Article Figures & Data
Figures
- Figure 1
Flow diagram summarizing the process of study selection.
- Figure 2
Forest plot for open surgery overall outcomes. ES, effect size.
- Figure 3
Forest plot for minimally invasive overall outcomes. ES, effect size.
- Figure 4
Forest plot for full endoscopy overall outcomes. ES, effect size.
- Figure 5
Forest plot for percutaneous fluoroscopic- or CT-guided overall outcomes. ES, effect size.
Tables
Authors Year Journal Design Recruitment Interval N Inclusion /Exclusion Criteria Outcome Measurement Cohort Characteristics Hellinger S et al22 2020 Journal of Spine Surgery P 2008–2014 48 Radiculopathy unresponsive to >12 wk of conservative care
MRI scans showing foraminal or lateral recess stenosis
VAS scores,MacNab scores Full endoscopy: transforaminal or interlaminar (local anesthesia and monitored sedation) Tacconi L et al13 2020 World Neurosurgery P 2017–2019 35 A single-level unilateral lumbar JFC
Cysts localized in the paramedian, paraforaminal, or intraforaminal location
Invalidating radicular pain for >6 wk
Adequate imaging (MRI)
Failed percutaneous or conservative treatment
NPRS scores, MacNab scores Full endoscopy: transforaminal or interlaminar (local anesthesia and monitored sedation) Kyung-Hoon K et al14 2019 Pain Physician R 40 Lumbar JFC resistant to conservative treatment Full endoscopy: transforaminal (local anesthesia and monitored sedation) Hahn P et al23 2018 Orthopedic Proceedings P 60 Single-level lumbar JFCs Microsurgical vs full-endoscopic approach Heo DH et al24 2018 World Neurosurgery R 2016 10 Radicular leg pain refractory to conservative management methods
No concomitant segment instability or suspected infectious disease
ODI scores, VAS scores Endoscopy, contralateral biportal approach a (epidural/general anesthesia) Siu CK et al25 2018 Journal of Clinical Neuroscience R 2000–2015 46 Patients with lumbar JFCs
Grade I listhesis
SF-12 values 46 HL Oertel J M et al26 2017 World Neurosurgery P 2014–2016 11 Detailed neurologic examinations focused on leg and back pain
Histopathologic report of the specimen
No previous lumbar spine surgery
A preoperative MRI scan
NPRS scores, MacNab scores Full endoscopy, interlaminar (general anesthesia) Bruder M et al27 2017 Journal of Neurosurgery: Spine R 1997–2004 140 Patients with lumbar JFCs
Not specified exclusion criteria
NPRS scores, MacNab scores 38 L, 102 HL Denis DR et al2 2016 International Journal of Spine Surgery R 2003–2014 53 Lumbar JFCs with or without concomitant grade 1 degenerative spondylolisthesis
Patients without instability on standing flexion-extension radiographs
>6 wk of conservative management
MacNab scores Mini-invasive surgery: ipsilateral approach Birch BD et al28 2016 World Neurosurgery R 1999–2015 40 Symptomatic JFCs MacNab scores Mini-invasive surgery: ipsilateral approach Eshraghi Y et al7 2016 Pain Physician R 2006–2013 30 Patients with moderate to severe lumbar radiculopathy NPRS scores Fluoroscopic-guided rupture (local anesthesia) Zhenbo Z et al29 2016 European Spine Journal R 2000–2012 24 Lumbago and refractory radiculopathy originated from JFCs
Confirmed by CT or MRI
No lumbar canal stenosis, disc herniation, tumor, or infection
JOA scores, VAS scores 24 hemilaminoplasty Alimi M et al30 2015 Journal of Neurosurgery: Spine R 2004–2011 110 No preoperative spondylolisthesis and mechanical back pain
