Microcervical Foraminotomy for Cervical Juxtafacet Cysts: Case Series and Literature Review

Yuki Kido; Naosuke Kamei; Yuki Fujioka; Toshio Nakamae; Nobuo Adachi; Masanobu Sasaki

doi:10.14444/8440

Microcervical Foraminotomy for Cervical Juxtafacet Cysts: Case Series and Literature Review

Int J Spine Surg. 2023 Jun;17(3):407-417. doi: 10.14444/8440. Epub 2023 Feb 24.

Authors

Yuki Kido^#^{1

2}, Naosuke Kamei^#³, Yuki Fujioka^{2

4}, Toshio Nakamae¹, Nobuo Adachi¹, Masanobu Sasaki^{2

5}

Affiliations

¹ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
² Department of Orthopaedic Surgery, JR Hiroshima Hospital, Hiroshima, Japan.
³ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan nahkamei@hiroshima-u.ac.jp.
⁴ Department of Orthopaedic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan.
⁵ Nishi-Hiroshima Rehabilitation Hospital, Hiroshima, Japan.

^# Contributed equally.

PMID: 36828634
PMCID: PMC10312148
DOI: 10.14444/8440

Abstract

Background: Juxtafacet cysts are located near or contiguous with the facet joints, and their occurrence is rare in the cervical spine. We report 4 cases of cervical juxtafacet cysts operated by microcervical foraminotomy (MCF) or a combination of MCF and laminoplasty. We simultaneously review previously reported cases in terms of location, clinical findings, and surgical technique.

Methods: Among the patients who underwent spine surgery at our hospital from 2015 to 2019, 4 had cervical juxtafacet cysts. The images and clinical records of the patients were retrospectively assessed. Relevant previous English literature was searched and reviewed using PubMed.

Results: In our series, all 4 patients presented with unilateral upper extremity muscle weakness preoperatively. Two patients underwent MCF, and the other 2 underwent a combination of MCF and laminoplasty with resection of the cyst. All showed improvement in muscle strength. In previously reported cases, the rate of muscle weakness was high. A review of previous cases showed that 75 of 139 patients had cysts at C7-T1. The most common surgical techniques consisted of a hemilaminectomy or laminectomy with the addition of posterior fusion in 28 patients. The number of male patients was twice that of female patients; however, the male-to-female ratio was almost the same in patients with cysts in C7-T1. On pathological diagnosis, there were 3 times more synovial cysts than ganglion cysts. The percentage of synovial cysts was higher in patients with radiculopathy, and the percentage of ganglion cysts was higher in patients with myelopathy.

Conclusions: Cervical juxtafacet cysts tend to occur in C7-T1 and cause muscle weakness. Surgical therapy is strongly recommended due to good postoperative improvement.

Clinical relevance: The results of this study suggest that microcervical foraminotomy for cervical juxtafacet cysts can provide favorable symptomatic improvement.

Keywords: cervical; facet cyst; ganglion cyst; juxtafacet cyst; surgery; synovial cyst.

This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.