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Heo J, Park HK, Baek JH, Ahn HS, Lee SC. Percutaneous Epidural Neuroplasty for Symptomatic Lumbar Juxtafacet Cysts. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1042. [PMID: 39064470 PMCID: PMC11278696 DOI: 10.3390/medicina60071042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: The term "Juxtafacet cyst" refers to both synovial cysts and ganglion pseudocysts associated with the lumbar facet joint. As conservative treatment for the juxtafacet cyst has a minimal effect, complete excision through surgery is considered the first choice of treatment. In this study, we retrospectively reviewed the clinical outcomes of percutaneous epidural neuroplasty for symptomatic lumbar juxtafacet cysts. Materials and Methods: We conducted a retrospective review of 34 patients with symptomatic juxtafacet cysts who visited a single institute from January 2010 to September 2023. Patients who received conservative treatment for at least 6 weeks but experienced no or insufficient effects were eligible for this study. After neuroplasty, a medical history check and neurological examination were performed during follow-up at 2 weeks, 1 month, 2 months, 3 months, 6 months, and once a year thereafter. Results: The pain improved for all patients to a VAS score of 3 or less immediately after neuroplasty; however, four of those patients (11%) had pain that worsened eventually to the same level as before the procedure and required surgery. The results showed that, regardless of cyst size, in cases with severe stenosis of the spinal canal, the outcome of neuroplasty was poor and often eventually required surgery. The cyst size was not associated with the procedure results. In addition, if the cyst was present at the L4-L5 level, or if diabetes mellitus was present, the likelihood of future surgery was significant (p-value = 0.003). Conclusions: Percutaneous neuroplasty showed a better success rate than other non-surgical treatments. In addition, severe spinal stenosis (Schizas grade C or higher), L4-L5 level, or diabetes mellitus produced a high possibility of surgery due to recurrence.
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Affiliation(s)
- Juneyoung Heo
- Joint & Arthritis Research, Department of Neurosurgery, Himchan Hospital, Seoul 21337, Republic of Korea;
| | - Hyung-Ki Park
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Seoul 31538, Republic of Korea;
| | - Ji-Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (H.-S.A.)
| | - Hye-Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (H.-S.A.)
| | - Su-Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (H.-S.A.)
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2
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Mercer RW, Vicentini JRT, Staffa SJ, Habib U, Cho R, Chang CY. CT-guided lumbar facet cyst rupture and corticosteroid injection: technique, approach, and procedural and clinical success rates. Skeletal Radiol 2024; 53:1135-1144. [PMID: 38097764 DOI: 10.1007/s00256-023-04544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 04/10/2024]
Abstract
PURPOSE To evaluate success rates of computed tomography (CT)-guided lumbar facet synovial cyst (LFC) rupture. MATERIALS AND METHODS We retrospectively reviewed all LFC ruptures performed by a single musculoskeletal radiologist with > 10 years of experience, using posterior facet approach and/or direct puncture by ipsilateral/contralateral interlaminar, or transforaminal approach. All patients also received a corticosteroid injection. Rupture rates were calculated, and clinical success rate was determined through medical record review. Pre-procedure magnetic resonance imaging (MRI) images and CT procedure images were also reviewed for LFC and facet joint imaging features that may predict rupture. RESULTS There were 37 patients, 17 (46%) female and 20 (54%) male, ages 62 ± 12 (range 39-87) years. Thirty-four (92%) of LFC were successfully ruptured, 17 (50%) by facet approach and 17 (50%) by direct cyst puncture. At least one direct puncture approach was possible in 35 (95%) patients. No MRI or CT LFC or facet joint features predicted cyst rupture. Thirty-one (91%) of patients reported immediate pain relief, and 19 (53%) did not have further intervention for LFC-related pain. Sixteen (84%) of these patients remained pain-free for an average follow-up time period of 28 months. Fourteen (39%) of patients required surgical intervention. There were no complications. CONCLUSION Our systematic approach to CT-guided LFC rupture is safe and has high technical and clinical success rates similar to prior studies. Since there are no definitive imaging features that determine rupture success, this procedure can almost always be attempted as a first-line treatment for LFC.
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Affiliation(s)
- Ronald W Mercer
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joao R T Vicentini
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Ukasha Habib
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Rosa Cho
- Department of Physical Medicine and Rehabilition, Division of Spine Care and Pain Management, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA, 02129, USA
| | - Connie Y Chang
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
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3
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Strohm A, Braun M, Kloth C, Sollmann N, Ozpeynirci Y, Pala A, Beer M, Schmitz BL, Rosskopf J. Effectiveness and Safety of CT-Guided Facet Joint Cyst Rupture for Radicular Pain as First Choice Therapy: A Retrospective Analysis. PAIN MEDICINE 2023; 24:158-164. [PMID: 35944225 DOI: 10.1093/pm/pnac116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate effectiveness and safety of computed tomography (CT)-guided cyst rupture with intraarticular contrast-enhanced injection of steroid and local anesthetic as first choice therapy in patients with facet joint cyst-induced radicular pain. DESIGN Retrospective data set analysis. SETTING University hospital. SUBJECTS One hundred and twenty-one patients suffering from radicular pain attributable to facet joint cysts were included. METHODS The rate of patients without following surgery was assessed and defined as surrogate to measure effectiveness. Patients' characteristics, procedure-associated complications, technical aspects, and imaging findings on magnetic resonance imaging (MRI) were analyzed. A subgroup of 65 patients (54%) underwent telephone interview to assess pain relief and clinical outcome measured by Numeric Rating Scale and Oswestry Disability Index. Analyses between the groups with and without surgery were performed by Fisher exact test and two-sample unpaired t-test, respectively. RESULTS The effectiveness of CT-guided cyst rupture was found to be 66.1%. Procedure-induced pain yielded in premature abort in two cases (1.7%). The detection of epidural contrast agent was statistically significantly associated with no need for surgery (P = .010). The cyst level was associated with the status of following surgery (P = .026), that is, cysts at lower lumbar spine were easier to rupture than cysts at other locations (cervical, thoracic, or upper lumbar spine). No further significant association was found. CONCLUSIONS CT-guided cyst rupture as the first-choice therapy in patients with cyst-induced radicular pain was safe and effective. Successful cyst rupture was associated with no need for surgery. Cysts at lower lumbar spine revealed the highest success rate.