No instability on flexion/extension films
ODI scores, VAS scores, MacNab scores Mini-invasive surgery: ipsilateral approach Sukkarieh HG et al31 2015 Journal of Neurosurgery: Spine R 2010–2014 13 Patients without a previous history of spinal surgery VAS scores, MacNab scores Mini-invasive surgery: contralateral approach Knafo S et al32 2015 Journal of Spinal Disorder & Techniques R 2004–2010 23 Patients with lumbar JFCs
Not specified exclusion criteria
MacNab scores 8 HL; 2 L + F, 2 L, 8 IL;3 METRX Komp M et al33 2014 Surgical Innovation P 2009–2010 74 No back pain
No spondylolisthesis more than Meyerding grade I;
No spinal stenosis or disc herniations at higher levels on the same side
VAS scores, German version of the North American Spine Society scale, Oswestry low back pain scale Full endoscopy: transforaminal/interlaminar(general anesthesia) Ortiz O et al34 2013 Journal of NeuroInterventional Surgery R 20 Unilateral lower-extremity radiculopathy with or without lower back pain
Not responders to conservative management
NPRS scores Tandem or coaxial percutaneous CT-guided (local and intravenous anesthesia) Cambron SC et al11 2013 American Journal of Neuroradiology R 2004–2011 154 Lower-extremity radiculopathy corresponding to the JFCs
MR imaging <2 mo before initial percutaneous rupture
CT-guided cyst aspiration and rupture (local anesthesia and intravenous sedation) Ganau M et al3 2013 Neurologia Medica-Chirurgica R 2000–2009 15 No specified exclusion criteria MacNab scores 12 HL; 5 L Ha SW et al35 2012 Journal of Korean Neurosurgical Society R 2007–2010 8 Unilateral radicular leg pain
No history of previous lumbar surgery
Failure of appropriate conservative treatment
Neither instability nor spondylolisthesis
VAS scores Full endoscopy: transforaminal(epidural anesthesia) James A et al36 2012 Journal of Spinal Disorders & Techiques R 2006–2009 16 Conservative treatment attempted for at least 3 mo VAS scores, MacNab scores Mini-invasive: contralateral approach Amoretti N et al11 2012 European Radiology R 2006–2010 120 JFCs on MRI (fluid, hemorrhagic, or calcification sign)
Imaging findings consistent with the clinical symptoms
VAS with a score >6/10
VAS scores, ODI scores CT-guided cyst aspiration and rupture (local anesthesia and intravenous sedation) Landi A et al37 2012 Neurosurgical Review R 1995–2007 15 No preexistence of spinal instability in preoperative assessment Reported percent of patients with complete vs partial satisfaction 6 L; 9 HL Schulz M et al16 2011 Ortophade P 45 Sciatica or claudication caused by lumbar JFCs Microsurgically vs percutaneous cyst rupture El Shazly A et al38 2011 Asian Journal of Neurosurgery R 2003–2008 13 Patients without previous spinal fusion MacNab scores 13 L Matsumoto M et al39 2010 Minimally Invasive Neurosurgery P 7 Ineffective conservative treatment JOA scores Microendoscopic Xu R et al40 2010 Spine R 1990–2009 174 Patients with lumbar JFCs
No specified exclusion criteria
54 HL; 40 L; 21 FC in situ F; 60 FC and instrumented F Allen TL et al10 2009 The Spine Journal R 2004–2007 40 No calcified JFCs
No previous cyst aspiration procedure
No multifactorial low back pain or symptoms associated with other underlying lumbar pathologies
NRS-11 scores, RMDQ scores, satisfaction questionnaire Fluoroscopic-guided cyst rupture Martha JF et al9 2009 The Spine Journal R 1999–2005 101 Patients with lumbar JFCs
