Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

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.

Emerging Indications for Interventional Oncology: Expert Discussion on New Locoregional Treatments

“…In case of palliation, it is recommended to consolidate osteolytic metastases with cement or through the use of screws. In the last few years, different studies have registered a growing use of ablation for oligometastatic diseases to the bone, in particular, for radiation-resistant lesions [87][88][89].…”

Update on Interventional Radiology of the Spine

“…They are minimally invasive procedures aiming to avoid patients undergoing open surgical approaches. 36 Specifically for synovial cysts originating from the facet joints, image-guided percutaneous rupture or evacuation combined with a steroid injection can be performed. The technique was shown to be a safe and efficacious therapy that can eliminate the need for surgery.…”