Objective: Lumbar facet cysts are a common cause of radiculopathy. Percutaneous facet cyst rupture (PFCR) offers a minimally invasive alternative to surgical decompression The aim of this study was to evaluate the effectiveness of PFCR based on facet orientation, focusing on pain relief and recurrence. Methods: A retrospective analysis was conducted of 55 patients (2014–2024) with acute radiculopathy from unilateral lumbar facet cysts. Patients were grouped by facet orientation (favorable vs. unfavorable). Outcomes included visual analogue scale score reduction, recurrence, and need for surgery. Results: Forty-nine of the 55 patients (90.9%) experienced immediate relief. Long-term pain relief was significantly better in patients with favorable orientation (23 of 24). Patients with unfavorable orientation had higher recurrence and surgical conversion. The complication rate was 0%. Conclusion PFCR is highly effective and safe, especially for patients with favorable facet orientation. It should be considered a first-line treatment, particularly for high-risk or older patients.