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Affiliation(s)
- Alexa Strohm
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| | - Michael Braun
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, Ludwig-Maximilian-University, Munich, Germany
| | - Andrej Pala
- Department of Neurosurgery, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Bernd L Schmitz
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
| | - Johannes Rosskopf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Section of Neuroradiology, University of Ulm, Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
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Lalanne LB, Carmona RL, Cirillo Totera JI, Lemos FA, Wilson JTM, Beaulieu Montoya AM. Surgically managed symptomatic intraspinal lumbar facet synovial cyst outcome of surgical treatment with resection and instrumented posterolateral fusion, a case series. BMC Surg 2022; 22:277. [PMID: 35841087 PMCID: PMC9287942 DOI: 10.1186/s12893-022-01712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background There is controversy regarding the treatment of symptomatic synovial cysts, specifically, the need for a concomitant fusion when surgical resection of the synovial cysts is required. We present a retrospective review of a series of patients treated for symptomatic synovial cysts of the lumbar region during the last 20 years by a single surgeon, analyzing the current available literature. Methods Retrospective review. The same surgical technique was applied to all patients. Demographic, clinical, surgical data and synovial cyst recurrence rate were recorded. Postoperative results reported by patients were documented according to the McNab score. Results Sixty nine subjects, with mean follow-up of 7.4 years. 62% (43) were female, with a mean 57.8 years at the time of surgery. In 91.3% (63), the primary management was conservative for a minimum period of 3 months. All subjects underwent surgery due to the failure of conservative treatment. The segment most operated on was L4–L5 (63.77%). 91.3% (63) of the sample reported excellent and good and 6 subjects (8.6%) fair or poor results. There was no evidence of synovial cysts recurrence at the operated level. Conclusion In symptomatic synovial cysts, it seems that conservative treatment is only effective in a limited number of patients and in the short term. Thus, the recommendation of a surgical indication should proceed as soon as the conservative management fails to result in significant symptom relief. Based on our results, we recommend, together with the resection of the cyst, the instrumentation of the segment to avoid its recurrence and the management of axial pain.
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Affiliation(s)
- Lyonel Beaulieu Lalanne
- Orthopaedic Spine Surgeon, Head of Spine Center, Clínica Universidad de los Andes, Santiago, Chile
| | | | - Juan I Cirillo Totera
- Orthopaedic Spine Surgeon, Clínica Universidad de los Andes, Santiago, Chile.,Orthopaedic Spine Surgeon, Hospital del trabajador, Santiago, Chile
| | - Facundo Alvarez Lemos
- Orthopaedic Spine Surgeon, Clínica Universidad de los Andes, Santiago, Chile. .,Las Condes, Los Trigales 7887, dep: 508, Santiago, RM, Chile.
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Bell J, Bhatia M, Hadeed MM, George J, Hill A, Novicoff WM, Nacey NC, Shimer AL. Fluoroscopically Guided Facet Cyst Rupture: Rate of Conversion to Surgery and Risk Factor Analysis. Clin Spine Surg 2021; 34:E410-E414. [PMID: 33633003 DOI: 10.1097/bsd.0000000000001146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/07/2020] [Indexed: 12/17/2022]
Abstract
STUDY DESIGN Retrospective case series at a single academic medical center. OBJECTIVE The aim was to determine if specific clinical, radiologic, and procedural factors are associated with conversion to surgery after fluoroscopically guided cyst rupture. SUMMARY OF BACKGROUND DATA Percutaneous fluoroscopic rupture of facet cysts can often be the definitive treatment; however, it is unknown before the procedure who will ultimately proceed to formal surgical decompression. Differences in clinical, radiographic, and procedural factors of facet cysts may relate to the difference in efficacy of fluoroscopically guided cyst rupture. METHODS A continuous cohort of 45 patients who underwent fluoroscopically guided cyst rupture was evaluated. The primary outcome measured rate of conversion to surgery and of those that underwent surgery, the rate of decompression and fusion compared with fusion alone was noted. Secondary outcomes included analysis of clinical, radiologic, and procedural variables to determine if there were risk factors associated with conversion to surgery. RESULTS Twenty-nine percent of patients eventually underwent a surgical procedure with an average interval to surgery of 95 days after attempted rupture. Thirty-eight percent of patients that underwent surgery had a decompression and fusion. Failure of percutaneous cyst rupture trended toward significance for a future surgical decompression (P=0.08). CONCLUSIONS Percutaneous facet cyst rupture is potentially a definitive treatment for this condition; however, it is unknown ahead of time who will proceed to definitive surgical decompression. On the basis of the data in this study, less than one-third of patients who had a fluoroscopically guided facet cyst rupture went on to surgery. There were no clinical, radiographic, or procedural details which could be used to robustly predict failure of percutaneous treatment. At this time, it is recommended to continue to attempt this nonoperative treatment intervention when there is a clinical indication after discussion of the risks and benefits with the patient.
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Affiliation(s)
| | | | | | | | - Andrew Hill
- Radiology, University of Virginia, Charlottesville, VA
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6
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Kim HJ, Lee E, Lee JW, Kang Y, Ahn JM. Efficacy of Fluoroscopy-Guided Lumbar Facet Joint Synovial Cyst Rupture with Intra-Articular Steroid Injection after Laminectomy. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:162-172. [PMID: 36237472 PMCID: PMC9432400 DOI: 10.3348/jksr.2019.0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/11/2020] [Accepted: 07/15/2020] [Indexed: 06/16/2023]
Abstract
PURPOSE We retrospectively evaluated the technical success rate and long-term efficacy of fluoroscopy-guided synovial cyst rupture followed by an intra-articular steroid injection at the post-laminectomy lumbar facet. MATERIALS AND METHODS We selected subjects who had undergone a fluoroscopy-guided synovial cyst rupture with simultaneous intra-articular steroid injection within 6 months of MRI and demonstrated a symptomatic facet joint synovial cyst at the level of a previous lumbar laminectomy. Fourteen patients were enrolled, and we determined whether cyst rupture and symptom improvement were achieved after each procedure. The degrees of symptom improvement were categorized into 4: 1) symptoms improved (30% or more reduction, based on pre-procedural and post-procedural Numerical Pain Rating Scale scores), 2) symptoms not improved, 3) patient underwent surgery after injection, and 4) loss of follow-up. RESULTS The success rate of percutaneous synovial cyst rupture decreased with repeated procedures (62.5% for the first procedure and 0% to 33.3% for additional procedures). However, 80% of the patients had symptom improvement with the procedures, overall. The surgery rate was 14.3% in 14 patients. CONCLUSION For patients with post-laminectomy symptomatic lumbar facet joint synovial cysts, fluoroscopy-guided synovial cyst rupture with intra-articular steroid injection may be an effective and less invasive treatment before considering a surgical approach.
