J Spine. 2006; 3:242–245.

5. Cho YD, Kim DH, Choi KH. Lumbar radiculopathy caused by intraspinal synovial cyst: a case report. Korean J Spine. 2008; 5:36–38.

6. Wilby MJ, Fraser RD, Vernon-Roberts B, Moore RJ. The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine (Phila Pa 1976). 2009; 34:2518–2524.

7. Métellus P, Fuentes S, Adetchessi T, et al. Retrospective study of 77 patients harbouring lumbar synovial cysts: functional and neurological outcome. Acta Neurochir (Wien). 2006; 148:47–54.

8. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001; 26:1873–1878.

9. Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. Case report. J Neurosurg. 1974; 41:372–376.

10. Oertel MF, Ryang YM, Gilsbach JM, Rohde V. Lumbar foraminal and far lateral juxtafacet cyst of intraspinal origin. Surg Neurol. 2006; 66:197–199. discussion 199.

11. Paolini S, Ciappetta P, Santoro A, Ramieri A. Rapid, symptomatic enlargement of a lumbar juxtafacet cyst: case report. Spine (Phila Pa 1976). 2002; 27:E281–E283.

12. Baba H, Furusawa N, Maezawa Y, et al. Ganglion cyst of the posterior longitudinal ligament causing lumbar radiculopathy: case report. Spinal Cord. 1997; 35:632–635.

13. Lyons MK, Atkinson JL, Wharen RE, Deen HG, Zimmerman RS, Lemens SM. Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. J Neurosurg. 2000; 93:S53–S57.

14. Fujiwara A, Tamai K, Yamato M, et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J. 1999; 8:396–401.

15. Khan AM, Synnot K, Cammisa FP, Girardi FP. Lumbar synovial cysts of the spine: an evaluation of surgical outcome. J Spinal Disord Tech. 2005; 18:127–131.

16. Choi JK, Ryu KS, Lee H, Lee K, Park CK. Correlation between the symptomatic lumbar synovial cyst and facet degeneration: retrospective study of 13 surgical cases. Korean J Spine. 2011; 8:113–117.

17. Alicioglu B, Sut N. Synovial cysts of the lumbar facet joints: a retrospective magnetic resonance imaging study investigating their relation with degenerative spondylolisthesis. Prague Med Rep. 2009; 110:301–309.

18. Apostolaki E, Davies AM, Evans N, Cassar-Pullicino VN. MR imaging of lumbar facet joint synovial cysts. Eur Radiol. 2000; 10:615–623.

19. Doyle AJ, Merrilees M. Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic resonance imaging. Spine (Phila Pa 1976). 2004; 29:874–878.

20. Noren R, Trafimow J, Andersson GB, Huckman MS. The role of facet joint tropism and facet angle in disc degeneration. Spine (Phila Pa 1976). 1991; 16:530–532.

21. Farfan HF, Sullivan JD. The relation of facet orientation to intervertebral disc failure. Can J Surg. 1967; 10:179–185.

22. Grogan J, Nowicki BH, Schmidt TA, Haughton VM. Lumbar facet joint tropism does not accelerate degeneration of the facet joints. AJNR Am J Neuroradiol. 1997; 18:1325–1329.

23. Lewinnek GE, Warfield CA. Facet joint degeneration as a cause of low back pain. Clin Orthop Relat Res. 1986; 213:216–222.

24. El Shazly AA, Khattab MF. Surgical excision of a Juxtafacet cyst in the lumbar spine: a report of thirteen cases with longterm follow up. Asian J Neurosurg. 2011; 6:78–82.

TOOLS

Similar articles