Outcomes After Decompression Only Versus Decompression and Fusion for Lumbar Facet Cysts: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: Lumbar facet cysts (LFCs) are considered the result of facet degeneration and segmental instability. Their surgical management has been controversial. Decompression only (DO) is less invasive, but it does not address the underlying degeneration/spondylolisthesis. Decompression and fusion (DF) is more invasive with higher perioperative morbidity. Comparative studies are scant in current literature. The objective of this study was to identify all such studies and synthesize outcomes including recurrence and reoperation rates. Secondary outcomes included back pain resolution, radiculopathy resolution, and length of stay. METHODS: In this PROSPERO-registered Preferred Reporting Items for Systematic Reviews and Meta-Analyses–compliant systematic review, the MEDLINE, Embase, and Cochrane databases were searched to identify comparative studies of DO vs DF patients with LFCs. A meta-analysis with random effects model was performed, and heterogeneity was assessed with the I 2 statistic. Visual representation of results was performed with forest plots. RESULTS: Nine comparative studies encompassing 3393 patients (DO: 1940, DF: 1453) were included. Spondylolisthesis rates were statistically significantly lower in the DO group (DO 24.3%; DF 65.8%; OR 0.04; CI 0.01-0.31; P < .01). The DO group had statistically significantly higher odds of cyst recurrence (DO 6.3%; DF 0%; OR 5.74; CI 1.51-21.72; P = .01) and lower odds of back pain resolution at follow-up (DO 56.6%; DF 74.5%; OR 0.43; CI 0.2-0.91; P = .03) compared with the DF group. Reoperation rates (DO 7.2%; DF 5.9%; OR 1.37; CI 0.72-2.6; P = .3) and odds for resolution of radiculopathy (DO 77.3%; DF 87.2%; OR 0.6; CI 0.3-1.21; P = .2) were comparable between the 2 groups. Length of stay was statistically significantly shorter in the DO group (mean difference −1.5; CI −2.38 to −0.63; P < .001). CONCLUSION: Decompression with concomitant fusion was associated with lower odds of cyst recurrence and higher odds of back pain resolution but slightly longer hospital stay. Reoperation rates and radiculopathy resolution were comparable between the two groups.