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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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Tan H, Yu L, Li X, Yang Y, Zhu B. Percutaneous uniportal full-endoscopic surgery for treating symptomatic lumbar facet joint cysts under local anesthesia combined with monitored anesthesia care: a preliminary report of eight cases with at least 1 year follow-up. Front Neurol 2023; 14:1278562. [PMID: 38145124 PMCID: PMC10748478 DOI: 10.3389/fneur.2023.1278562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Background Lumbar facet joint cysts (FJCs) are a relatively rare clinical pathology that can result in radiculopathy or neurogenic claudication. Various treatments such as percutaneous aspiration and surgery have been reported to have good clinical outcomes. However, few clinical studies have aimed to treat symptomatic lumbar FJCs by using uniportal full-endoscopic (UFE) surgery. This study aimed to investigate the preliminary clinical outcomes of UFE surgery for the treatment of lumbar FJCs under local anesthesia combined with monitored anesthesia care (MAC). Methods Eight patients (five males and three females) with symptomatic lumbar FJCs who underwent UFE surgery under local and MAC anesthesia were enrolled in this study between January 2018 and April 2022. The clinical characteristics, radiological features, operative information, visual analog scale (VAS) score, Oswestry disability index (ODI), and overall outcome rating based on the modified MacNab criteria were retrospectively analyzed. Results Of the eight patients, four underwent a transforaminal approach and four underwent an interlaminar approach. Postoperatively, the mean VAS score for leg pain decreased from 6.1 before surgery to 0.6 after surgery, and the ODI decreased from 74.5% to 14.7%. All patients were followed up for more than 1 year, and the good-to-excellent rate based on the modified MacNab criteria remained 100% at the last follow-up. No complications occurred during the follow-up period. Conclusion Lumbar FJCs can cause severe radiating leg pain and/or neurogenic claudication due to the dural sac compression and nerve roots. As an alternative treatment, UFE decompression under local and MAC anesthesia may provide effective clinical outcomes for symptomatic lumbar FJCs.
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Affiliation(s)
| | | | | | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Said N, Amrhein TJ, Joshi AB, N NCN, Kranz PG. Facets of facet joint interventions. Skeletal Radiol 2023; 52:1873-1886. [PMID: 36245007 DOI: 10.1007/s00256-022-04184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 02/02/2023]
Abstract
Facet joint (FJ) disease is a common cause of axial low back pain with many minimally invasive image-guided treatment options. This article discusses fluoroscopic and CT-guided intraarticular FJ injections, medial branch (MB) radiofrequency ablation (RFA), and lumbar facet synovial cyst (LFSC) aspiration, rupture, or fenestration. Additionally, the article will highlight medial branch blocks (MBBs) utilized to diagnose facet-mediated pain and to predict outcomes to RFA.
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Affiliation(s)
- Nicholas Said
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA.
| | - Timothy J Amrhein
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Anand B Joshi
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Nicholas C Nacey N
- Department of Radiology and Medical Imaging, University of Virginia, 1215 Lee St, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Peter G Kranz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
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Masala S, Lacchè A, Salimei F, Ursone A, Pipitone V, Masino F, D'Arma GMA, Guglielmi G. CT-guided ozone mixture injection in treatment of symptomatic lumbar facet synovial cysts. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023025. [PMID: 36786272 PMCID: PMC9987492 DOI: 10.23750/abm.v94i1.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/08/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM To evaluate the clinical and radiological outcomes, in terms of safety and efficacy, of a new treatment method for symptomatic lumbar facet synovial cysts (LFSC), based on ozone injection inside the cyst. METHODS We retrospectively reviewed clinical records and imaging studies of 77 patients who underwent CT-guided ozone treatment of symptomatic facet joint synovial cysts in our department over a 5-year span. Clinical outcome was assessed with Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) evaluations, obtained prior to the intervention and at 1-, 3-, 6- and 12-months follow-up. Follow-up MRI imaging at 6 and 12 months were obtained and confronted with the pre-procedural MRI to analyse cyst modification after the intervention. RESULTS Ozone administration was technically successful in 100% of procedures; no immediate complications occurred. At 1 month evaluation, 92% of the patients referred partial or complete symptomatic response; 86% of patients at 3 months and 84% at 6 months confirmed symptoms improvement; final assessment, at 12 months after intervention, outlined overall significant clinical improvement in 81% of patients. During the 12 months of follow-up only 3 patients had a relapse of the cyst (at 6 months) that were retreated with a 100% success. CONCLUSIONS CT-guided ozone therapy for symptomatic LFSC is a safe and innovative treatment option, with good clinical results at 12 months follow-up in a significative percentage of patients, thus reducing the need for invasive surgical interventions.
