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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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Chun YM, Boudier-Revéret M, Lee SH, Chang MC. Neuropathic Pain due to Compression of Cervical Medial Branch by Cervical Juxtafacet Cyst: A Case Report. Pain Pract 2022; 22:662-665. [PMID: 35607892 DOI: 10.1111/papr.13129] [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: 11/28/2022]
Abstract
In the current report, we describe an interesting case of cervical juxtafacet that developed outside the intervertebral foramen, compressing the cervical medial branch and causing neuropathic pain in the posterior inferior neck pain. A 61-year-old woman visited a local pain clinic due to neuropathic pain with a tingling and burning nature (numeric rating scale [NRS]: 5 out of 10) on the left posterior inferior neck area for 4 months. Paresthesia was observed in the left posterior inferior neck area. On cervical radiography, segmental instability was observed at the C3-4 and C4-5 levels. Moreover, on the magnetic resonance imaging (MRI) of the cervical spine, a cyst (size: 1.3 cm × 0.7 cm × 1 cm) was outside the intervertebral foramen, contacting the left C4-5 facet joint and left C5 articular pillar. We thought that compression of the left C5 medial branch by the cyst could cause the patient's pain. We conducted computed tomography (CT)-guided percutaneous needle aspiration of a cervical juxtafacet cyst. An 18-gauge needle was advanced under the guidance of CT into the largest portion of the cyst through a posterolateral oblique approach. Gelatinous mucoid fluid (approximately 0.5 cc) was aspirated. Immediately after the aspiration, 80% of the patient's pain was disappeared, and dysesthesia was completely disappeared. At the 1-, 3-, and 6-month follow-ups, the patient reported slight pain (NRS: 1) on the left posterior inferior neck. Cervical juxtafacet cysts can develop outside of the intervertebral foramen and spinal canal. Percutaneous needle aspiration can be a useful therapeutic tool for the treatment of such cysts.
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Affiliation(s)
- Yoon Mok Chun
- Department of Physical Medicine and Rehabilitation, Wooridul Spine Hospital, Seoul, Republic of Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Sang Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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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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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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Shin KM, Kim MS, Ko KM, Jang JS, Kang SS, Hong SJ. Percutaneous aspiration of lumbar zygapophyseal joint synovial cyst under fluoroscopic guidance -A case report-. Korean J Anesthesiol 2012; 62:375-8. [PMID: 22558506 PMCID: PMC3337386 DOI: 10.4097/kjae.2012.62.4.375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/23/2011] [Accepted: 08/08/2011] [Indexed: 02/08/2023] Open
Abstract
A 51-year-old man with a 1-month history of lower back pain and radiating pain visited to our pain clinic. A magnetic resonance imaging (MRI) scan demonstrated a cyst like mass at the level of the L4-5 interspace and compression of the thecal sac and the nerve root on the right side. We performed percutaneous needle aspiration of the lumbar zygapophyseal joint synovial cyst under fluoroscopic guidance. The patient felt an immediate relief of symptoms after the aspiration, and had no signs or symptoms of recurrence at the follow-up 6 months later. No demonstrable lesion was found in the 6 months follow-up MRI.
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Affiliation(s)
- Keun-Man Shin
- Department of Anesthesiology and Pain Medicine, Kang-Dong Sacred Heart Hospital, Seoul, Korea
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Rauchwerger JJ, Candido KD, Zoarski GH. Technical and imaging report: fluoroscopic guidance for diagnosis and treatment of lumbar synovial cyst. Pain Pract 2010; 11:180-4. [PMID: 20807352 DOI: 10.1111/j.1533-2500.2010.00411.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Lumbar synovial cysts can be a source of low back pain with or without radiculopathy depending upon the size and location of the mass. Options for treatment range from analgesics to surgery, depending upon the degree of nerve root or spinal cord impingement. Attempts at minimally invasive treatment such as computed tomography-assisted aspiration and cyst rupture are documented in the radiology literature with varying degrees of reported success. This case report is the first to document the fluoroscopically-guided management of a lumbar synovial cyst in the pain medicine literature and highlights the knowledge and technical skills required when treating such cases.