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7
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Chazen JL. Long-term pain relief following percutaneous steroid treatment of spinal synovial cysts: a population-based cohort study. J Neurointerv Surg 2020; 12:836. [DOI: 10.1136/neurintsurg-2020-016322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/04/2022]
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8
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Fletcher-Sandersjöö A, Edström E, Kuntze Söderqvist Å, Grane P, Elmi-Terander A. Long-term pain relief following percutaneous steroid treatment of spinal synovial cysts: a population-based cohort study. J Neurointerv Surg 2020; 12:874-878. [PMID: 32354843 DOI: 10.1136/neurintsurg-2020-015890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Spinal synovial cysts are fluid-filled sacs that develop after facet joint degeneration and can give rise to radicular pain. If resistant to conservative management, surgical decompression or percutaneous steroid treatment is usually recommended. Percutaneous treatment minimizes the risk of spinal instability, but it has been uncertain whether it provides any long-term symptom relief. Moreover, it is unclear whether cyst rupture provides any added benefit. OBJECTIVE To assess long-term pain relief in patients with spinal synovial cysts who were treated with percutaneous intra-articular steroid treatment without cyst rupture. METHODS A population-based cohort-study was conducted of all patients with symptomatic synovial cysts who were treated with percutaneous intra-articular steroid treatment without cyst rupture between 1995 and 2014. RESULTS Thirty-eight patients were included. All patients had variations of lower back and radicular pain. Intra-articular access was achieved in 35 (92%) patients, and there were no treatment-related complications. At short-term assessment, 30 (79%) had pain relief. During the median follow-up of 11 years, 12 (32%) patients showed sustained pain relief without the need for decompressive surgery. CONCLUSIONS Percutaneous intra-articular steroid treatment without cyst rupture is a safe treatment for symptomatic spinal synovial cysts and eliminates the need for surgery in a substantial number of patients. It can be suggested as a first line of treatment.
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Affiliation(s)
- Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden .,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Åsa Kuntze Söderqvist
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Grane
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Yoo BR, Lee E, Lee JW, Kang Y, Ahn JM, Kang HS. Incidence and pattern of epidural spread during lumbar facet joint injection: a prospective study. Acta Radiol 2020; 61:636-643. [PMID: 31510763 DOI: 10.1177/0284185119874480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In clinical practice, we have often observed contrast material spreading into the epidural space during lumbar facet joint injection. However, the exact incidence of epidural spread and contrast pattern have not been reported. Purpose To evaluate the incidence and pattern of epidural spread in lumbar facet joint injection. Material and Methods One hundred consecutive patients (38 men, 62 women; mean age 68 years; age range 20–88 years) who underwent lumbar facet joint injection at two sites between April 2014 and June 2014 were investigated in this prospective study. Initial oblique, final anteroposterior, and lateral fluoroscopic images were obtained and evaluated for the presence of epidural spread and its contrast pattern (based on direction and extent) with the consensus of three radiologists. The relationship between epidural spread and its potential predictors was analyzed using the chi-squared test, Fisher’s exact test, and the t-test. Results The incidence of epidural spread during lumbar facet joint injection was 64.6% (n=64) in 99 patients and 49.5% (n=95) in 192 procedures; ventral spread occurred in 29.2% and foraminal spread in 18.8%. When epidural spread occurred, the most commonly identified distributions were unilateral (73.7%), dorsal (92.6%), and cephalad (92.6%). Epidural spread increased significantly in the caudocephalic direction ( P < 0.0001), in men (relative risk [RR]=1.478), in the adjacency of posterior fusion level (RR=1.545), in patients with spondylolisthesis (RR=1.454), and when there was no other leakage (RR=0.334). Conclusion Epidural spread occurred at about half the number of lumbar facet joint injections and showed a contrast pattern similar to that seen with the interlaminar approach.
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Affiliation(s)
- Bo Reum Yoo
- Department of Radiology, Cosmo Internal Medicine, Daejeon, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Intra-articular facet joint steroid injection–related adverse events encountered during 11,980 procedures. Eur Radiol 2019; 30:1507-1516. [DOI: 10.1007/s00330-019-06483-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
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Elmasry SS, Asfour SS, Travascio F. Finite Element Study to Evaluate the Biomechanical Performance of the Spine After Augmenting Percutaneous Pedicle Screw Fixation With Kyphoplasty in the Treatment of Burst Fractures. J Biomech Eng 2019; 140:2672192. [PMID: 29392289 DOI: 10.1115/1.4039174] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 12/13/2022]
Abstract
Percutaneous pedicle screw fixation (PPSF) is a well-known minimally invasive surgery (MIS) employed in the treatment of thoracolumbar burst fractures (TBF). However, hardware failure and loss of angular correction are common limitations caused by the poor support of the anterior column of the spine. Balloon kyphoplasty (KP) is another MIS that was successfully used in the treatment of compression fractures by augmenting the injured vertebral body with cement. To overcome the limitations of stand-alone PPSF, it was suggested to augment PPSF with KP as a surgical treatment of TBF. Yet, little is known about the biomechanical alteration occurred to the spine after performing such procedure. The objective of this study was to evaluate and compare the immediate post-operative biomechanical performance of stand-alone PPSF, stand-alone-KP, and KP-augmented PPSF procedures. Novel three-dimensional (3D) finite element (FE) models of the thoracolumbar junction that describes the fractured spine and the three investigated procedures were developed and tested under mechanical loading conditions. The spinal stiffness, stresses at the implanted hardware, and the intradiscal pressure at the upper and lower segments were measured and compared. The results showed no major differences in the measured parameters between stand-alone PPSF and KP-augmented PPSF procedures, and demonstrated that the stand-alone KP may restore the stiffness of the intact spine. Accordingly, there was no immediate post-operative biomechanical advantage in augmenting PPSF with KP when compared to stand-alone PPSF, and fatigue testing may be required to evaluate the long-term biomechanical performance of such procedures.
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Affiliation(s)
- Shady S Elmasry
- Biomechanics Research Laboratory, Department of Industrial Engineering, University of Miami, 1251 Memorial Drive, McArthur Engineering Building, #156, Coral Gables, FL 33146 e-mail:
| | - Shihab S Asfour
- Biomechanics Research Laboratory, Department of Industrial Engineering, University of Miami, 1251 Memorial Drive, McArthur Engineering Building, #268, Coral Gables, FL 33146 e-mail:
| | - Francesco Travascio
- Mem. ASME Biomechanics Research Laboratory, Department of Industrial Engineering, University of Miami, 1251 Memorial Drive, McArthur Engineering Building, #276, Coral Gables, FL 33146 e-mail:
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12
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Is fluoroscopy-guided percutaneous rupture of facet cyst an alternative to surgery? A case report. Turk J Phys Med Rehabil 2019; 64:362-365. [PMID: 31453534 DOI: 10.5606/tftrd.2018.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/22/2017] [Indexed: 11/21/2022] Open
Abstract
Lumbar intraspinal synovial cysts (LISCs) are rare cause of the lumbosacral radicular syndrome. Fluoroscopy-guided percutaneous cyst rupture (PCR) is an option in the treatment. This report introduces long-term symptom relief after fluoroscopy-guided PCR of LISC. A 73-year-old patient presented with low back pain radiating to right leg. L5 radiculopathy was suspected by physical examination; however, an intraspinal cystic mass was visualized through imaging studies. The patient reported immediate pain relief after fluoroscopy-guided PCR, which sustained for one year. In conclusion, fluoroscopy-guided PCR appears to be a safe and effective treatment option and should be considered before surgery in patients with LISCs.
