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Lumbar juxta facet cysts (JFC) are an uncommon cause of radiculopathy. Spontaneous regression of symptomatic JFC has not often been reported. We describe 2 patients, a 59-year-old man and a 55-year-old man, with radiculopathy of the 5th lumbar nerve root due to a JFC at L4-5. The first patient recovered spontaneously. After 8 months, the JFC had clearly reduced on MRI. In the second patient the JFC was surgically resected due to progressive pain, after which the patient remained without symptoms. In the literature it is suggested that surgical removal of the JFC should be the treatment of choice. However, of the 5 patients who were diagnosed with a JFC in our department, 3 recovered spontaneously and 2 after surgery. In our opinion further studies on the course and management of symptomatic lumbar JFC are warranted.

An operation for a herniated disc is successful in the majority of cases. In most patients the pain in the affected leg disappears almost immediately. However in 10-40% of cases the symptoms either do not disappear or recur. In spite of this high complication rate, it is reported that almost 90% of patients are satisfied with the operation. This should be interpreted as a compliment to the attending physician and not as the outcome of the operation. The high rate of symptoms or recurrences after operation calls for better prognostic studies. Based on better predictions, patients and their doctors may make better decisions on treatment.

Objective: To determine the mid-long-term outcomes after surgery in patients with lumbosacral radicular syndrome (LRS) and to identify prognostic factors for persisting LRS symptoms., Design: Descriptive retrospective and prospective., Method: A total of 250 consecutive patients operated on by 7 neurosurgeons in four hospitals between May and December 2001 were selected from medical records. They were asked to take part in a telephone questionnaire at 6 and 19 months after operation. They had all undergone discectomy for LRS at L4-L5 or L5-S1 and were aged from 18 to 65., Results: Of the 250 patients, 163 participated in the study: 63% reported that they still had LRS-related symptoms 19 months after surgery. However, severe leg pain had decreased in 83% of the patients. In general the patients were satisfied with their treatment. Female gender and an age of 51-65 were prognostic factors for persistent LRS symptoms., Conclusion: More than half of the patients reported LRS symptoms 19 months after surgery.

In the period 1985-1986 twenty-four patients with a recurrent lumbar disk herniation were subjected to surgery in the department of Neurosurgery in the Academic Medical Hospital of Utrecht. In 25% of these patients the second lumbar disk herniation was at the same level and side as the first one. Recurrence of the disk rupture at the same side and level as the first one occurred most often within two years after initial surgery. A recurrent slipped disk at different lumbar level occurred after a time interval of two years or more. Correct diagnosis depends on the results of imaging techniques. All reoperated patients did well after surgery and could return to their work or normal daily obligations.