Intraspinal Lumbar Juxtaarticular Cyst Treatment through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome

Abstract

Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years).Fifteen of twenty procedures were successful and cyst rupture was confirmed by CT-scans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.

Fazettgelenkzysten – Diagnose, Management und Outcome

“…29 % der Patienten erhielten im Beobachtungszeitraum eine weitere perkutane Behandlung und 38 % benötigten eine operative Dekompression mit Zystenresektion. Patienten, bei denen die perkutane Technik primär misslang wie von Kursumovic et al beschrieben, sind häufig in den Studien gar nicht mitaufgeführt [25]. Gründe für die niedrige langfristige Erfolgsquote sind auf der einen Seite die geringe Volumenreduktion durch die Aspiration.…”

A novel technique for managing symptomatic spinal cysts using epiduroscopic neural laser decompression: technical note and preliminary results

“…Open procedures for treating benign cysts include (1) laminectomy for cyst decompression and nerve root resection [ 2 – 4 ], (2) laminoplasty and cyst fenestration [ 5 ], (3) incision and cyst drainage with plication of cyst [ 6 ], (4) and lumbo-peritoneal CSF shunting [ 7 ]. Percutaneous procedures for addressing benign cysts include (1) computed tomography (CT)-guided cyst rupture [ 8 , 9 ], (2) fluoroscopic fenestration and injections [ 10 ], and (3) trans-foraminal approach and cyst removal or fenestration [ 11 ]. However, these surgical methods have several important drawbacks, including the possibility of triggering neurological deficits, technical difficulty, and possible complications such as instability of the spine.…”