J Minim Invasive Spine Surg Tech.  2022 Apr;7(1):157-163. 10.21182/jmisst.2022.00010.

A Novel Technique of the Full Endoscopic Interlaminar Contralateral Approach for Symptomatic Extraforaminal Juxtafacet Cysts

• Kim HS
• Kim JY
• Lee DC
• Lee JH
• Jang IT

• KMID: 2562130
• DOI: http://doi.org/10.21182/jmisst.2022.00010

Abstract

Objective
Extraforaminal juxtafacet cyst is rare and present a surgical challenge due to its anatomical location. This study aimed to introduce the surgical technique of interlaminar contralateral endoscopic lumbar foraminotomy (ICELF) for extraforaminal juxtafacet cyst removal and reveal its approach-related benefits. Method: The endoscope was docked on the ipsilateral spinolaminar junction and access the contralateral foraminal area through the contralateral sublaminar space created by the fine drilling. As the foraminal was enlarged by foraminal ligament removal and the superior articular process drilling, the endoscope was introduced deeper to the extraforaminal area without violation of the foraminal disc. Combined foraminal stenosis was also resolved while exploring the foraminal space. Subsequently, the extraforaminal cyst was safely and entirely removed while exposing the cyst-nerve root adhesion site with an endoscopic view looking up obliquely.
Results
Radiating pain in the right leg, back pain, leg hypesthesia, and ankle weakness improved.
Conclusion
ICELF for the treatment of extraforaminal JFC can be an alternative surgical method to resolve symptomatic foraminal stenosis and the cyst simultaneously. The endoscopic system moves parallel to the exiting nerve root during ICELF, facilitating clear visualization of the cranial-dorsally or cranial-ventrally located extraforaminal JFCs. The entire cyst contour and the site of cyst-nerve root adhesion can be detected without nerve root retraction, and meticulous dissection is possible without violating the cystic wall.

Keyword

Endoscopy; Synovial cyst; Lumbar; Contralateral; Extraforaminal