Treatment of Facet Cysts Associated With Neurogenic Intermittent Claudication With X-Stop

Background: Facet degeneration often leads to the formation of synovial facet cysts. As facet cysts invade the spinal canal, they become a contributing factor to spinal stenosis. Previous studies have demonstrated successful treatment of neurogenic intermittent claudication (NIC), a major symptom of spinal stenosis, with an interspinous process device. Purpose: To compare clinical outcomes of patients with and without synovial facet cysts treated with an interspinous process device. Study Design: Retrospective review of prospective data of consecutive patients undergoing the X-Stop procedure at an institution. Outcome Measures: Visual Analog Scale; Oswestry Disability Index; sitting, standing, and walking tolerances; and satisfaction survey. Methods: Review of all patients from 2006 to 2010 undergoing X-Stop procedure at an institution. Imaging studies were used to identify the presence and measure the size of the facet cysts in 285 patients with a minimum of 6-month follow-up. Comparative clinical outcomes determined if X-Stop is a successful treatment option for patients with NIC in conjunction with synovial facet cysts (< 3 mm, >= 3 mm). Results: Fifty-eight of 285 patients (20.4%) were determined to have a synovial cyst as a contributing component of spinal stenosis. Twelve of 58 patients were noted to have a cyst >= 3mm. The mean follow-up time for patients with and without a facet cyst was 21 months (6-55 +/- 12 mo) and 22 months (6-61 +/- 12 mo), respectively. The age of the patient at the time of the operation with and without facet cysts was 73 (+/- 10 y). Patients without synovial cysts, with synovial cysts, and cysts >= 3mm had an average change in Oswestry Disability Index of 15.6, 15.8, and 16.2, respectively. Visual Analog Scale scores were 2.3, 1.8, and 2.3, respectively. In addition, on satisfaction surveys 72.4%, 82.0%, and 77.8% were either very or somewhat satisfied, respectively. Overall complications included 4 spinous process fracture, 4 hematomas, 1 wound infection, and 1 implant migration. Conclusions: No statistical difference was noted in any of the outcome measures among patients with small facet cysts, large facet cysts, or without facet cysts when treated with an interspinous process device. We can thus conclude that X-Stop is an appropriate treatment consideration for NIC with or without the presence of synovial facet cysts.