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Kim HT, Choi JH, Shin YD, Kim TY, Lee JY. Successful treatment of symptomatic facet joint synovial cysts using C-arm fluoroscopy-guided percutaneous aspiration: report of two cases. Am J Transl Res 2022; 14:3547-3553. [PMID: 35702115 PMCID: PMC9185068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Lumbar facet-joint synovial cysts are an important cause of back pain and radiculopathy. Treatment options for facet-joint synovial cysts include surgical excision, facet-joint steroid injections, and facet-joint cyst aspiration. Although percutaneous facet-joint synovial cyst aspiration is an effective and minimally invasive procedure for treating patients with symptomatic facet-joint synovial cysts, its success rate is known to be low. Here, we report out experience with treating two men using this approach. The men presented with back pain or radiculopathy. In both cases, magnetic resonance imaging showed facet-joint synovial cysts in the lumbar spine at various locations. Depending on the location of the cysts, 2-3 needles and various needle approaches were required for treatment. The facet-joint synovial cysts were aspirated using the intra-articular, interlaminar, or safe triangle approach. After aspiration, both patients experienced immediate improvement in their symptoms, and neither of them relapsed during more than 12 months of follow-up. Percutaneous aspiration of symptomatic facet-joint synovial cysts under fluoroscopic guidance is a treatment option worth considering in patients with facet-joint synovial cysts.
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Dillon WP. 50th anniversary of computed tomography: past and future applications in clinical neuroscience. J Med Imaging (Bellingham) 2021; 8:052112. [PMID: 34676278 PMCID: PMC8523063 DOI: 10.1117/1.jmi.8.5.052112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: It has been 50 years since computed tomography was introduced to the worldwide neurologic medical and surgical community. In that time, tremendous advances in computer software and hardware, as well as creative changes in computerized tomographic (CT) hardware and tube technology, have dramatically improved the temporal and spatial resolution of CT. In this paper, I address what I feel are some of the most important impacts of CT in the field of clinical neuroscience over the last 50 years, as well as potential applications of CT that are on the horizon. Approach: I have recounted from literature, colleagues, and personal recollection the historical impact of CT on neuroradiology practice and what appear to be near-term future applications. Conclusions: Therapeutic applications beyond diagnosis, such as image-guided procedures, radiation, and surgical planning, and development of the field of theranostics have emerged and further increased the need for faster and more precise CT imaging. The integration of machine learning into the acquisition chain and radiologist tool kit has great implications for standardization, analysis, and diagnosis worldwide.