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13
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Ramhmdani S, Ishida W, Perdomo-Pantoja A, Witham TF, Lo SFL, Bydon A. Synovial Cyst as a Marker for Lumbar Instability: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 122:e1059-e1068. [DOI: 10.1016/j.wneu.2018.10.228] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 01/25/2023]
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Anand A, Pfiffner TJ, Mechtler L. The Role of Imaging in the Management of Cystic Formations of the Mobile Spine (CYFMOS). Curr Pain Headache Rep 2018; 22:70. [PMID: 30145776 DOI: 10.1007/s11916-018-0723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to give a better understanding of the pathogenesis of cystic formations of the mobile spine (CYFMOS) and the correlating imaging findings. This would help with medical decision-making, given the plethora of conservative, interventional, and surgical treatment options. RECENT FINDINGS There has been a general understanding that CYFMOS are associated with degenerative spine changes. More recent articles however have suggested that identifying detailed imaging characteristics can assist in determining outcomes when CYFMOS are treated with interventional percutaneous methods or surgical decompression with or without concomitant fusion. CYFMOS although uncommon are not a rare finding seen in the spine when there is a background of degenerative spine changes. These cystic lesions are generally symptomatic by exhibiting mass effect on adjacent structure. Most treatments are aimed at decompression by interventional percutaneous or surgical means. Various imaging characteristics of these CYFMOS described in this article including their signal intensity, presence of spinal instability, particular patterns of adjacent degenerative changes, and imaging changes following interventional treatments can help guide physicians when managing these cases.
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Affiliation(s)
- Amar Anand
- DENT Neurologic Institute, 3980 Sheridan Dr, Buffalo, NY, 14226, USA.
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15
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Wu HH, Chu L, Zhu Y, Cheng CY, Chen CM. Percutaneous Endoscopic Lumbar Surgery via the Transfacet Approach for Lumbar Synovial Cyst. World Neurosurg 2018; 116:35-39. [DOI: 10.1016/j.wneu.2018.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 01/23/2023]
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Shah VN, von Fischer ND, Chin CT, Yuh EL, Amans MR, Dillon WP, Hess CP. Long-Term Effectiveness of Direct CT-Guided Aspiration and Fenestration of Symptomatic Lumbar Facet Synovial Cysts. AJNR Am J Neuroradiol 2017; 39:193-198. [PMID: 29122762 DOI: 10.3174/ajnr.a5428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/19/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar facet synovial cysts are commonly seen in facet degenerative arthropathy and may be symptomatic when narrowing the spinal canal or compressing nerve roots. The purpose of this study was to analyze the safety, effectiveness, and long-term outcomes of direct CT-guided lumbar facet synovial cyst aspiration and fenestration for symptom relief and for obviating an operation. MATERIALS AND METHODS We retrospectively reviewed the medical records and imaging studies of 64 consecutive patients between 2006 and 2016 who underwent 85 CT-guided lumbar facet synovial cyst fenestration procedures in our department. We recorded patient demographics, lumbar facet synovial cyst imaging characteristics, presenting symptoms, change in symptoms after the procedure, and whether they underwent a subsequent operation. We also assessed long-term outcomes from the medical records and via follow-up telephone surveys with patients. RESULTS Direct CT-guided lumbar facet synovial cyst puncture was technically successful in 98% of procedures. At first postprocedural follow-up, 86% of patients had a complete or partial symptomatic response. During a mean follow-up of 49 months, 56% of patients had partial or complete long-term relief without the need for an operation; 44% of patients underwent an operation. Patients with calcified, thick-rimmed, or low T2 signal intensity cysts were less likely to respond to the procedure and more likely to need an operation. CONCLUSIONS CT-guided direct lumbar facet synovial cyst aspiration and fenestration procedures are safe, effective, and minimally invasive for symptomatic treatment of lumbar synovial facet cysts. This procedure obviates an operation in a substantial number of patients, even at long-term follow-up, and should be considered before surgical intervention.
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Affiliation(s)
- V N Shah
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
| | - N D von Fischer
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - C T Chin
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - E L Yuh
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - M R Amans
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - W P Dillon
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - C P Hess
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
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Chazen JL, Leeman K, Singh JR, Schweitzer A. Percutaneous CT-guided facet joint synovial cyst rupture: Success with refractory cases and technical considerations. Clin Imaging 2017; 49:7-11. [PMID: 29120814 DOI: 10.1016/j.clinimag.2017.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/11/2017] [Accepted: 10/23/2017] [Indexed: 01/23/2023]
Abstract
Percutaneous image-guided rupture of lumbar facet synovial cysts can improve clinical outcomes and obviate the need for open surgery. This series describes eleven patients who had successful CT-guided lumbar facet synovial cyst ruptures, 82% of which experienced excellent pain relief at a minimum of one-year follow-up. Of the five patients who failed prior fluoroscopic-guided synovial cyst rupture, 80% had a successful CT-guided rupture and one-year sustained pain relief. These findings reinforce minimally invasive CT-guided treatment as an excellent option to improve patient symptoms and potentially avoid open surgery.