No specified exclusion criteria
NPRS scores, ODI scores Fluoroscopic-guided rupture(local anesthesia) Terao T et al41 2007 Neurologia Medica-Chirurgica R 1998–2006 10 Patients with lumbar JFCs
No specified exclusion criteria
Scores: excellent/good/ poor 10 L Weiner BK et al42 2007 Journal of Orthopaedic Surgery and Research R 1984–2001 46 patients with lumbar JFCs
no specified exclusion criteria
VAS scores, satisfaction questionnaire 46 HL Sehati N et al43 2006 Neurosurgical Focus R 2003–2005 19 >6 wk of nonoperative management
No previous surgery at the JFCs level or at adjacent spinal segments
MacNab scores Mini-invasive surgery: ipsilateral approach Acharya R et al1 2006 Neurology India R 1993–1982 26 Patients with lumbar JFCs
No specified exclusion criteria
Reported percent of satisfactory relief 15 L, 9 HL Metellus P et al44 2006 Acta Neurochirrgica R 1992–1998 77 Patients with lumbar JFCs
No specified exclusion criteria
Scores: excellent/good/ poor 51 HL + PF + MF; 26 L + F + MF Deinsberger R et al15 2006 Journal of Spinal Disorder & Techniques R 2002–2004 30 Patients with lumbar JFCs
No specified exclusion criteria
MacNab scores 26M MF; 4 L+MF Sandhu FA et al45 2004 Neurosurgery R 1999–2003 25 Detailed neurological examinations
Dynamic radiological studies of the lumbosacral spine
Preoperative MRI imaging
MacNab scores Mini-invasive surgery: ispilateral approach Epstein NE et al46 2004 Spine R 80 Patients with lumbar JFCs
No specified exclusion criteria
Short Form (36) Health Survey values, MacNab scores 80 L Pirotte B et al47 2003 Journal of Neurosurgery: Spine R 1990–2001 46 Patients with lumbar JFCs
No specified exclusion criteria
Reported patients with satisfactory relief 12 IL, 24 HL 10 L Bureau NJ et al12 2001 Radiology R 1995–2000 12 Patients with lumbar JFCs
No specified exclusion criteria
MacNab scores Fluoroscopic- and CT-guided cyst rupture Salmon B et al48 2001 Acta Neurochirgica R 1989–1997 28 Patients with lumbar JFCs
No specified exclusion criteria
Reported percent of satisfactory relief 28 L Banning C S et al46 2001 Spine R 1993–1998 29 Patients with lumbar JFCs
No specified exclusion criteria
Measurement: completely improved/better—still some problems/no change/worse 29 L or HL Trummer M et al49 2001 Journal of Neurology, Neurosurgery, and Psychiatry R 1994–1998 19 Intractable radicular pain or neurological deficits caused JFCs MacNab scores 6 HL; 5 L; 8 IL Lyons MK et al50 2000 Journal of Neurosurgery: Spine R 1974–1996 194 Patients with lumbar JFCs
No specified exclusion criteria
Reported patients with excellent or good scores 159 MF, 23 TF, 12 unknown aPercutaneous biportal full-endoscopic procedure under continuous irrigation.
CT, computerized tomography; F, fusion; FC, facetectomy; HL, hemilaminectomy; IL, interlaminar approach; JFC, juxtafacet cyst; JOA, Japanese Orthopaedic Association; L, laminectomy; M, medial; METRX, Micro Endoscopic Spine Surgery Retractor; MF, medial facetectomy; MRI, magnetic resonance imaging; NPRS, numeric pain rating score; NRS-11, 11-point numeric rating scale; ODI, Oswestry disability index; P, prospective; PF, posterior fixation; R, retrospective; RMDQ, Roland Morris Disability Questionnaire; SF-12, 12-Item Short Form; TF, total facetectomy; VAS, visual analog scale.