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Affiliation(s)
- William P Dillon
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, California, United States
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Xun R, Lu H, Wang X. Identification of CDC25C as a Potential Biomarker in Hepatocellular Carcinoma Using Bioinformatics Analysis. Technol Cancer Res Treat 2020; 19:1533033820967474. [PMID: 33111630 PMCID: PMC7607810 DOI: 10.1177/1533033820967474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most aggressive type of gastrointestinal tumor, with a high rate of mortality. However, identifying biomarkers for the treatment of HCC remains to be developed. We aimed to determine whether cell division cycle 25C (CDC25C) could be used as a novel diagnostic and therapeutic biomarker in HCC. Expression of CDC25C in HCC was analyzed by using GEPIA (Gene Expression Profiling Interactive Analysis) and UALCAN databases. GEPIA and CBioPortal databases were applied to analyze patients’survival and CDC25C mutations, respectively. PPI (Protein-Protein Interaction) network was further built by STRING (Search Tool for the Retrieval of Interacting Genes) and Metascape Web portals. To the best of our knowledge, the novel observations identified in the present study reveal that the expression of CDC25C in HCC was significantly enhanced when compare to that in normal liver tissues (P < 0.001). A higher CDC25C expression resulted in a remarkably shorter disease free survival as well as overall survival. Moreover, the expression of CDC25C in HCC was related to HCC patients’grade and race, but not gender. The expression levels of CDC25C elevated gradually from stage 1 to 3 but decreased in stage 4. The specific gene mutations V41A, L87 H, N222 K and X309-splice of CDC25C occurred in HCC samples and these unique mutations were not detected in any other tumor tissues. Finally, PPI networks and GO enrichment analysis suggested that CDC25C might be associated with cell cycle and p53 signaling pathway. Taken together, bioinformatics analysis revealed that CDC25C might be a potential diagnostic predictor for HCC.
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Affiliation(s)
- Ruifeng Xun
- Department of Biochemistry and Molecular Biology, Health Science Center, Yangtze University, Jingzhou, China.,Department of Orthopedic, Peoples Hospital of Linquan County, Fuyang, China
| | - Hougen Lu
- Department of Orthopedic, The Second School of Clinical Medicine & Jingzhou Central Hospital, Yangtze University, Jingzhou, China
| | - Xianwang Wang
- Department of Biochemistry and Molecular Biology, Health Science Center, Yangtze University, Jingzhou, China
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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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Hohenberger C, Brawanski A, Ullrich OW, Höhne J, Zeman F, Schebesch KM. Degenerative symptomatic spinal synovial cysts: Clinical presentation and functional outcome. J Clin Neurosci 2018; 62:112-116. [PMID: 30580916 DOI: 10.1016/j.jocn.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/29/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023]
Abstract
Spinal synovial cysts (SSC) are a rare but important differential diagnosis for degenerative or space-occupying spinal lesions. There is controversy about the most beneficial treatment, which can be conservative or surgical. We provide a review of our surgical data for purposes of quality assessment and improvement. 5313 patients with surgically treated degenerative spinal diseases were analyzed retrospectively. The incidence of SSC was 1.14%. 61 patients (31 women, 30 men; mean age 65.3 years) with SSC were included in this study. The charts, surgical reports, and radiographic data were reviewed for demographics, duration of symptoms, size of SSC, anatomical site, surgical approach, Visual Analog Scale (VAS), and neurological performance including the Japanese Orthopedic Association Score (JOA score) and the Frankel score. Laminotomy was the most common surgical approach in 93.4% of the patients followed by hemilaminectomy in 6.6%. The predominant site of SSC was the lumbar spine in 86.9%. 95.1% had experienced local and radicular pain as the predominant symptom and 47.5% preoperative sensory and motor deficits. At discharge, the JOA score was significantly increased compared to admission (median value of 17). At follow-up, 94.4% had normal neurological function and 5.6% showed grade 1 neurological deficits. Leg pain had decreased in 94.4% and back pain in 70.6%. At long-term follow-up, all patients presented neurologically stable. The median value for pain classified with the VAS had decreased from 6 at admission to 1 at long-term follow-up. During long-term follow-up, 6 patients (9.8%) had developed spinal instability requiring stabilization, 5 patients had received facet joint infiltration due to symptomatic facet joint syndrome. The epidemiological and clinical patterns of symptomatic SSC are similar to those of other degenerative spinal diseases. Thus, SSC should always be considered as a rare but important differential diagnosis. Surgical outcome was excellent with immediate symptom relief and recovery, which further improved over time. Our data support the benefit of surgical treatment and may be useful in recommending neurosurgical therapy to patients with SSC.
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Affiliation(s)
- Christoph Hohenberger
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Alexander Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Odo Winfried Ullrich
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
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