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Factors associated with recurrent back pain and cyst recurrence after surgical resection of one hundred ninety-five spinal synovial cysts: analysis of one hundred sixty-seven consecutive cases. Spine (Phila Pa 1976) 2010; 35:1044-53. [PMID: 20173680 DOI: 10.1097/brs.0b013e3181bdafed] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Compare outcomes of different treatment methods for intraspinal synovial cysts. SUMMARY OF BACKGROUND DATA Intraspinal synovial cysts are cited as an increasing cause of back pain and radiculopathy. To date, few studies have compared outcomes of differing treatment methods in patients with synovial cysts. METHODS We retrospectively reviewed 167 consecutive patients undergoing surgical management of 195 symptomatic synovial cysts at a single institution over 19 years. The incidence of postoperative mechanical back pain, radiculopathy, and cyst recurrence was compared between patients undergoing unilateral hemilaminectomy (n = 51), bilateral laminectomy (n = 39), facetectomy with in situ fusion (n = 18), and facetectomy with instrumented fusion (n = 56). RESULTS A total of 155 (97.5%) patients presented with radiculopathy, 132(82.5%) with mechanical back pain, 31 (20%) with neurogenic claudication, and 5 (3.2%) with bladder dysfunction. Most cysts occurred in the lumbar spine. After surgery, back and radicular pain improved in 91.6% and 91.9% patients, respectively. By a mean follow-up of 16 +/- 9 months, 36 (21.6%) patients developed recurrent back pain, 20 (11.8%) recurrent leg pain, and 5 (3%) recurrent synovial cysts. Patients undergoing laminectomy had a significantly increased cyst recurrence incidence compared to fusion groups via log-rank test (P = 0.042), and this risk was decreased to baseline with instrumented fusion on reoperation. Laminectomy was also associated with the highest increased risk of recurrent back pain in both log-rank test (P = 0.018) and proportional hazards regression (HR): 1.64 (1.00-3.45), P = 0.05. Instrumented fusion had the lowest risk for back pain recurrence. CONCLUSION Hemilaminectomy or laminectomy remains one of the mainstay surgical treatments for symptomatic intraspinal synovial cysts. Our experience shows that the majority of patients undergoing decompression/excision of synovial cysts will have immediate improvement in back and leg pain. However, within 2 years, patients receiving hemilaminectomy or laminectomy alone have an increased incidence of back pain and cyst recurrence. Decompression with instrumented fusion appears to be associated with the lowest incidences of cyst recurrence or back pain.
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Velán O, Rabadán A, Paganini L, Langhi L. Atlantoaxial Joint Synovial Cyst: Diagnosis and Percutaneous Treatment. Cardiovasc Intervent Radiol 2008; 31:1219-21. [DOI: 10.1007/s00270-008-9347-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 03/24/2008] [Accepted: 04/02/2008] [Indexed: 11/30/2022]
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Nabeta M, Yoshimoto H, Sato S, Hyakumachi T, Yanagibashi Y, Masuda T. Discal cysts of the lumbar spine. J Neurosurg Spine 2007; 6:85-9. [PMID: 17233299 DOI: 10.3171/spi.2007.6.1.17] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓Discal cysts are rare lesions that can result in refractory sciatica. Because they are so rare, their exact origin and details of the clinical manifestations are still unknown. The authors report on five men treated for discal cysts. The mean age of the patients at the time of the surgery was 32 years (range 25–38 years). All patients suffered from lower-extremity pain and the results of the straight leg–raising test were positive in all cases. Three patients reported motor weakness and four had sensory disturbance—symptoms similar to those found in patients with lumbar disc herniation. Magnetic resonance imaging demonstrated spherically shaped extradural lesions of various sizes with low and high signal intensities on T1- and T2-weighted images, respectively. Discography revealed obvious communication between the cyst and the intervertebral disc with reproducible leg pain in all patients. All patients underwent posterior decompression and excision of the cysts either with or without additional discectomy. The radicular symptoms were remarkably improved in all patients immediately after surgery, and no recurrent lesions were noted during follow up.
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Affiliation(s)
- Masaharu Nabeta
- Department of Orthopaedic Surgery, Eniwa Hospital, Kogane-cho, Eniwa, Japan.
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Oertel MF, Ryang YM, Gilsbach JM, Rohde V. Lumbar foraminal and far lateral juxtafacet cyst of intraspinal origin. ACTA ACUST UNITED AC 2006; 66:197-9; discussion 199. [PMID: 16876628 DOI: 10.1016/j.surneu.2005.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2005] [Accepted: 11/02/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Symptomatic lumbar juxtafacet cysts (JFC) arise from the facet joint and almost exclusively are located in the posterolateral spinal canal. A foraminal and far lateral JFC of intraspinal origin is an exceptional finding. We report the unique case of a lumbar intra-, trans-, and extraforaminal JFC to illustrate the rare location and unusual presentation and discuss its anatomical variants, diagnostic difficulties, and therapeutic consequences. CASE DESCRIPTION A patient presented with a left L3 radiculopathy. Computed tomography revealed an intraspinal cystic posterolateral mass at level L3-L4, accompanied by an intra- and extraforaminal lesion compressing the upper nerve root. Based on these findings, a JFC and an additional extraforaminal disc herniation were suspected. Magnetic resonance imaging showed that the intraforaminal and extraspinal mass communicated with the intraspinal lesion and was cystic as well. The patient was treated successfully by combining an interlaminar and paraisthmic access. Microsurgery disclosed a JFC, which had a small intraspinal, panforaminal, and large extraspinal part. CONCLUSION An unusual case of a JFC originating intraspinally and extending through the neuroforamen to become a symptomatic extraspinal lesion with compression of the upper nerve root is reported. The patient's excellent response to operative treatment confirmed the effectiveness of the combined microsurgical approach applied. The occurrence of JFC should be kept in mind in differential diagnosis of both intra- and extraspinal and foraminal lumbar lesions.
