131. Fluoroscopic Percutaneous Lumbar Zygapophyseal Joint Cyst Rupture: A Clinical Outcome Study

Percutaneous CT-Guided Treatment of Lumbar Facet Joint Synovial Cysts

“…Regardless of the presence of facet joint osteoarthrosis and micro-instability, facet joint cysts are relatively rare with a reported prevalence in symptomatic patients of 0.65–2.3% [1, 2]. The next most common level for synovial cyst occurrence is L5–S1 followed by L3–4, followed by L2–3 [4].…”

“…Treatment for lumbar facet joint synovial cysts includes both conservative and surgical treatments with reports of spontaneous resolution if left untreated [1]. While surgery is the gold standard for the treatment for symptomatic facet joint cysts, conservative options include bed rest, physical therapy, acupuncture, oral analgesics and anti-inflammatories, and percutaneous injection and aspiration [4, 7]. Surgical treatment is most effective, with very rare instances of recurrence when the entire cyst is excised but is not without inherent risks.…”

“…Surgical treatment is most effective, with very rare instances of recurrence when the entire cyst is excised but is not without inherent risks. Typically, surgical treatment requires laminectomy and/or facetectomy and now includes a minimally invasive endoscopic/microscopic approach [4, 7]. Common surgical risks include spinal instability, dural tear, neurologic injury, epidural hemorrhage and hematoma, seroma, and cyst recurrence [4].…”

“…Typically, surgical treatment requires laminectomy and/or facetectomy and now includes a minimally invasive endoscopic/microscopic approach [4, 7]. Common surgical risks include spinal instability, dural tear, neurologic injury, epidural hemorrhage and hematoma, seroma, and cyst recurrence [4]. In some instances, spinal fusion is performed, especially if there is concurrent spinal instability [7].…”

“…Under image-guided assistance, transforaminal or interlaminar epidural corticosteroid and anesthetic injection can be performed pre-emptively or concurrently to reduce the risk of procedure-related pain [4]. The advantage of CT over fluoroscopy is the direct treatment of synovial cysts as well as ganglion, posterior longitudinal ligament, and ligamentum flavum cysts that do not communicate with the facet joint, therefore allowing direct, safe, and reliable puncture of the cyst without dural violation.…”