Efficacy of Intraoperative Facet Arthrography Using Indigo Carmine in Full-Endoscopic Spine Surgery for Juxtafacet Joint Cyst:A Case Report

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Purpose:Juxtafacet joint cysts (JFJCs) are degenerative lesions of the lumbar spine that may cause neurological symptoms due to central canal or foraminal stenosis. This report aims to demonstrate the efficacy of transforaminal full-endoscopic cystectomy under local anesthesia utilizing indigo carmine–enhanced facet joint arthrography for a primary JFJC. Basic procedures:A 74-year-old male professional golfer presented with a 2-year history of right medial thigh pain refractory to conservative treatment. Magnetic resonance imaging (MRI) showed central canal and lateral recess stenosis with a JFJC at the L2/3 level on the right. We performed full-endoscopic ventral facetectomy and cystectomy under local anesthesia, and intraoperative facet joint arthrography with indigo carmine before decompression. Main findings:The blue staining clearly delineated the facet joint cartilage and cyst wall, facilitating safe and precise resection under endoscopic guidance. Postoperative MRI confirmed decompression of the L3 nerve root, with the dural sac cross-sectional area increasing from 47 mm² to 122 mm². The patient experienced immediate pain relief, restoration of right L3 nerve function, and early return to full sporting activity within two months. No recurrence was observed at the six-month follow-up. Principal conclusions:Indigo carmine–enhanced facet joint arthrography can substantially improve intraoperative orientation during full-endoscopic surgery for primary JFJC. J. Med. Invest. 73 : 533-536, August, 2026