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Affiliation(s)
- Markus F Oertel
- Department of Neurosurgery, University Hospital, RWTH Aachen University, 52074 Aachen, Germany.
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Sabers SR, Ross SR, Grogg BE, Lauder TD. Procedure-based nonsurgical management of lumbar zygapophyseal joint cyst-induced radicular pain. Arch Phys Med Rehabil 2005; 86:1767-71. [PMID: 16181940 DOI: 10.1016/j.apmr.2004.11.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 06/30/2004] [Accepted: 11/11/2004] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the success of fluoroscopically guided, contrast-enhanced lumbar zygapophyseal joint (Z-joint) aspiration and steroid injection combined with transforaminal epidural steroid injections (TFESIs) for the treatment of lumbar Z-joint cyst-induced radicular pain. DESIGN Retrospective case series with independent follow-up. SETTING Institutional, referral center. PARTICIPANTS Twenty-three patients referred to a single provider for procedure-based management of radicular pain believed secondary to lumbar Z-joint cyst. Inclusion criteria consisted of lumbar radicular pain that was consistent with the level and side of the Z-joint cyst as a causative lesion. INTERVENTIONS Eighteen patients were treated with a fluoroscopically guided, contrast-enhanced Z-joint aspiration and steroid injection at the level of the causative cyst coupled with a fluoroscopically guided, contrast-enhanced TFESI over the level of the presumably irritated spinal nerve. MAIN OUTCOME MEASURES Patient satisfaction, and whether or not surgery was performed. RESULTS Fifty percent of patients treated with the procedure had significant long-term benefit and avoided surgical intervention at an average follow-up of 9.9 months. CONCLUSIONS Fluoroscopically guided, contrast-enhanced spinal procedures as part of an aggressive nonsurgical treatment program are a safe and effective alternative to surgical intervention for lumbar Z-joint cyst-induced radicular pain.
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Affiliation(s)
- Steven R Sabers
- Department of Physical Medicine and Rehabilitation, Mayo Medical School, Rochester, MN 55905, USA
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Wills JH, Wiesel S, Abram SE, Rupp FW. Synovial Cysts and the Lithotomy Position Causing Cauda Equina Syndrome. Reg Anesth Pain Med 2004. [DOI: 10.1097/00115550-200405000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND CONTEXT Lumbar intraspinal synovial cysts are an important cause of axial and radicular spine pain. Controversy about nonsurgical versus surgical treatment persists. PURPOSE To evaluate the efficacy of nonsurgical management of symptomatic lumbar intraspinal synovial cysts (LISCs). STUDY DESIGN/SETTING Retrospective review set in outpatient physiatry office. PATIENT SAMPLE Ten patients (8 women, 2 men; average age, 60 years) with LISCs and average symptom duration of 7.9 months. OUTCOME MEASURES Numerical pain rating scale (NRS-11), Roland-Morris disability outcome measure, patient satisfaction, and surgery. METHODS Patients with LISCs were identified and their charts were reviewed. Those patients whose symptoms correlated with the level of LISC-induced extradural compression were eligible. All patients received conservative care and a fluoroscopic-guided lumbar spine injection. The primary author conducted telephone follow-up. RESULTS All 10 patients had unilateral radicular pain. Seven had stable neurologic deficits. Magnetic resonance imaging and computed tomography/myelography, respectively, identified a LISC in 8 and 2 patients. Five patients had cyst aspiration followed by steroid instillation; 5 patients had cyst aspiration followed by a transforaminal epidural steroid injection. Average length of follow-up was 50.4 weeks. Only 1 patient had sustained benefit. One patient had no benefit and refused surgery. Eight patients underwent surgery and had a good result. CONCLUSION In our opinion, nonsurgical management in patients with LISC-induced radicular pain does not appear to be as successful as surgery.
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Affiliation(s)
- Rinoo V Shah
- Physiatry Service, The Hospital for Special Surgery, New York, NY 10021, USA.
