Percutaneous Endoscopic Lumbar Surgery via the Transfacet Approach for Lumbar Synovial Cyst

Percutaneous Endoscopic Lumbar Approach to a Facet Joint Synovial Cyst: Case Report and Review of the Literature

“…The natural history and development of lumbar facet joint . It has been linked in previous studies to degenerative spine diseases, such as spondylolistheses and scoliosis 3) . Considering this association and the fact that open microscopic approaches oftentimes lead to spinal instability, the minimally invasive treatment through an endoscopic approach may be more beneficial to patients with this lesion, avoiding instability and the need for spinal instrumentation 4) .…”

“…It allows a complete resection of the cyst and its capsule rather than just aspiration of its contents. Although there are no randomized trials comparing open and endoscopic approaches, some studies have shown the endoscopic approach to have similar success rates to open approaches [2][3][4] . Using the percutaneous endoscopic approach, the lesion is reached through the facet joint, avoiding muscle and ligament injury incurred by the open approach.…”

“…Using the percutaneous endoscopic approach, the lesion is reached through the facet joint, avoiding muscle and ligament injury incurred by the open approach. Furthermore, the open approach also requires a medial facetectomy increasing the risk of spinal instability and the need for instrumentation [2][3][4] . A interesting point was the use of the Tomshid cannula (a non-disposable device) instead of an electric drill to access the spinal canal.…”

“…It does not respond well to clinical management, oftentimes requiring surgical intervention. Different approaches may be used, such as corticosteroids and local anesthetic injections, Computed Tomography (CT) guided needle aspiration, microscopic resection and, nowadays, endoscopic resection [2][3][4] . These cysts seldom disappear without intervention and the open microscopic approach may lead to spinal instability after removing part of the facet joint.…”

The benefit zone of full-endoscopic spine surgery

“…As endoscopic spine surgery continues to enjoy wider adoption, spine surgeons are expanding potential indications for use of this technology. Numerous case series have shown potential applications in patients with complex pathology including burst fractures (113), BMP related heterotopic ossification (114,115), synovial cysts (116,117), migrated hardware (115), discitis (118), spinal cord untethering (119), and tumors (120) (Figure 8). While direct comparisons to more traditional techniques for these complex scenarios is limited, current available evidence highlights the versatility of endoscopic spine surgery in achieving favorable outcome with minimal morbidity.…”