title: Transpedicular endoscopic surgery for lumbar spinal synovial cyst-report of two cases.
abstract: BACKGROUND
  Lumbar facet cysts are a benign, degenerative, and fairly uncommon cause for lumbar radiculopathy. The standard surgical treatment for lumbar facet cysts often requires a laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for transpedicular endoscopic access to the pathology that obviates the need to violate the lamina or facet.
  
  
  METHODS
  Two patient cases are described where the lumbar 4-5 facet cysts arise medial to the pedicle. Percutaneous access to the cysts was established by drilling through the adjacent pedicle creating a 7-mm corridor to establish access for the endoscopic tubular retractor and the working channel endoscope. Straight and bendable forceps were used to remove the cysts under direct visualization.
  
  
  RESULTS
  Following surgery, the patients' symptoms showed immediate regression with complete relief of one patient's foot drop by 6 months.
  
  
  CONCLUSIONS
  Transpedicular endoscopic access is described as novel minimally invasive surgical option in the awake patient for lumbar facet cysts adjacent to the Lumbar 4 or 5 pedicle.
authors.affiliation: SRH Hospital Waltershausen-Friedrichroda, Friedrichroda, Germany.
authors.forename: Guntram
authors.initials: G
authors.lastname: Krzok
authors.affiliation: Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Albert E
authors.initials: AE
authors.lastname: Telfeian
authors.affiliation: Ligamenta Spine Centre, Frankfurt am Main, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Wagner
authors.affiliation: Spine Clinic Iprenburg, Veenhuizen, The Netherlands.
authors.forename: Menno
authors.initials: M
authors.lastname: Iprenburg
keywords: Transpedicular; endoscopic spine surgery; lumbar synovial cysts; minimally-invasive