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Houten JK, Sanderson SP, Cooper PR. Spontaneous regression of symptomatic lumbar synovial cysts. Report of three cases. J Neurosurg 2003; 99:235-8. [PMID: 12956468 DOI: 10.3171/spi.2003.99.2.0235] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Synovial cysts emanating from the lumbar facet joints may compromise the spinal canal and produce symptoms of radiculopathy or stenosis. Good results have been reported after excision of the symptomatic lesions. There are limited data, however, on the natural history involving nonoperative management and little information to suggest that these lesions ever regress spontaneously. The authors report on three patients in whom symptomatic lumbar synovial cysts spontaneously resolved and review the relevant literature.
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Affiliation(s)
- John K Houten
- Department of Neurosurgery, New York University School of Medicine, New York, New York 10016, USA
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Lutz GE, Shen TC. Fluoroscopically guided aspiration of a symptomatic lumbar zygapophyseal joint cyst: a case report. Arch Phys Med Rehabil 2002; 83:1789-91. [PMID: 12474188 DOI: 10.1053/apmr.2002.34601] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lumbar zygapophyseal joint cysts are potential pain generators in patients with axial pain and/or lower-limb radicular pain. The traditional treatment of symptomatic cysts that do not respond to conservative measures is surgical decompression. Percutaneous needle aspiration under fluoroscopic guidance is a potential minimally invasive treatment option. We present a patient with a large symptomatic L4-5 zygapophyseal joint cyst and right L5 radiculopathy who responded well to percutaneous aspiration.
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Bureau NJ, Kaplan PA, Dussault RG. Lumbar facet joint synovial cyst: percutaneous treatment with steroid injections and distention--clinical and imaging follow-up in 12 patients. Radiology 2001; 221:179-85. [PMID: 11568337 DOI: 10.1148/radiol.2211010213] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the imaging characteristics of lumbar facet joint synovial cysts after percutaneous treatment with steroid injections and distention of the cyst and to correlate these findings with the clinical outcome. MATERIALS AND METHODS Clinical outcome and imaging findings were retrospectively studied in 12 patients (four men, eight women) aged 45-79 years (mean, 60 years) with a symptomatic lumbar facet joint synovial cyst treated with percutaneous steroid injections. At varying times after the procedure, patients were contacted for clinical follow-up, and repeat imaging was performed to verify the status of the cyst. RESULTS Excellent pain relief was achieved in nine (75%) of 12 patients. At follow-up imaging, the cyst completely regressed in six (67%) of these nine patients, partially regressed in two (22%) patients, and was unchanged in one (11%) patient. One (8%) of the 12 patients had transient pain relief, with recurrence of symptoms at short intervals after each of three injections. No pain relief was achieved in two (17%) of 12 patients. CONCLUSION Image-guided percutaneous steroid injections are often effective in the treatment of lumbar facet joint synovial cysts and may result in complete regression of the cyst.
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Affiliation(s)
- N J Bureau
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, 1058 Saint-Denis St, Montreal, Quebec, Canada H2X 3J4.
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Slipman CW, Lipetz JS, Wakeshima Y, Jackson HB. Nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain. Arch Phys Med Rehabil 2000; 81:973-7. [PMID: 10896015 DOI: 10.1053/apmr.2000.5584] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the role of fluoroscopically guided injection procedures in the nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain. DESIGN Retrospective study with independent clinical review. PARTICIPANTS Fourteen patients (average age, 60.2 yrs), with an average symptom duration of 18.8 months, were included. METHODS Medical records were reviewed; patients with a radiographically observed zygapophyseal joint cyst that may have represented a compressive lesion corresponding to the patient's symptoms of radicular pain were eligible for inclusion. The level of nerve root involvement was confirmed by physical examination or electrodiagnostic findings. Patients whose root level involvement remained undetermined were required to demonstrate a positive response to a fluoroscopically guided diagnostic selective nerve root block (SNRB). Nonsurgical treatments included therapeutic SNRB, intraarticular zygapophyseal joint corticosteroid injection, and cyst puncture. Data collection and analysis were performed by an independent clinical reviewer. OUTCOME MEASURES Pain score, work status, medication usage, and patient satisfaction with treatment. RESULTS The majority of the observed cysts (71.4%) were at the L4-L5 level. Follow-up data collection was done at an average of 1.4 years after termination of treatment. An excellent outcome was observed in 4 patients (28.6%). Fifty percent of patients underwent surgery. CONCLUSIONS Preliminary findings suggest a role for fluoroscopically guided injection techniques in the nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain, with up to one-third of patients experiencing lasting symptomatic relief.
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Affiliation(s)
- C W Slipman
- Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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