48. Fusion and decompression vs decompression only for lumbar facet cysts

Abstract

BACKGROUND CONTEXT Lumbar facet cysts are associated with radiculopathy, neurogenic claudication and higher risk of dural tears. Consensus on the best method to address these lesions is lacking (fusion vs decompression only). Outcomes after surgery are of increasing interest to spine surgeons, particularly when seeking to offer the most conservative, yet effective, option. Our objective is to describe complications, outcomes and recurrence rates following surgical intervention of facet cysts. PURPOSE To evaluate surgical outcomes of facet cyst treatment. STUDY DESIGN/SETTING Retrospective cohort PATIENT SAMPLE Patients with lumbar facet cyst treated at a single site by multiple surgeons between 2009 and 2017. OUTCOME MEASURES Revision surgeries, estimated blood loss, adjacent segment disease, length of hospital stay. METHODS A retrospective analysis of patients diagnosed with lumbar facet cysts who underwent treatment for their condition at a single academic tertiary care facility between 2008 and 2018. Patients underwent surgical treatment (fusion + decompression [DF] or decompression only [DO]). All patients were evaluated for surgical approach, facet cyst level, postop complication, cyst recurrence, EBL and length of hospital stay. Adjacent segment disease rates were also assessed. RESULTS A total of 140 patients were assessed. Mean age was 63.4 (43-93) including 80F and 60M. A total of 114 underwent DO and 26 patients underwent DF. The majority of the cysts 56% (n=78) were at L4-L5, followed by 24% (n=34) at L5-S1, 16% (n=22) at L3-L4 and 4% (n=6) at L2-L3. The recurrence rate in the DO group was 8% (9/114) as compared to 0 in the DF (p CONCLUSIONS Patients who undergo DF have an increased risk of adjacent segment degeneration but decreased rate of recurrence. The rate of cyst recurrence is higher among those treated by decompression alone; however, adjacent segment disease, blood loss, and length of hospital stay are lower. Four patients treated initially with DO underwent revision procedures with fusions after cyst recurrence. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.