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July 6, 2026Open Access

Navigation-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) for Lumbar Facet Synovial Cysts Associated With Degenerative Spondylolisthesis: A Case Series and Surgical Technique

Key Points

This study aims to present the surgical technique and outcomes of navigation-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar facet synovial cysts associated with degenerative spondylolisthesis.
Case series of three patients with symptomatic lumbar facet synovial cysts and degenerative spondylolisthesis.
Treatment involved cyst resection, neural decompression, and percutaneous instrumentation using spinal neuronavigation.
Patients were evaluated with MRI and dynamic radiographs pre- and post-surgery.
All patients exhibited significant clinical improvement, including reduced radicular pain and enhanced functional status after surgery.
Neuronavigation enabled precise cyst resection and sufficient neural decompression while maintaining posterior bony integrity.
No major complications or early recurrences were reported during follow-up.

Abstract

Lumbar facet synovial cysts (LFSCs) are degenerative lesions associated with facet arthropathy and segmental instability, predominantly occurring at the L4-L5 level. They may cause radiculopathy and neurogenic claudication, and although conservative management may provide temporary relief, cases associated with degenerative spondylolisthesis (DS) frequently require surgical treatment. Minimally invasive spine surgery assisted by spinal navigation allows precise cyst resection and adequate stabilization. The aim of this study was to present a case series of LFSCs associated with DS treated with navigation-assisted minimally invasive transforaminal lumbar interbody fusion and to describe the surgical technique and role of spinal neuronavigation in minimally invasive decompression and instrumentation. We report a series of three patients with symptomatic LFSCs associated with DS refractory to conservative treatment. All patients were evaluated using magnetic resonance imaging and dynamic radiographs and were treated with cyst resection, neural decompression, and percutaneous instrumentation assisted by neuronavigation. All patients demonstrated significant clinical improvement following surgical treatment, with reduction of radicular pain and functional improvement during postoperative follow-up. Most cases were associated with DS and advanced facet arthropathy changes. Neuronavigation allowed precise cyst resection with adequate neural decompression and preservation of posterior bony structures, without major complications or early recurrence during follow-up. LFSCs are closely associated with lumbar degenerative instability, and navigation-assisted resection represents a safe and effective minimally invasive alternative allowing adequate decompression while preserving spinal anatomy. Modern minimally invasive techniques and interventional therapies are emerging as complementary options in selected patients.

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