Effective Lumbar Facet Joint Cyst Treatment with Biportal Endoscopic Spine Surgery: a Rare Case Report

doi:10.21203/rs.3.rs-5252540/v1

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Case Report

Effective Lumbar Facet Joint Cyst Treatment with Biportal Endoscopic Spine Surgery: a Rare Case Report

https://doi.org/10.21203/rs.3.rs-5252540/v1

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Introduction: Facet joint cyst (FJC) are rare, benign lesions that most commonly affect the lumbar region. They are frequently associated with degenerative changes or instability in the spine. FJC often asymptomatic, but in some cases may cause significant neurological symptoms by compressing nearby neural structures causing lumbar spinal stenosis and lumbar foraminal stenosis, resulting in back pain, radicular pain, and neurological deficit. Surgical intervention, including minimally invasive approaches, is often required in symptomatic cases where conservative treatments fail.

Case Presentation:

A 64-year-old female presented with severe low back pain and left leg radicular pain for three months, unrelieved by conservative treatment. Her pain was rated 7–8 on Visual Analog Scale (VAS), and she exhibited neurological deficits with a high Owestry Disability Index (ODI) of 84%. MRI revealed lumbar FJC at L5-S1 causing severe spinal stenosis. Biportal endoscopic spine surgery (BESS) cyst decompression and resection were performed. Postoperatively, the patient experienced significant pain relief and improved function. At one-year follow-up, the patient was pain-free, with no recurrence or complications.

Discussion: FJC, though uncommon, can cause significant neurological symptoms when compressing nerve structures. Surgical management is often required for symptomatic cses, with BESS offering a minimally invasive option. This case showed excellent outcomes with no recurrence, aligning with similar reports in the literature. However, further studies are needed to assess long-term efficacy and recurrence rates.

Conclusion: BESS provides a safe and effective approach for treating Lumbar Facet Joint Cysts, offering symptomatic relief and functional recovery in patients resistant to conservative treatment. Further research is warranted to validate ling-term outcomes.

Facet Joint cyst

spinal stenosis

spine surgery

minimal invasive

human & medicine

Facet joint cyst (FJC) are rare, benign lesions that reside adjacent to facet joints.[1,2] FJC may present in cervical, thoracic and lumbar region, but they are most commonly found in the lumbar region, and often in sites of degenerative changes or instability.[1,3–5] Patients with FJC typically occurs in the age of sixties.[1,3] FJC often asymptomatic, but in some cases this may compress adjacent neural structures causing lumbar spinal stenosis and lumbar foraminal stenosis, resulting in back pain, radicular pain, and neurological deficit.[1–5] Treatment for symptomatic FJC range from conservative to surgical, surgical procedure may be indicated in patients that fail from conservative treatment.[1,3,4,6] We report a case of lumbar FJC, in this case we performed decompression with Minimally invasive surgery using Biportal Endoscopic Spinal Surgery (BESS).

This study was reprted following the SCARE criteria guidelines.[7]

A 64-Year-old female patient presented with chief complaint of severe lower back pain and radicular pain in her left leg for 3 months before presentation, it was described as continuous sharp pain and intermittent tingling sensation on left leg, with pain scaled with Visual Analog Scale (VAS) 7–8, patient also experience weakness on the right leg, and Owestry Disability Index (ODI) 84%. Before presentation, patients have been conservative treatment with analgetic medicine and physical therapy, but the pain is not getting better. On physical examination straight leg raise were positive with radicular pain L5-S1 dermatome distribution. and patient felt extra pain when standing. Patients are recommended to do lumbosacral MRI to evaluate the lumbar spine region. The MRI showed FJC causing severe lumbar spinal stenosis on right L5-S1 (Fig. 1.). An orthopedic spine surgeon recommended decompression surgery after conducting full evaluation. BESS was performed to treat this condition.

Post operative day 1 pain has reduced significantly, VAS 3–4, no tingling sensation, patient can walk without pain doing light activity, and ODI score has reduced to 58%. Patient was discharged 2 days post operation and can walk by herself. One week post operation patient can come to clinic walking on her own, no pain felt, and could walk around house without extra pain, however be felt after sitting or standing for more than 30 minutes.

Three months post operation follow-up patient had no pain, able to do house chores without any restriction, on physical examination straight leg raise and forward bending showed no pain, ODI score has reduced to 20%.

