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Risk of Subsequent Fusion After Isolated Decompression of Lumbar Facet Cysts.

Authors :: Federico VP
Forlenza EM
Acuna AJ
Vucicevic RS
Conaway WK
Nie JW
Butler AJ
Gabriel S
Lopez GD
An HS
Colman MW
Phillips FM
Source :: The Journal of the American Academy of Orthopaedic Surgeons [J Am Acad Orthop Surg] 2024 Apr 15; Vol. 32 (8), pp. 339-345. Date of Electronic Publication: 2024 Feb 01.
Publication Year :: 2024
Abstract: Introduction: Lumbar facet cysts represent a potential source of nerve root compression in elderly patients. Isolated decompression without fusion has proven to be a reasonable treatment option in properly indicated patients. However, the risk of lumbar fusion after isolated decompression and facet cyst excision has yet to be elucidated.<br />Methods: The PearlDiver database was reviewed for patients undergoing isolated laminectomy for lumbar facet cyst from January 2015 to December 2018 using Current Procedural Terminology coding. Patients undergoing concomitant fusion or additional decompression, as well as those diagnosed with preexisting spondylolisthesis or without a minimum of 5-year follow-up, were excluded. Rates of subsequent lumbar fusion and potential risk factors for subsequent fusion were identified. Statistical analysis included descriptive statistics, chi square test, and multivariate logistic regression. Results were considered significant at P < 0.05.<br />Results: In total, 10,707 patients were ultimately included for analysis. At 5-year follow-up, 727 (6.79%) of patients underwent subsequent lumbar fusion after initial isolated decompression. Of these, 301 (2.81% of total patients, 41.4% of fusion patients) underwent fusion within the first year after decompression. Multivariate analysis identified chronic kidney disease, hypertension, and osteoarthritis as risk factors for requiring subsequent lumbar fusion at 5 years following the index decompression procedure ( P < 0.033; all).<br />Conclusion: Patients undergoing isolated decompression for lumbar facet cysts undergo subsequent lumbar fusion at a 5-year rate of 6.79%. Risk factors for subsequent decompression include chronic kidney disease, hypertension, and osteoarthritis. This study will assist spine surgeons in appropriately counseling patients on expected postoperative course and potential risks of isolated decompression.<br /> (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)