Authors Design Representatives of Exposed Cohort Selection of Nonexposed Cohort Ascertainment of Exposure Assesment of Outcome Length Follow-Up Hellinger S et al22 ● ● ● ●● ●● ● Tacconi L et al13 ● ● ● ●● ●● Kyung-Hoon K et al14 ● ● Hahn P et al23* ● ●● ● Heo DH et al24 ● ● ●● ● Siu CK et al25 ●● ● ●● ● ● Oertel JM et al26 ● ● ● ●● ●● Bruder M et al27 ●● ● ●● ● ● Denis DR et al2 ●● ● ●● ● Birch BD et al28 ● ● ● ● Eshraghi Y et al7 ● ● ● ● Zhenbo Z et al29 ● ● ●● ●● ● Alimi M et al30 ●● ● ●● ●●● ● Sukkarieh HG et al31 ● ● ●● ●● Knafo S et al32 ● ● ● Komp M et al33 ● ●● ● ●● ●●● Ortiz O et al51 ● ● ● Cambron SC et al11 ●● ●● ● Ganau M et al3 ● ● ● ● Ha SW et al35 ● ● ●● ● James A et al36 ● ● ●● Amoretti N et al11 ●● ● ●● ●● Landi A et al37 ● ● ●● ● Schulz M et al16 ● ● ● ● El Shazly A et al38 ● ● ● ● Matsumoto M et al39 ● ● ● ● ● Xu R et al40 ●● ●● Allen TL et al10 ● ● ●● ●●● Martha JF et al9 ● ● ●● ● Terao T et al41 ● ● ● ● Weiner BK et al39 ● ● ●● Sehati N et al43 ● ●● ● Acharya R et al1 ● ● ● Metellus P et al44 ●● ● ● ● Deinsberger R et al15 ● ● ● ● Sandhu FA et al45 ● ●● ● Epstein NE et al46 ●● ● ●● Pirotte B et al47 ● ● ● ● Bureau NJ et al12 ● ● ● Salmon B et al48 ● ● ● ● Banning CS et al46 ● ● ● ● Trummer M et al49 ● ● ● ● Lyons MK et al50 ●● ● ● ● Design: One dot for prospective or randomized controlled trials. Representatives of exposed cohort: One dot for study reporting detailed inclusion criteria, two dots for studies reporting detailed inclusion and exclusion criteria. Selection of non-exposed cohort: One dot for each study reporting a control group. Ascertainment of exposure: One dot for the authors confirming the intraoperative presence of a JFC, two dots if the histological confirmation was reported and an accurate JFC description provided. Assesment of outcome: One dot for each different clinical score utilized by authors for measuring postoperative outcomes. Length of follow-up: One dot if the follow-up was more than 24 months.
Variable Open Surgery Minimally Invasive Full Endoscopic Percutaneous CystRupture and Aspiration P Value < 0.05 N 1112 279 263 497 Age, y, mean (range) 63 (54.4–73) 65.3 (62–72.4) 49.2 (23.1–68.6) 63.2 (58.7–68.2) Sex, male 51.9% 55.6% 52.9% 57.8% Follow-up, mo, mean (range) 39.5 (8.3–116.4) 24.0 (11.5–79) 27.5 (18–55.5) 24.2 (11–44.5) Preoperative degenerative listhesis, % 33.6% 21.1% 8.3% 3.9% a,b,c,d,e,f Satisfactory outcome, % MacNab excellent—good scores (95% CI) 93.0% (88.3%–96.7%) 82.7% (61.2%–97.5%) 90.9% (83.8%–96.4%) 66.2% (52.9%–78.4%) c,e,f Recurrence, % (95% CI) 1.4% (0.3%–3.2%) 2.3% (0.3%–5.5%) 3.0% (0.0%–9.9%) 34.3% (20.3%–49.6%) c,e,f Revisions, % (95% CI) 3.0% ( 1.3%–5.3%) 3.6% (1.0%–2.3%) 2.2% (0.0%–8.3%) 29.8% (18.9%–42%) c,e,f Developing postoperative instability, % (95% CI) 3.5% ( 0.6%–8.0%) 3.2% (0.2%–8.4%) 0% / Intraoperative/procedural adverse events, % (95% CI) 1.1% ( 0.1%–3.0%) 8.4% (2.7%–16.3%) 1.8% (0.0%–5.3%) 0.1% (0.0%–1.2%) a,d,c,e,f Significant differences between: a = open vs minimally invasive; b = open vs full endoscopic; c = full-endoscopic vs percutaneous cyst aspiration and rupture; d = minimally invasive vs full endoscopic; e = minimally invasive vs percutaneous cyst aspiration and rupture; f = full-endoscopic vs percutaneous cyst aspiration and rupture; / : not reported.
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