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Affiliation(s)
- J Levi Chazen
- Weill Cornell Medicine, Department of Radiology, United States.
| | - Kristen Leeman
- Weill Cornell Medicine, Department of Radiology, United States
| | - Jaspal R Singh
- Weill Cornell Medicine, Department of Rehabilitation Medicine, United States
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Lutz GE, Nicoletti MR, Cyril GE, Harrison JR, Lutz C, Solomon JL, Cooke PM, Wyss JF, Herzog RJ, Moley PJ. Percutaneous Rupture of Zygapophyseal Joint Synovial Cysts: A Prospective Assessment of Nonsurgical Management. PM R 2017; 10:245-253. [DOI: 10.1016/j.pmrj.2017.07.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/19/2017] [Accepted: 07/30/2017] [Indexed: 10/19/2022]
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Haider SJ, Na NR, Eskey CJ, Fried JG, Ring NY, Bao MH, Pastel DA. Symptomatic Lumbar Facet Synovial Cysts: Clinical Outcomes Following Percutaneous CT–Guided Cyst Rupture with Intra-articular Steroid Injection. J Vasc Interv Radiol 2017; 28:1083-1089. [PMID: 28549711 DOI: 10.1016/j.jvir.2017.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022] Open
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Bruder M, Cattani A, Gessler F, Droste C, Setzer M, Seifert V, Marquardt G. Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts. J Neurosurg Spine 2017; 27:256-267. [PMID: 28686146 DOI: 10.3171/2016.12.spine16756] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Synovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery. METHODS A total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors' department were analyzed. Medical reports with regard to signs and symptoms, operative findings, complications, and short-term outcome were reviewed. Assessment of long-term outcome was performed with a standardized telephone questionnaire based on the Oswestry Disability Index (ODI). Furthermore, patients were questioned about persisting pain, symptoms, and further operative procedures, if any. Subjective satisfaction was classified as excellent, good, fair, or poor based on the Macnab classification. RESULTS The approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation. CONCLUSIONS Surgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion.
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Affiliation(s)
- Markus Bruder
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Christian Droste
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University, Frankfurt, Germany
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Atypical presentation of a cervical synovial cyst. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2267-2271. [PMID: 28150051 DOI: 10.1007/s00586-017-4947-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/01/2017] [Accepted: 01/08/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Synovial cysts of the cervical spine are rare. These lesions have been associated with other spinal conditions as osteoarthritis, spondylolisthesis, and disc degeneration, with authors postulating a possible link with segmental spinal instability. This study aims to describe an atypically presenting case of a cervical synovial cyst. CASE REPORT A 65-year-old man presented with complaints of cervical radicular pain (VAS of 7) that evolved with development of paresthesia and muscular weakness, compatible with C8 right compression. This symptomatology had an odd pattern with total regression of symptoms when lying supine or upon extreme efforts, leading to a delayed referral to MRI. A C7-T1 synovial cyst was identified, compressing the C8 nerve root. The patient was submitted to decompression and instrumented fusion of the affected level and showed total regression of symptoms. CONCLUSIONS Although rare, cervical synovial cysts are associated with a significant impairment in patients' daily activities. The atypical pattern of symptoms described in this case may be associated with the fluid content of the cyst, with postural changes causing different degrees of root compression. Most authors agree on a surgical option, but the need for associated fusion is still under debate.
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Interventions for Lumbar Synovial Facet Joint Cysts: A Comparison of Percutaneous, Surgical Decompression and Fusion Approaches. World Neurosurg 2017; 98:492-502. [DOI: 10.1016/j.wneu.2016.11.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023]
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Huang AJ, Bos SA, Torriani M, Simeone FJ, Chang CY, Pomerantz SR, Bredella MA. Long-term outcomes of percutaneous lumbar facet synovial cyst rupture. Skeletal Radiol 2017; 46:75-80. [PMID: 27771754 DOI: 10.1007/s00256-016-2513-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/02/2016] [Accepted: 10/05/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the therapeutic value, safety, and long-term clinical outcomes of percutaneous lumbar facet synovial cyst (LFSC) rupture. MATERIALS AND METHODS Our study was institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant. The study group comprised 71 patients (44 women, mean age: 65 ± 17 years) who underwent CT- or fluoroscopy-guided percutaneous LFSC rupture. The technical success of LFSC rupture, the long-term clinical outcome, including repeat procedures or surgery, and imaging findings on MRI and CT were recorded. RESULTS Seventy-nine LFSC ruptures were performed in 71 patients. CT guidance was used in 57 cases and fluoroscopy guidance in 22 cases. LFSC rupture was technically successful in 58 out of 79 cases (73 %). Mean injection volume for cyst rupture was 3.6 ± 2.2 mL and a combination of steroid and anesthetic was injected in all cases. Over a mean follow-up time of 44 months, 12 % of patients underwent repeat cyst rupture, and 46 % eventually underwent surgery, whereas the majority of patients (55 %) experienced symptomatic relief and did not undergo surgery. There was no significant association between a successful outcome and age, sex, level, or size of LFSC (p > 0.1). LFSCs with T2 hypointensity were more likely to require surgery (p = 0.02). There was one complication, a bacterial skin infection that completely resolved following antibiotic therapy. CONCLUSION Percutaneous LFSC rupture is an effective and safe nonsurgical treatment option for LFSC. More than half of treated patients were able to avoid subsequent surgery. Therefore, percutaneous LFSC rupture should be considered before surgical intervention.
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Affiliation(s)
- Ambrose J Huang
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Stijn A Bos
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - F Joseph Simeone
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Connie Y Chang
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Stuart R Pomerantz
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
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Abstract
Lumbar facet cysts are a rare but increasingly common cause of symptomatic nerve root compression and can lead to radiculopathy, neurogenic claudication, and cauda equina syndrome. The cysts arise from the zygapophyseal joints of the lumbar spine and commonly demonstrate synovial herniation with mucinous degeneration of the facet joint capsule. Lumbar facet cysts are most common at the L4-L5 level and often are associated with spondylosis and degenerative spondylolisthesis. Advanced imaging studies have increased diagnosis of the cysts; however, optimal treatment of the cysts remains controversial. First-line treatment is nonsurgical management consisting of oral NSAIDs, physical therapy, bracing, epidural steroid injections, and/or cyst aspiration. Given the high rate of recurrence and the relatively low satisfaction with nonsurgical management, surgical options, including hemilaminectomy or laminotomy to excise the cyst and decompress the neural elements, are typically performed. Recent studies suggest that segmental fusion of the involved levels may decrease the risks of cyst recurrence and radiculopathy.
