Moon Kang Suk, Villanueva-Solórzano Pedro Leonardo, Mondragón-Soto Michel G, Lee Chungnam, Seo Hyun-Nam
Department of Spine Surgery, Ileona Hospital, Siheung, KOR.
Cureus. 2025 Aug 21;17(8):e90663. doi: 10.7759/cureus.90663. eCollection 2025 Aug.
Interspinous ligamentoplasty (ILP) is an effective, minimally invasive technique used to treat low-grade degenerative spondylolisthesis (DSL) and lumbar spinal stenosis (LSS). However, it may be associated with postoperative complications, including the formation of a facet cyst (FC). Various surgical strategies have been developed to address these clinical challenges. In recent decades, minimally invasive techniques, such as unilateral biportal endoscopy (UBE), have gained popularity for achieving adequate decompression while preserving segmental stability. We report two cases of patients with Grade I DSL and LSS who initially experienced symptomatic relief following treatment with ILP. Within months, both developed recurrent radicular pain and neurogenic claudication. Magnetic resonance imaging (MRI) revealed FCs at the previously decompressed levels. After the failure of conservative treatment, UBE-assisted cyst resection and decompression were performed. In both cases, operative time was brief, and patients achieved significant symptom resolution without perioperative complications. ILP may be a motion-preserving alternative to pedicle-based fusion for mild-to-moderate LSS with low-grade DSL. However, residual micromotion and facet stress may predispose to FC formation. UBE is a minimally invasive management alternative for cyst resection and nerve decompression, preserving facet integrity and potentially reducing the risk of adjacent segment disease. In patients with advanced instability, fusion may still be required. While early outcomes have shown to be favorable, the limited follow-up highlights the need for longitudinal studies to clarify long-term recurrence rates, indications for secondary fusion, and comparative outcomes against traditional fusion techniques. UBE may enable precise FC removal with minimal tissue disruption, offering an alternative option for recurrent radiculopathy after ILP. This approach may help preserve spinal motion while effectively addressing symptomatic lesions. Larger prospective studies with more extended follow-up periods are necessary to confirm these findings and refine treatment algorithms for FCs arising after ILP.
棘突间韧带成形术（ILP）是一种用于治疗低度退行性椎体滑脱（DSL）和腰椎管狭窄症（LSS）的有效微创技术。然而，它可能与术后并发症相关，包括小关节囊肿（FC）的形成。已开发出各种手术策略来应对这些临床挑战。近几十年来，诸如单侧双孔内镜检查（UBE）等微创技术在实现充分减压同时保留节段稳定性方面受到欢迎。我们报告了2例I级DSL和LSS患者，他们最初在接受ILP治疗后症状得到缓解。数月内，两人均出现复发性神经根性疼痛和神经源性间歇性跛行。磁共振成像（MRI）显示在先前减压的节段有FC。保守治疗失败后，进行了UBE辅助的囊肿切除和减压。在这两个病例中，手术时间短，患者症状得到显著缓解，且无围手术期并发症。对于轻度至中度LSS合并低度DSL，ILP可能是一种保留运动功能的替代基于椎弓根融合的方法。然而，残余的微动和小关节应力可能易导致FC形成。UBE是一种用于囊肿切除和神经减压的微创管理替代方法，可保留小关节完整性并可能降低相邻节段疾病的风险。对于具有严重不稳定的患者，可能仍需要融合。虽然早期结果显示良好，但有限的随访突出表明需要进行纵向研究，以阐明长期复发率、二次融合的适应症以及与传统融合技术相比的疗效。UBE可以在最小程度组织破坏的情况下精确切除FC，为ILP后复发性神经根病提供另一种选择。这种方法可能有助于保留脊柱运动，同时有效解决有症状的病变。需要进行更大规模的前瞻性研究，并延长随访期，以证实这些发现并完善针对ILP后出现的FC的治疗算法。
