The Biportal Endoscopic Contralateral Approach for Juxtafacet Cystic Lesions of the Lumbar Spine

Abstract

Juxtafacet cysts in the lumbar region are a rare cause of radiculopathy and low back pain. They are usually associated with spondylolisthesis and arthritis of the facet joints and are present in older adults. Conservative treatment includes various nonsurgical modalities that can be offered to patients with mild symptoms without neurological impairment. However, a large number of patients often require a surgical alternative. Laminectomy and partial facetectomy to decompress the neural elements are usually performed in conventional surgery or microsurgery. Lumbar fusion may be reserved in cases of unstable spondylolisthesis. However, minimally invasive treatments continue to evolve, and there are currently several endoscopic options that allow complete decompression with minimal impact on the biomechanics of patients with this type of injury. A particular case is a biportal endoscopy, which through a contralateral route allows to remove this type of lesions, decompress the neural elements, and even fulfill other objectives such as performing bilateral decompressions if required. In this chapter, the authors describe the biportal endoscopic sublaminar contralateral approach to remove juxtafacet cystic lesions of the lumbar region.