PURPOSE 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. METHODS 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). RESULTS 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. CONCLUSIONS 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.

中文翻译：

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小关节滑膜囊肿的新分类。

目的 小关节囊肿是由于关节突关节退化而发展的，可导致神经根病和神经源性跛行。有多种手术选择可用于小关节囊肿切除。目的是促进基于新分类的腰椎小关节囊肿的手术治疗。方法 我们回顾性分析了过去 10 年中所有通过手术切除小关节囊肿的患者（同侧椎板切开术、对侧椎板切开术和节段性融合术）。分析了几个放射学参数并将其与患者的结果（残留症状、围手术期并发症、再次手术的需要、二次融合的需要、小关节囊肿复发）相关联。结果 可以确定 111 名患者（55 名女性；中位年龄 64 岁）。69 例中有 33 例 (48%) 的 MRI 数据可用，被归类为内侧小关节囊肿（压迫椎管），6 个小关节囊肿位于椎间孔内（9％）和 30 例（43％）中间外侧（两者的组合）。对侧入路的翻修手术率最低 (7.5%, p = .038)，残留投诉率最低 (7.5%, p = .109)。脊椎滑脱和小关节的更高/更陡的角度与较差的患者预后相关。结论 外侧小关节囊肿最好通过对侧入路切除，提供最佳结果，而内侧囊肿适合通过同侧椎板切开术切除。内侧囊肿的入路可根据椎板的宽度和关节的角度来确定。在检测到脊椎滑脱和/或陡峭的小关节的情况下，应考虑节段性融合。