One year follow-up patient was pain free and did not show any recurring symptoms, therefore no radiological examination was performed. No complication was found in this patient.

FJC is a rare benign lesion that can compress the spinal cord, dorsal root ganglion (DRG), or nerve root that might cause lower back pain, radiculopathy, and neurological deficits.[1,8] FJC appear more frequent in female and during their sixties.[2,8] In this case FJC found in female patient during sixth decade of life provoking foraminal stenosis and compressing right L5-S1 nerve root that causing severe pain and neurological deficits on the patient.

Conservative measure has been attempted in this patient, but no improvement seen following conservative treatment.[1,2,6] In some cases FJC can be treated with epidural spinal injection and aspiration of the cyst, however this method may experienced recurrence.[9]

Sagoo NS et al., conducted a case report of FJC, in their case they performed bilateral laminomies and interlaminar stabilization with standard posterior midline approach.[1] With their approach they resulted in immideate improvement of the patient symptoms.[1] This case author opted to perform BESS a minimal invasive surgery (MIS) for decompression and resection of FJC, it yielded in a satisfying results for the patient, no complication occured, and has not show recurrency in one year follow-up. Sehati et al., performed MIS in 19 patients with FJC, resulted 18 patients were having good-excellent and one patient had fair outcome. they reported intraoperative dural tears in two patients.[10]

Recurrence is a concern regarding FJC and the effectiveness of minimal invasive approach on this particular case need further research, therefore larger sample size and longer follow-up in future study will be needed.

Facet joint cyst can compress neural structure causing back pain, radiating leg pain, and neurological deficits. This study reported BESS decompression and cyst resection can be used to safely and effectively treating FJC.

Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request

Source of funding

No funding was provided

Ethical approval

Ethical clearance was not necessary as the format of this paper is a case report

Declaration of competing interest

The authors have no conflict of interest to report

Sagoo NS, Bhatti H, Rowe SE, Sharma I, Haider AS. Lumbar Facet Joint Cyst Treated With Decompression and Interlaminar Stabilization. Cureus [Internet]. 2020 Jul 25 [cited 2023 Sep 8]; Available from: https://www.cureus.com/articles/37398-lumbar-facet-joint-cyst-treated-with-decompression-and-interlaminar-stabilization
Splavski B. Lumbar Spine Synovial Cyst: A Case Series Report and Review of Surgical Strategies. Acta Clin Croat [Internet]. 2019 [cited 2023 Sep 8]; Available from: https://hrcak.srce.hr/index.php?show=clanak&id_clanak_jezik=334725
Epstein NE. Lumbar Synovial Cysts: A Review of Diagnosis, Surgical Management, and Outcome Assessment. J Spinal Disord Tech. 2004 Aug;17(4):321–5.
Murata S, Minamide A, Takami M, Iwasaki H, Okada S, Nonaka K, et al. Microendoscopic decompression for lumbar spinal stenosis caused by facet-joint cysts: a novel technique with a cyst-dyeing protocol and cohort comparison study. J Neurosurg Spine. 2021 Jan;1–7.
Campbell RJ, Mobbs RJ, Rao PJ, Phan K. Interventions for Lumbar Synovial Facet Joint Cysts: A Comparison of Percutaneous, Surgical Decompression and Fusion Approaches. World Neurosurg. 2017 Feb;98:492–502.
James A, Laufer I, Parikh K, Nagineni VV, Saleh TO, Härtl R. Lumbar Juxtafacet Cyst Resection: The Facet Sparing Contralateral Minimally Invasive Surgical Approach. J Spinal Disord Tech. 2012 Apr;25(2):E13–7.
Sohrabi C, Mathew G, Maria N, Kerwan A, Franchi T, Agha RA, et al. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2023 May;109(5):1136–40.
Yoo YM, Kim KH. Facet joint disorders: from diagnosis to treatment.
Kim KH. A Staged Treatment of Symptomatic LumbarIntraspinal Synovial Cysts. Pain Physician. 2019 Sep 11;5(22;5):E451–6.
Sehati N, Khoo LT, Holly LT. Treatment of lumbar synovial cysts using minimally invasive surgical techniques. Neurosurg Focus. 2006 Mar;20(3):1–6.

No competing interests reported.

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Effective Lumbar Facet Joint Cyst Treatment with Biportal Endoscopic Spine Surgery: a Rare Case Report

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