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Denis DR, Hirt D, Shah S, Lu DC, Holly LT. Minimally invasive surgery for lumbar synovial cysts with coexisting degenerative spondylolisthesis. Int J Spine Surg 2016; 10:37. [PMID: 27909658 DOI: 10.14444/3037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND About one third of lumbar synovial cysts are associated with degenerative spondylolisthesis. Segmental instability is thought to contribute to the pathogenesis and recurrence of synovial cysts and lumbar fusion has been advocated as a treatment of choice in the presence of spondylolisthesis. In patients with spondylolisthesis, minimally invasive resection of lumbar synovial cysts, without fusion, could minimize surgically induced segmental instability while providing good pain relief. METHODS Clinical and radiological outcomes of lumbar synovial cyst patients with and without spondylolisthesis were retrospectively compared. Pain outcomes were assessed with modified Macnab criteria. RESULTS Fifty-three patients (18 with grade 1 spondylolisthesis) underwent minimally invasive synovial cyst resection and all had either excellent or good pain outcome at ≤ 8 post- operative weeks (P = 1.000, n = 53). At > 8 post-operative weeks (mean (SD) follow-up of 200 (175) weeks), excellent or good outcomes were noted in 89% of patients without spondylolisthesis and in 75% of patients with spondylolisthesis (P = 0.425, n = 40). Four patients developed a new grade 1 spondylolisthesis at a mean follow-up of 2.6 ± 2.1 years. Nine patients were assessed for spondylolisthesis measurements at 1.2 ± 1.3 years of follow up and no significant difference was observed (5 ± 0 vs 5 ± 1 mm; P = 0.791). Two patients without spondylolisthesis and none of the patients with spondylolisthesis had a synovial cyst recurrence. CONCLUSION Patients with concomitant lumbar degenerative spondylolisthesis and synovial cyst can have good short- and long-term clinical outcomes with minimally invasive surgery without fusion. Post-operative segmental instability does not appear to be significant in patients with spondylolisthesis. All patients included in this article signed an informed consent for the use of their medical information for research.
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Affiliation(s)
- Daniel R Denis
- Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Daniel Hirt
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Saumya Shah
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Langston T Holly
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
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Jin HS, Bae JY, In CB, Choi EJ, Lee PB, Nahm FS. Epiduroscopic Removal of a Lumbar Facet Joint Cyst. Korean J Pain 2015; 28:275-9. [PMID: 26495082 PMCID: PMC4610941 DOI: 10.3344/kjp.2015.28.4.275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 01/07/2023] Open
Abstract
Facet joint synovial cysts are usually associated with osteoarthritis of the adjacent facet joint and/or spondylolisthesis. In between the conservative and operative ends of the treatment spectrum lie minimally invasive techniques such as cyst rupture using epiduroscopy. In this report, we describe an 82-year-old male patient presenting with low back pain radiating to his lower left extremity and associated paresthesia. Magnetic resonance imaging of the lumbar spine revealed a synovial cyst at left L4/5 facet joint. Using epiduroscopy, the cyst was mechanically ruptured by popping it with the tip of the scope. The patient remained symptom-free at his successive visits until 12 months after the procedure, and was opened for desired follow up.
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Affiliation(s)
- Hyun Seung Jin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jun Yeol Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chi Bum In
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pyung Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Percutaneous Rupture of a Symptomatic Facet Joint Synovial Cyst Using 2-Needle Distention. Reg Anesth Pain Med 2015; 40:635-8. [PMID: 26110442 DOI: 10.1097/aap.0000000000000278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This case report calls attention to an alternative approach for management of a symptomatic facet joint synovial cyst. We describe a patient with a symptomatic facet joint synovial cyst who failed an attempted percutaneous rupture using a single-needle technique. This patient was subsequently successfully managed with percutaneous rupture using a 2-needle technique. CASE REPORT A 60-year-old woman presented with low back pain, right lower extremity pain, and paresthesias. Magnetic resonance imaging revealed a right L5-S1 facet joint cyst, which compressed the right L5 nerve root. Before presentation, the patient failed an attempted single-needle percutaneous rupture. The decision was made to proceed with percutaneous rupture using a 2-needle technique. A 22-gauge needle was inserted into the right L5-S1 facet joint, and a Tuohy needle was inserted directly into the cyst through an interlaminar approach. A solution of methylprednisolone and hyaluronidase was simultaneously injected through both needles, and the cyst was continuously distended until rupture was achieved. Rupture was confirmed by injecting contrast into the facet joint and visualizing a normal epidurogram. The patient reported significant pain relief immediately after the procedure. At 4-month follow-up, the patient reported continued pain relief and denied any radicular symptoms. CONCLUSIONS Percutaneous rupture of a symptomatic facet joint synovial cyst using a single-needle technique has been validated as an efficacious form of management. In a select group of patients who fail single-needle percutaneous rupture, a 2-needle approach for percutaneous facet cyst rupture may be considered as an option for management.
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Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique. Cardiovasc Intervent Radiol 2015; 39:127-31. [PMID: 25944146 DOI: 10.1007/s00270-015-1106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/27/2015] [Indexed: 11/15/2022]
Abstract
We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4-L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.
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Shuang F, Hou SX, Zhu JL, Ren DF, Cao Z, Tang JG. Percutaneous resolution of lumbar facet joint cysts as an alternative treatment to surgery: a meta-analysis. PLoS One 2014; 9:e111695. [PMID: 25389771 PMCID: PMC4229115 DOI: 10.1371/journal.pone.0111695] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/19/2014] [Indexed: 12/11/2022] Open
Abstract
PURPOSE A comprehensive review of the literature in order to analyze data about the success rate of percutaneous resolution of the lumbar facet joint cysts as a conservative management strategy. METHODS A systematic search for relevant articles published during 1980 to May 2014 was performed in several electronic databases by using the specific MeSH terms and keywords. Most relevant data was captured and pooled for the meta-analysis to achieve overall effect size of treatment along with 95% confidence intervals. RESULTS 29 studies were included in the meta-analysis. Follow-up duration as mean ± sd (range) was 16±10.2 (5 days to 5.7 years). Overall the satisfactory results (after short- or long-term follow-up) were achieved in 55.8 [49.5, 62.08] % (pooled mean and 95% CI) of the 544 patients subjected to percutaneous lumbar facet joint cyst resolution procedures. 38.67 [33.3, 43.95] % of this population underwent surgery subsequently to achieve durable relief. There existed no linear relationship between the increasing average duration of follow-up period of individual studies and percent satisfaction from the percutaneous resolutions procedure. CONCLUSION Results shows that the percutaneous cyst resolution procedures have potential to be an alternative to surgical interventions but identification of suitable subjects requires further research.
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Affiliation(s)
- Feng Shuang
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- Department of Orthopedics, The 94th Hospital of Chinese PLA, Nanchang, China
| | - Shu-Xun Hou
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- * E-mail: (JGT); (SXH)
| | - Jia-Liang Zhu
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Dong-Feng Ren
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Zheng Cao
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
| | - Jia-Guang Tang
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese PLA, Beijing, China
- * E-mail: (JGT); (SXH)
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Zhenbo Z, Huanting L, Jin W, Haifeng G, Yuan F, Ming L. Hemilaminoplasty for the treatment of lumbar intraspinal synovial cysts (LISCs) and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 25:3393-3402. [DOI: 10.1007/s00586-014-3570-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 01/17/2023]
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Lumbar L4-L5 ganglion cyst with hemicauda equina syndrome. Report of a case and review of the literature. ROMANIAN NEUROSURGERY 2013. [DOI: 10.2478/romneu-2013-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Mostly associated with degenerative facet joints and spondylolisthesis, symptomatic lumbar juxta facet cysts - ganglion and synovial cysts are uncommon lesions of the spine. They can mimic herniated discs, causing low back pain, radiculopathy or even cauda equina syndrome; also some of them are associated with spinal instability. Referring to a case with hemicauda equina syndrome where microsurgical decompression was performed with very good result; alternative treatment solutions are discussed: conservative therapy for symptomatic lesions is often unsuccessful, spinal fusion should be made for those cases with spinal instability, although there are reports of spontaneous resolution of these cysts as well as the symptoms associated with them.
