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New classification of facet joint synovial cysts

  • Original Article - Spine degenerative
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Facet cysts develop due to degeneration of the zygapophyseal joints and can lead to radiculopathy and neurogenic claudication. Various surgical options are available for facet cyst excision. The aim was to facilitate surgical treatment of lumbar facet cysts based on a new classification.


We retrospectively analyzed all patients of the last 10 years in whom a facet cyst was surgically removed (ipsilateral laminotomy, contralateral laminotomy, and segmental fusion). Several radiological parameters were analyzed and correlated with the patients’ outcome (residual symptoms, perioperative complications, need for re-operation, need for secondary fusion, facet cyst recurrence).


One hundred eleven patients (55 women; median age 64 years) could be identified. Thirty-three (48%) of 69 cases, for which MRI data were available, were classified as medial facet cyst (compressing the spinal canal), 6 facet cysts were localized intraforaminal (9%) and 30 cases (43%) mediolateral (combination of both). The contralateral approach had the lowest rate for revision surgery (7.5%, p = .038) and the lowest prevalence of residual complaints (7.5%, p = .109). A spondylolisthesis and a higher/steeper angle of the facet joints were associated with poorer patient outcome.


Lateral facet joint cysts are best resected by a contralateral approach offering the best outcome while medial cysts are suitable for removal by an ipsilateral laminotomy. The approach of mediolateral cysts can be determined by the width of the lamina and the angle of the joint. Segmental fusion should be considered in cases with detected spondylolisthesis and/or steep facet joints.

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Correspondence to Peter Vajkoczy.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The authors describe 111 patients who had lumbar surgical facet cysts removed. They propose a classification system based on the location of the cyst, as well as if there is associated spondylolisthesis. The authors recommend different surgical approaches depending on the location of the cyst. This seems very reasonable. Unfortunately, however, the follow-up is quite short (6-12 weeks), and out of the 111 patients, only 69 had available MRI scans to be studied for this review. Nonetheless, I applaud the authors for suggesting a novel classification system and suggesting different surgical approaches based on that system.

Volker Sonntag


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Rosenstock, T., Vajkoczy, P. New classification of facet joint synovial cysts. Acta Neurochir 162, 929–936 (2020).

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