Acute development of spinal lumbar synovial facet cyst within 1 week after lumbar decompression: illustrative case

Abstract

BACKGROUND Synovial facet cysts can sometimes develop in patients with lumbar spinal stenosis after decompressive laminectomy. The etiology of spinal lumbar synovial cysts is still unclear, but their formation is associated with underlying spinal instability, facet joint arthropathy, and degenerative spondylolisthesis. OBSERVATIONS A 61-year-old-male patient presented with neurogenic claudication due to lumbar spinal stenosis. Radiographic studies showed grade I spondylolisthesis and radiological predictors of delayed spinal instability. He underwent lumbar decompression and shortly thereafter developed spinal instability and recurrent symptoms, with formation of a new spinal lumbar synovial facet cyst. He required revisional decompression, cyst excision, and posterolateral spinal fusion for definitive treatment. LESSONS The literature reports postoperative spinal instability in up to one-third of patients with lumbar spinal stenosis and stable degenerative spondylolisthesis who undergo decompressive laminectomy. Close radiographic monitoring and early advanced imaging may be prudent in this patient population if they develop new postoperative neurological symptoms and show radiographic predictors of instability on preoperative imaging. Posterolateral spinal fusion with instrumentation should be considered in addition to lumbar decompression in this select group of patients who demonstrate radiographic predictors of delayed spinal instability if they are medically capable of tolerating a spinal fusion procedure.

Commentary: Proximal Junctional Fracture and Kyphosis: Correction With Posterior Vertebral Column Resection and the “Rail Technique”: 2-Dimensional Operative Video

“…The “rail technique” was described by Theologis and Gupta et al 2 in 2020 for closing three-column osteotomy (3CO) and more recently by Sarmiento et al 3 for a construct-to-construct biplanar cantilever technique for kyphoscoliosis correction. Closing of a 3CO, whether a pedicle subtraction osteotomy or vertebral column resection, is most commonly performed through segmental compression, cantilever bending, and in situ bending.…”