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Improved outcomes with direct percutaneous CT guided lumbar synovial cyst treatment: advanced approaches and techniques. J Neurointerv Surg 2013; 6:790-4. [DOI: 10.1136/neurintsurg-2013-010891] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cambron SC, McIntyre JJ, Guerin SJ, Li Z, Pastel DA. Lumbar facet joint synovial cysts: does T2 signal intensity predict outcomes after percutaneous rupture? AJNR Am J Neuroradiol 2013; 34:1661-4. [PMID: 23449657 DOI: 10.3174/ajnr.a3441] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar facet synovial cysts are a cause of back pain and radiculopathy with facet joint degeneration, the most common cause for cyst formation. Typically, LFSCs are T2 hyperintense on MR imaging, but the signal intensity is variable. Treatment options include percutaneous rupture and surgical resection. This study evaluates the relationship between LFSC signal intensity on MR imaging and outcomes as it relates to percutaneous rupture success and need for subsequent surgery. MATERIALS AND METHODS A retrospective review of 110 patients who underwent CT fluoroscopic-guided rupture of symptomatic LFSCs was performed. The LFSCs were characterized by their T2 signal intensity on MR imaging and divided into 3 groups: high, intermediate, and low T2 signal intensity. The rates of successful cyst rupture and need for subsequent surgery were recorded. RESULTS Percutaneous LFSC rupture was technically successful in 87% of all cases. Cyst rupture was successful in 89% and 90% of high and intermediate signal intensity cysts, respectively, and in 65% of low signal intensity cysts (P = .017, .030). High signal intensity cysts had lower postprocedural surgical rates (29%) when compared with intermediate and low signal cyst as a group (P = .045). CONCLUSIONS T2 hyperintense and intermediate signal intensity LFSCs are easier to rupture, perhaps because the cysts contain a higher proportion of fluid and are less gelatinous or calcified than T2 hypointense cysts. Patients with T2 hyperintense LFSCs are less likely to need surgery.
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Affiliation(s)
- S C Cambron
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA.
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35
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Bahuleyan B, Groff MW. Management Strategies for Patients with Spinal Synovial Cysts. World Neurosurg 2013; 79:277-80. [DOI: 10.1016/j.wneu.2012.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 11/09/2012] [Indexed: 12/11/2022]
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GANAU M, ENNAS F, BELLISANO G, GANAU L, AMBU R, FAA G, MALECI A. Synovial Cysts of the Lumbar Spine. Neurol Med Chir (Tokyo) 2013; 53:95-102. [DOI: 10.2176/nmc.53.95] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mario GANAU
- Chair of Neurosurgery, University of Cagliari
| | | | | | - Laura GANAU
- Chair of Neurosurgery, University of Cagliari
| | - Rossano AMBU
- Institute of Anatomic Pathology, University of Cagliari
| | - Gavino FAA
- Institute of Anatomic Pathology, University of Cagliari
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El Shazly AA, Khattab MF. Surgical excision of a Juxtafacet cyst in the lumbar spine: A report of thirteen cases with long-term follow up. Asian J Neurosurg 2012; 6:78-82. [PMID: 22347328 PMCID: PMC3277074 DOI: 10.4103/1793-5482.92162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
CONTEXT Juxtafacet cysts of the lumbar spine are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. Surgical treatment is indicated when there is failure of conservative measures. Primary spinal fusion at the time of surgical excision of the cyst is a matter of controversy. Few reports have described long-term follow-up for surgical treatment of spinal cysts. AIM The purpose of this study is to assess the long-term outcome of the surgical excision of a Juxtafacet cyst without spinal fusion. STUDY DESIGN This is a retrospective case series study, level IV evidence. MATERIALS AND METHODS This is a retrospective case series study on 13 patients with Juxtafacet cysts, who were treated with surgical excision of the cysts without spinal fusion. A questionnaire scoring system was used for evaluation of the surgical outcome. RESULTS The study was conducted on 13 patients, seven females (54%) and six males (46%), their age ranging from 38 to 69 years, with a mean age of 52 (±9.93 STD) years. The mean duration of the symptoms was 10.5 (±6.22 STD) months. All patients got benefit from surgery, with six excellent (46%), six good (46%), and one fair outcome (8%), with no surgery-related complications. The mean follow-up period of the patients at the time of this study was 4.2 years (±1.43 STD). CONCLUSION Long-term follow-up for surgical excision of symptomatic Juxtafacet cysts without spinal fusion revealed excellent to good results in 92% of the patients, with a satisfaction rate of 80% (±8.41 STD).
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Affiliation(s)
- Ayman A El Shazly
- Departments of Neurosurgery and Orthopedics, Ain Shams University, Ramses Extension Road, Abbasia Square, Cairo, Egypt
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Cox JM. Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report. J Chiropr Med 2012; 11:7-15. [PMID: 22942836 DOI: 10.1016/j.jcm.2011.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/15/2011] [Accepted: 08/18/2011] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The purpose of this study is to report the findings resulting from chiropractic care using flexion distraction spinal manipulation for a patient with low back and radicular pain due to spinal stenosis caused by a synovial cyst. CASE REPORT A 75-year-old man presented with low back pain radiating to the right anterior thigh and down the left posterior leg of 3 years' duration. Physical and imaging examinations showed a synovial cyst-induced spinal stenosis at the right L3-L4 level and bilateral L4-L5 spinal stenosis. INTERVENTION AND OUTCOMES Flexion distraction spinal manipulation and physiological therapeutics were applied at the levels of stenosis. After 4 visits, the patient noted total absence of the right and left lower extremity pain and no adverse reaction to treatment. After 3 months of treatment and 16 visits, his low back and buttock pain were minimal; and he had no leg pain. CONCLUSION Lumbar synovial cyst and stenosis-generated low back and radicular pain was 80% relieved in a 75-year-old man following Cox flexion distraction spinal manipulation.
