(496) Percutaneous rupture and aspiration of lumbar intra-facet cysts: a case report

Abstract

Synovial cysts arising from the lumbar spine facet joints are most commonly seen in the setting of degenerative spondylosis. These cysts are often termed juxta-facet cysts since they are located beside the facet joint and only exhibit a communicating pathway with the joint itself. There may be a small amount of fluid within the facet joint but the majority of the fluid lies within the cyst. Treatment options include surgical resection and percutaneous rupture. Percutaneous rupture of lumbar facet cysts is most commonly performed indirectly through the facet joint by use of CT guidance or fluoroscopy. We present a unique case that describes the percutaneous rupture and aspiration of lumbar facet cysts located entirely in the joint itself (intra-facet cysts) using fluoroscopy. A 52-year-old female presented with a one-year history of axial low back pain worse when lying down. The pain radiated to her bilateral buttocks but she denied parasthesias. She had already tried oral anti-inflammatory medications, physical therapy, and opioid medications with no improvement in her pain. Lumbar spine MRI revealed large bilateral intra-facet cysts at L4-L5 with a grade 2 spondylolisthesis at L4-L5. The patient was seen by a spine surgeon who recommended conservative treatment with no surgical intervention at that time. After surgical consultation, the decisionwasmade to perform percutaneous rupture and aspiration of the bilateral intra-facet cysts at L4-L5 followed by intra-articular facet steroid injections under fluoroscopy. One milliliter of synovial fluid was aspirated from each of her facet joints using a 22-guage needle with no complications. Following the procedure, the patient reported an 80% decrease in her pain score. Although juxta-facet cysts are the most common presentation of lumbar spine synovial cysts, intra-facet cysts may also occur and can be successfully treated with percutaenous rupture and aspiration under fluoroscopy.