Abstract

Extradural expensive lesions in the spinal channel can lead to a compression of the nerve root, the myelon or the cauda equina with related symptoms. Most common are disc herniations or bony/ligamentous constrictions. Very rare the symptoms are caused by clinical relevant cysts from the intervertebral joint. The terminus Juxta-facet cysts have been founded by Kao et al. 1974. This includes the different forms of cysts by the intervertebral joints. We are finding synovial cysts by degenerative articular joints or ganglions by mucoid degeneration of the periarticular tissue. Meanwhile synovial cysts are connected to the joint and have a good response of conservative treatment; the ganglions are without any connection to the articular space and have a bad tendency for regression. Especially here is the surgical decompression necessary. Mostly for the surgical treatment the open microsurgical removal of the cyst and a part of the intervertebral joint is the standard procedure. Her we are experiencing the same problems as by microsurgical spine procedures. Especially the potentially induced instability by a partly resection of the intervertebral joint leads to a recommendation of a concomitant fusion. The endoscopic interlaminar access allows a minimalisation of the approach related damages. Beside the disc surgery the endoscopic decompression of facet cysts has shown a good alternative for surgical treatment of these pathology. Methods: The surgical technique is an endoscopic approach to the interlaminar foramen with a 7mm tube. The flavum and the lamina is partly removed over the cyst in a limited area. After release of adhesions between the cyst and the neurological structures the cysts is solely removed by preserving the facet joint. The Patients had been evaluated preoperatively and 6 weeks postoperatively. Results: Until now we treated 3 patients with this technique. The neurological radicular symptoms recovered in all in all cases. One patient remained local back pain by facet arthrosis and treated further by rhizotomy. No complications had been experienced. The recovery time was by approximately 2 days. Conclusion: The endoscopic technique gives us a new option for the minimal aggressive removal of clinical relevant cysts by the intervertebral joints. The results are comparable to an open procedure. Cause of the limited account of cases is a statistical evaluation of the outcome difficult. The decision of the intervention is by unsuccessful conservative treatment or by verification of a ganglion. For the patient this technique is less harming and gives a fast recovery.