Durability of Decompression Alone for Lumbar Synovial Facet Cysts With Versus Without Degenerative Spondylolisthesis
Jacob M. Tadje, Maxwell J. Rakutt, Chason Ziino, David J. Lunardini, Michael DeSarno, Nathan J. SinzStudy Design:
Retrospective cohort study.
Objective:
To determine characteristics of patients with facet cysts undergoing laminectomy and cyst excision, to evaluate the risk of subsequent arthrodesis following decompression alone, and to evaluate the temporality of subsequent arthrodesis.
Summary of Background Data:
Although patients with symptomatic lumbar synovial facet cysts (LSFCs) can benefit from surgical decompression, the odds of subsequent arthrodesis with concomitant degenerative spondylolisthesis (DS) remain unclear.
Methods:
A large insurance claims database was utilized to retrospectively identify a cohort of 6,034 patients between 30 and 79 years old with facet cysts undergoing decompression. Patients with and without lumbar spondylolisthesis were identified. Groups were matched on demographic characteristics. Subsequent posterior arthrodesis within five years was identified for matched groups and compared utilizing χ 2 analyses using an alpha value of 0.05 for statistical significance. Odds ratios were calculated, and a Kaplan-Meier analysis was performed. Effect size was calculated using Cramér V.
Results:
When comparing patients with facet cysts who underwent decompression with and without concomitant spondylolisthesis, those with spondylolisthesis tended to be female, non-smokers, and older. Categorical Elixhauser Comorbidity Indices (ECI) differed between groups, with a higher proportion of severe ECI scores in those with spondylolisthesis, although the average ECI difference was insignificant. After matching for suspected confounders, the 5-year reoperation rate was 4.2% with and 2.5% without spondylolisthesis. Kaplan-Meier analysis showed a significantly greater incidence of subsequent arthrodesis for those with spondylolisthesis, progressively divergent from those without after two years following index decompression.
Conclusion:
Decompression alone for symptomatic facet cysts has nearly twice the odds of subsequent posterior arthrodesis in the setting of spondylolisthesis compared to without spondylolisthesis, although the overall incidence and effect size were low. Divergence occurred around two years postoperatively and increased as time elapsed from index surgery.