Facet Effusion without Radiographic Instability Has No Effect on the Outcome of Minimally Invasive Decompression Surgery

Abstract

Study design: Retrospective cohort study.

Objective: Lumbar segmental instability is a key factor determining whether decompression alone or decompression and fusion surgery is required to treat lumbar spinal stenosis (LSS). Some recent reports have suggested that facet joint effusion is correlated with spinal segmental instability. The aim of this study is to report the effect of facet effusion without radiographic segmental instability on the outcome of less-invasive decompression surgery for LSS.

Methods: Seventy-nine patients with LSS (32 women, mean age: 69.1 ± 9.1 years) who had no segmental instability on dynamic radiographs before undergoing L4-L5 microsurgical decompression and who were followed for at least 2 years postoperatively were analyzed. They were divided into three groups on the basis of the existence and size of L4-L5 facet effusion using preoperative magnetic resonance imaging: grade 0 had no effusion (n = 31), grade 1 had measurable effusion (n = 35), and grade 2 had large effusion (n = 13). Japanese Orthopedics Association (JOA) score, visual analog scale (VAS), and the Short-Form (SF)-36 scores were recorded preoperatively and 12 and 24 months postoperatively.

Results: JOA score; VAS of low back pain, leg pain, and numbness; and SF-36 (physical component summary and mental component summary) scores did not differ significantly between the three groups in every terms (p = 0.921, 0.996, 0.950, 0.693, 0.374, 0.304, and 0.624, respectively, at final follow-up).

Conclusion: In the absence of radiographic instability, facet joint effusion has no effect on the outcome of less-invasive decompression surgery.

Keywords: decompression surgery; facet effusion; lumbar spinal stenosis; outcome; segmental instability.

Fig. 1

Diagram of patients with lumbar spinal stenosis treated by surgery from 2008 to 2010.

Fig. 2

Representative magnetic resonance images of facet joints showing effusions. (A) Grade 0 had no effusion. (B) Grade 1 had measurable effusion (<1.5 mm). (C) Grade 2 had large effusion (≥1.5 mm).