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Affiliation(s)
- James M Cox
- Clinician and Chief of Radiology, Chiropractic Medicine, Inc, Fort Wayne, IN 46845
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Bykowski JL, Wong WHW. Role of facet joints in spine pain and image-guided treatment: a review. AJNR Am J Neuroradiol 2012; 33:1419-26. [PMID: 21940805 PMCID: PMC7966535 DOI: 10.3174/ajnr.a2696] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chronic low back and neck pain remain prevalent medical concerns, with much debate regarding the effective evaluation and treatment. Facet disease has been implicated as a source of axial nonradiating low back pain. We discuss patient evaluation, the role of imaging, current and emerging image-guided therapies for facet-related pain, and the increasing importance of outcome-related research in this arena.
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Affiliation(s)
- J L Bykowski
- Department of Radiology, UCSD Medical Center, San Diego, CA, USA.
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Epstein NE, Baisden J. The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surg Neurol Int 2012; 3:S157-66. [PMID: 22905322 PMCID: PMC3422091 DOI: 10.4103/2152-7806.98576] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/04/2012] [Indexed: 12/13/2022] Open
Abstract
Background: The surgical management of lumbar synovial cysts that have extruded into the spinal canal remains controversial (e.g. decompression with/without fusion). Methods: The neurological presentation, anatomy, pathophysiology, and surgical challenges posed by synovial cysts in the lumbar spine are well known. Neurological complaints typically include unilateral or, more rarely, bilateral radicular complaints, and/or cauda equina syndromes. Anatomically, synovial cysts constitute cystic dilatations of synovial sheaths that directly extrude from facet joints into the spinal canal. Pathophysiologically, these cysts reflect disruption of the facet joints often with accompanying instability, and potentially compromise both the cephalad and caudad nerve roots. Results: Aspiration of lumbar synovial cysts, which are typically gelatinous and non-aspirable, and typically performed by “pain specialists” (e.g. pain management, rehabilitation, radiologists, others) utilizing fluoroscopy or CT-guided aspiration, is associated with 50–100% failure rates. Surgical decompression with/without fusion (as the issue regarding fusion remains unsettled) results in the resolution of back and radicular pain in 91.6–92.5% and 91.1–91.9% of cases, respectively. Conclusions: After a thorough review of the literature, it appears that the treatment with the best outcome for patients with synovial cysts is cyst removal utilizing surgical decompression; the need for attendant fusion remains unsettled. The use of an alternative treatment, percutaneous aspiration of cysts, appears to have a much higher recurrence and failure rate, but may be followed by surgery if warranted.
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Affiliation(s)
- Nancy E Epstein
- Clinical Professor of Neurological Surgery, The Albert Einstein College of Medicine, Bronx, NY, 10461, and Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, NY 11501
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Amoretti N, Huwart L, Foti P, Boileau P, Amoretti ME, Pellegrin A, Marcy PY, Hauger O. Symptomatic lumbar facet joint cysts treated by CT-guided intracystic and intra-articular steroid injections. Eur Radiol 2012; 22:2836-40. [DOI: 10.1007/s00330-012-2533-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 04/23/2012] [Accepted: 04/27/2012] [Indexed: 11/30/2022]
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Perkutane CT-gesteuerte Destruktion vs. mikrochirurgische Resektion lumbaler Juxtafacettzysten. DER ORTHOPADE 2011; 40:600-6. [DOI: 10.1007/s00132-011-1744-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Friedrich JM, Standaert CJ. Resolution of an intraspinal cyst associated with spondylolysis causing radiculopathy in an adolescent athlete: a case report. PM R 2010; 2:1059-62. [PMID: 21093843 DOI: 10.1016/j.pmrj.2010.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 05/10/2010] [Accepted: 05/18/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Jason M Friedrich
- Department of Rehabilitation Medicine, Box 356490, BB-928 Health Sciences Bldg, University of Washington, Seattle, WA 98195-6490, USA.
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Abstract
Bydon A, Xu R, Parker SL, et al. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systemic review of reported postoperative outcomes. Spine J 2010;10:820-826 (in this issue).
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Affiliation(s)
- Arun Gupta
- Physiatry Department, Hospital for Special Surgery, New York, NY 10021, USA
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Abstract
Synovial cysts have long been known to create radicular pain in the spine, with the clinical effect mimicking a disk herniation. These cysts have traditionally been treated with open surgical therapy. Now a minimally invasive, image-guided approach to treatment is available to relieve this problem, using a simple percutaneous needle stick and injection. This article describes the technical aspects and precautions needed for this intervention.
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Affiliation(s)
- John M Mathis
- Centers for Advanced Imaging, Roanoke, VA 24014, USA.
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DePalma MJ. Driving the lane: a clearer view of facet joint cyst intervention. Spine J 2009; 9:921-3. [PMID: 19775940 DOI: 10.1016/j.spinee.2009.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 08/13/2009] [Indexed: 02/03/2023]
Affiliation(s)
- Michael J DePalma
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Spine Center, 8700 Stony Point Pkwy, Suite 260, Richmond, VA 23235, USA.
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Oppenheimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: a historical review. Neurosurg Focus 2009; 27:E9. [DOI: 10.3171/2009.7.focus09121] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The trend of using smaller operative corridors is seen in various surgical specialties. Neurosurgery has also recently embraced minimal access spine technique, and it has rapidly evolved over the past 2 decades. There has been a progression from needle access, small incisions with adaptation of the microscope, and automated percutaneous procedures to endoscopically and laparoscopically assisted procedures. More recently, new muscle-sparing technology has come into use with tubular access. This has now been adapted to the percutaneous placement of spinal instrumentation, including intervertebral spacers, rods, pedicle screws, facet screws, nucleus replacement devices, and artificial discs. New technologies involving hybrid procedures for the treatment of complex spine trauma are now on the horizon. Surgical corridors have been developed utilizing the interspinous space for X-STOP placement to treat lumbar stenosis in a minimally invasive fashion. The direct lateral retroperitoneal corridor has allowed for minimally invasive access to the anterior spine.
In this report the authors present a chronological, historical perspective of minimal access spine technique and minimally invasive technologies in the lumbar, thoracic, and cervical spine from 1967 through 2009. Due to a low rate of complications, minimal soft tissue trauma, and reduced blood loss, more spine procedures are being performed in this manner. Spine surgery now entails shorter hospital stays and often is carried out on an outpatient basis. With education, training, and further research, more of our traditional open surgical management will be augmented or replaced by these technologies and approaches in the future.
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Affiliation(s)
- Jeffrey H. Oppenheimer
- 1Division of Neurosurgery, Department of Surgery, Central Arkansas Veterans Hospital; and
| | - Igor DeCastro
- 2Division of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dennis E. McDonnell
- 1Division of Neurosurgery, Department of Surgery, Central Arkansas Veterans Hospital; and
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