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Removal of Facet Joint Cyst

What are Facet Joint Cysts?

Facet joint cysts, also called synovial cysts, are benign, fluid-filled sacs that develop due to degeneration of the facet joints of the spine. These cysts normally occur in the lumbar spine (lower back) area and may not cause problems, but when large enough, they can cause spinal stenosis or narrowing of the spinal canal leading to compression of the spinal cord or spinal nerves. 

Indications for Removal of Facet Joint Cysts

Spinal stenosis caused by a facet joint cyst may be associated with: 

  • Pain and cramping in the lower back and legs 
  • Pain that radiates down the back of the leg to the foot
  • Numbness or tingling in the legs
  • Increased pain with standing or walking 

Rarely, a facet joint cyst can lead to cauda equina syndrome, a serious condition which can lead to paralysis and loss of bladder and bowel function. This may be permanent if not treated emergently. 

Surgical removal of the facet joint cyst is indicated when symptoms are severe and not relieved by conservative treatment such as pain medication, activity modification and joint injections.

Preparing for the Procedure

Imaging studies of the spine are performed to plan the surgery. You may have to stop taking certain medications prior to the procedure. Smokers are advised to quit well before the procedure to avoid problems such as delayed healing and infection. 

How is a Facet Joint Cyst Removed?

To remove the cyst and relieve pressure on the spinal cord or spinal nerves your doctor will perform a procedure called microdecompression. This is often followed by fusion of the adjacent vertebrae to avoid recurrence of the cyst.  

The procedure is performed under general anesthesia and you will lie face down on the operating table.

  • Your surgeon will make an incision of 1 to 1½-inches in the midline over the affected region of spine identified by previous imaging studies.
  • The overlying back muscles are lifted off the involved vertebrae and moved to the side.
  • The bony arches and facet joint of the vertebrae are exposed.
  • A small portion of bone is removed from the vertebral arches to improve access.
  • A ligamentous membrane (ligamentum flavum) between the vertebral arches is also removed.
  • The cyst in the facet joint is then completely removed to decompress the spinal nerve.
  • The muscles are moved back into place and the incision is closed.

If spinal fusion is indicated, bone graft is placed between the vertebrae being fused. Metal plates, screws or rods are used to hold the vertebrae while the bones fuse. Fusing the joint provides stability and prevents the cyst from regenerating.

Recover After Removal of a Facet Joint Cyst

As you recover from surgery, you may be instructed to: 

  • Avoid activities such as bending, lifting, or twisting initially 
  • Take only short walks for the first 2 weeks post surgery
  • Wear a brace when you are sitting or walking to limit motion
  • Avoid sleep positions that cause back pain
  • Avoid driving for at least the first 2 weeks after surgery and travel only short distances as a passenger  
  • Avoid smoking or use of other nicotine products

Risks Associated with Removal of a Facet Joint Cyst

As with any form of spine surgery, there are certain risks associated with removal of a facet joint cyst.  These include but are not limited to:

  • Bleeding
  • Infection
  • Nerve root damage
  • Leakage of cerebrospinal fluid
  • Deep vein thrombosis in the leg

Benefits of the Procedure

Potential benefits of facet joint cyst removal include: 

  • Minimally invasive surgery 
  • High rate of success
  • Relatively quick recovery
  • No cyst reformation 
  • Oregon Medical Association
  • American Academy of Orthopaedic Surgeons
  • Scoliosis Research Society
  • North American Spine Society