JUXTAFACET CYSTS

What is a Juxtafacet Cyst?

The medical term “Juxtafacet Cyst” refers to the lesions associated with spinal facet joints (Ulus, Altun, & Senel, 2020). Juxtafacet cysts encompass both ganglion cysts and synovial cysts arising from the ligamentum flavum of the spinal facet joints. Usually, both cysts share the same clinical and radiological characteristics, while synovial cysts differ from ganglion cysts by their histological properties. Synovial cysts arise from the periarticular tissue through weakened or destroyed facet joint capsules with continued direct communication with the joint. In contrast, ganglion cysts develop from mucinous degeneration of ligamentous tissue in the mobile spine and they have no direct communication with the facet joint. These cysts produce intraspinal lesions that may exhibit symptoms of spinal stenosis or disc herniation. The actual etiology of juxtafacet cysts remains unknown. 

Clinical signs of juxtafacet cysts of the lumbar spine comprise extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. Sometimes, these cysts narrow down the spinal canal and produce pressure on the nerve roots, and cause radiculopathy. These cysts can exist unilaterally or bilaterally and mostly sit in the lumbar spinal column, particularly at the L4–L5 level (Ghent, Davidson, & Mobbs, 2014). These cysts usually appear with facet joint degeneration and cause focal weakness in the facet capsule. Most of the patients with juxtafacet cysts develop spondylolisthesis or facet arthritis. In most cases, knowing the precise diagnosis makes little difference in terms of treatment. Patients aged above 50 years mostly produce these lesions of juxtafacet cysts and produce spinal instability.

What are the Common Symptoms and Causes of Juxtafacet Cysts?

Symptoms of a juxtafaect cyst include severe back pain, and unilateral or bilateral radiculopathy in 55-97% of the cases (Ulus et al., 2020). Other symptoms include neurological deficits such as motor deficits, sensory deficits, reflex abnormalities, neurogenic claudication, cauda equina syndrome, etc. These cysts may produce central or lateral spinal stenosis. Patients with juxtafacet cysts may suffer extrusion of synovial fluid from the joint capsule, myxoid degeneration, development of a cyst within the connective tissue, and latent growth of a developmental rest. Most of these lesions occur in the lumbar spine (88-99%), thoracic spine (up to 8%), and cervical region (1 to 4%) (El Shazly & Khattab, 2011). The etiology of JFC includes degenerative processes due to physical stress, repetitive trauma, and micro-instability. The formation of these cysts occurs due to the arthritic disruption of the facet joint in mobile segments.

How do Spinal Specialists Diagnose Juxtafacet Cysts?

The initial diagnosis of a juxtafacet cyst includes a brief clinical presentation and pain patterns of patients. With increased lordosis of the spine and under weight-bearing circumstances, particularly when standing, the detection rate of JFC increases. Neurosurgeons perform further tests to confirm the diagnosis, which includes the following (Song, Musleh, Christie, & Fessler, 2006):

  •     Magnetic resonance imaging (MRI): This acts as the first imaging modality of choice to diagnose this condition. This test uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of soft tissues and bones.
  •     X-rays: X-ray uses electromagnetic energy beams (X-rays) to produce images of bones and provides an overall assessment of the bone anatomy and alignment of the vertebral column with any kind of abnormalities like spinal dislocation or slippage (also known as spondylolisthesis), kyphosis, scoliosis, etc.
  •     Computerized tomography (CT) scan:  Using computer scans helps to produce images of bones and soft tissues to detect problems related to the bones. This can help find calcified cystic lesions adjacent to a facet joint with or without the presence of gas.

How do Neurosurgeons treat a Juxtafacet Cyst?

Neurosurgeons prefer surgical treatment rather than non-surgical conservative treatment when treating a juxtafacet cyst. Non-surgical conservative options usually produce short-term benefits, while surgery helps to decompress stenosis, resect cysts, and maintain stability. The conservative treatment procedures may include (Yurt et al., 2016):

  • Complete bed rest that can help the patient for a short time
  • Mediations: Several pain relievers like NSAIDs such as ibuprofen and acetaminophen help to reduce the pain.
  • Steroid injections: Intra-articular injection of corticosteroid drugs helps to relieve the pain temporarily and CT-guided needle aspiration helps to drain the excess synovial fluid
  • Orthopedic corsets: This supports the spine and helps to stabilize the posture of the patient. 

However, neurosurgeons recommend surgical treatment due to their efficiency. Surgery refers to the safe and effective treatment of the excision of lumbar juxtafacet cysts. Thus, non-surgical treatments often show short-term or no improvement at all. Surgical treatment helps to manage all cases of intractable pain or neurological deficit. The Surgery depends upon the size, site, and other facts of the cysts, such as involvement of surrounding structures, durations of the symptoms, etc. Unstable slipping or increased angular movement affects the size of juxtafacet cysts. Juxtafacet cyst surgery includes unilateral or bilateral laminotomies, hemilaminectomies, or laminectomies. Although, neurosurgeons may perform surgical excision of the JFC in conjunction with primary spinal fusion, which produces good results in patients. For any information, please contact us.

References

El Shazly, A., & Khattab, M. (2011). Surgical excision of a Juxtafacet cyst in the lumbar spine: A report of thirteen cases with long-term follow up. Asian Journal of Neurosurgery, 6(2), 78. https://doi.org/10.4103/1793-5482.92162

Ghent, F., Davidson, T., & Mobbs, R. J. (2014). Haemorrhagic Lumbar Juxtafacet Cyst with Ligamentum Flavum Involvement. Case Reports in Orthopedics, 2014, 1–3. https://doi.org/10.1155/2014/126067

Song, J. K., Musleh, W., Christie, S. D., & Fessler, R. G. (2006). Cervical juxtafacet cysts: case report and literature review. Spine Journal, 6(3), 279–281. https://doi.org/10.1016/j.spinee.2005.09.006

Ulus, A., Altun, A., & Senel, A. (2020). Lumbar juxtafacet cysts. Turkish Neurosurgery, 30(3), 416–421. https://doi.org/10.5137/1019-5149.JTN.27588-19.2

Yurt, A., Seçer, M., Aydin, M., Akçay, E., Ertürk, A. R., Akkol, I., … Palaz, M. N. (2016). Surgical management of Juxtafacet cysts in the lumbar spine. International Journal of Surgery, 29, 9–11. https://doi.org/10.1016/j.ijsu.2016.03.003