The Feasibility and Perioperative Results of Bi-Portal Endoscopic Resection of a Facet Cyst Along With Minimizing Facet Joint Resection in the Degenerative Lumbar Spine

BACKGROUND: Presentation of degenerative facet cysts (FC) as radicular pain in patients is well established. The traditional treatment of FCs has been decompressive laminectomy with a medial facetectomy and cyst excision. A major disadvantage of open procedures with medial facetectomy is predisposition to further instability. OBJECTIVE: To describe a contralateral bi-portal endoscopic excision of FC along with minimizing facet joint resection. METHODS: Thirteen patients between March 2016 and December 2017 were evaluated retrospectively for clinical, radiological, and morphometric outcomes. Patients with complaints of unilateral radiculopathy with associated neurogenic claudication from degenerative lumbar FC were included. Clinical evaluation was by NRS leg pain and ODI scores, radiological evaluationwas by MRI. Formorphometric analysis, cross-sectional area of facet joint (CSA-FJ) was measured on MRI in square millimeters. RESULTS: Thirteen FCs were decompressed (no adverse events) NRS leg pain and ODI improved from 6.85 +/- 0.69 and 65.08 +/- 7.95 preoperatively to 1 +/- 0.91 and 13.46 +/- 5.19 at 1-yr follow-up, respectively. CSA-FJ remained relatively well preserved from 212.83 +/- 58.05 to 189.77 +/- 62.93 post decompression (statistically insignificant, P = .3412). CONCLUSION: Bi-portal endoscopic decompression of FC can be performed with good clinical and radiological outcomes. This surgical technique may be recommended for further evaluation as an addition in the armamentarium of a spine surgeon for treatment of degenerative lumbar FC.