ArticleSurgical neurology international2025
Intraoperative navigation-based lumbar facet assessment for considering fusion in unilateral biportal endoscopic cyst excision.
Article in Surgical neurology international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Overly extensive removal of the facet joint during lumbar facet synovial cyst (SC) excision may lead to iatrogenic instability. The objective of this study was to evaluate whether intraoperative navigation could better guide decisions regarding the need for simultaneous fusion. Methods: This prospective, single-surgeon study included eight patients with magnetic resonance imaging-confirmed lumbar SCs refractory to ≥6 weeks of conservative management. All underwent navigation-assisted unilateral biportal endoscopic decompression. Patients with preoperative dynamic X-ray evidence of instability were excluded. Intraoperative navigation quantified facet joint resection; those with ≤50% resection (Group A, Results: The mean age was 48.6 years, and most procedures were performed at L4-L5. Postoperative VAS and ODI scores documented improvement in all cases at 12 months. In Group B, 100% achieved radiographic fusion, while none of the Group A patients developed postoperative instability. Conclusion: Intraoperative navigation allowed objective quantification of facet resection, guiding the selective use of fusion. Patients with >50% resection achieved solid fusion, while those with ≤50% remained stable without fusion. This navigation-guided, data-driven strategy personalizes surgical management, reduces overtreatment, and enhances biomechanical safety.
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