Awake transforaminal endoscopic lumbar facet cyst resection: technical note and case series

Matthew J. Hagan, Albert E. Telfeian, Rahul Sastry, Rohaid Ali, Kai Uwe Lewandrowski, Sanjay Konakondla, Sean Barber, Kendall Lane, Ziya L. Gokaslan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


OBJECTIVE The aim of this study was to describe a minimally invasive transforaminal surgical technique for treating awake patients presenting with lumbar radiculopathy and compressive facet cysts. METHODS Awake transforaminal endoscopic decompression surgery was performed in 645 patients over a 6-year period from 2014 to 2020. Transforaminal endoscopic decompression surgery utilizing a high-speed endoscopic drill was performed in 25 patients who had lumbar facet cysts. All surgeries were performed as outpatient procedures in awake patients. Nine of the 25 patients had previously undergone laminectomies at the treated level. A retrospective chart review of patient-reported outcome measures is presented. RESULTS At the 2-year follow-up, the mean (± standard deviation) preoperative visual analog scale leg score and Oswestry Disability Index improved from 7.6 ± 1.3 to 2.3 ± 1.4 and 39.7% ± 8.1% to 13.0% ± 7.4%, respectively. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period. CONCLUSIONS A minimally invasive awake procedure is presented for the treatment of lumbar facet cysts in patients with lumbar radiculopathy. Approximately one-third of the treated patients (9 of 25) had postlaminectomy facet cysts.

Original languageEnglish (US)
Pages (from-to)843-850
Number of pages8
JournalJournal of Neurosurgery: Spine
Issue number6
StatePublished - Dec 2022


  • endoscopic foraminotomy
  • facet cyst
  • lumbar
  • radiculopathy
  • surgical technique
  • transforaminal

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology


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