Tan Haining, Yu Lingjia, Li Xiang, Yang Yong, Zhu Bin
Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2023 Dec 7;14:1278562. doi: 10.3389/fneur.2023.1278562. eCollection 2023.
Lumbar facet joint cysts (FJCs) are a relatively rare clinical pathology that can result in radiculopathy or neurogenic claudication. Various treatments such as percutaneous aspiration and surgery have been reported to have good clinical outcomes. However, few clinical studies have aimed to treat symptomatic lumbar FJCs by using uniportal full-endoscopic (UFE) surgery. This study aimed to investigate the preliminary clinical outcomes of UFE surgery for the treatment of lumbar FJCs under local anesthesia combined with monitored anesthesia care (MAC).
Eight patients (five males and three females) with symptomatic lumbar FJCs who underwent UFE surgery under local and MAC anesthesia were enrolled in this study between January 2018 and April 2022. The clinical characteristics, radiological features, operative information, visual analog scale (VAS) score, Oswestry disability index (ODI), and overall outcome rating based on the modified MacNab criteria were retrospectively analyzed.
Of the eight patients, four underwent a transforaminal approach and four underwent an interlaminar approach. Postoperatively, the mean VAS score for leg pain decreased from 6.1 before surgery to 0.6 after surgery, and the ODI decreased from 74.5% to 14.7%. All patients were followed up for more than 1 year, and the good-to-excellent rate based on the modified MacNab criteria remained 100% at the last follow-up. No complications occurred during the follow-up period.
Lumbar FJCs can cause severe radiating leg pain and/or neurogenic claudication due to the dural sac compression and nerve roots. As an alternative treatment, UFE decompression under local and MAC anesthesia may provide effective clinical outcomes for symptomatic lumbar FJCs.
腰椎小关节囊肿（FJCs）是一种相对罕见的临床病理情况，可导致神经根病或神经源性间歇性跛行。据报道，诸如经皮抽吸和手术等各种治疗方法都有良好的临床效果。然而，很少有临床研究旨在通过单通道全内镜（UFE）手术治疗有症状的腰椎FJCs。本研究旨在探讨在局部麻醉联合监护下麻醉（MAC）的情况下，UFE手术治疗腰椎FJCs的初步临床效果。
2018年1月至2022年4月期间，本研究纳入了8例在局部麻醉和MAC麻醉下接受UFE手术治疗有症状腰椎FJCs的患者（5例男性和3例女性）。对患者的临床特征、影像学特征、手术信息、视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）以及基于改良MacNab标准的总体疗效评级进行回顾性分析。
8例患者中，4例行经椎间孔入路，4例行椎板间入路。术后，腿部疼痛的平均VAS评分从术前的6.1降至术后的0.6，ODI从74.5%降至14.7%。所有患者均随访超过1年，末次随访时基于改良MacNab标准的优良率仍为100%。随访期间未发生并发症。
腰椎FJCs可因硬脊膜囊受压和神经根而导致严重的放射性腿痛和/或神经源性间歇性跛行。作为一种替代治疗方法，在局部麻醉和MAC麻醉下进行UFE减压可能为有症状的腰椎FJCs提供有效的临床效果。
